Palliatieve sedatie na introductie KNMG-richtlijn

Objective

To evaluate the practice of continuous palliative sedation after the introduction of a national guideline.

Design

Investigation by questionnaire.

Method

In 2008, 1580 physicians were asked to fill out a questionnaire regarding the last patient for whom they had prescribed continuous sedation until death.

Results

The response was 38% (n = 606). Eighty-two percent of the respondents were aware of the national guideline. Dyspnoea, pain and physical exhaustion were most often mentioned as the decisive indications for continuous sedation. The decision to use sedation was discussed with all mentally competent patients; in 18% of these cases, the patients had only been informed of the decision. Life expectancy at the start of continuous sedation was estimated to be less than 2 weeks in 97% of the cases. In 14% of the cases, the physicians felt pressured to start the sedation, predominantly by patients and relatives. Physicians were present at the start of sedation in 81% of the cases. Midazolam was used to induce sedation in 92%, and 41% of the physicians estimated that continuous sedation had hastened death to some extent. Most physicians believed that their patients’ symptoms had been adequately relieved by continuous sedation, that the relatives were satisfied and that the quality of dying had been good.

Conclusion

Continuous sedation practice in the Netherlands largely reflects the recommendations of the national guideline. Issues needing further attention are the pressure felt by physicians to start continuous sedation, as well as the possible life-shortening effect of continuous sedation as perceived by some of the physicians.

Conflict of interest: none declared. Financial support: This study was made possible with financial support from ZonMw (a Dutch organisation for health research and development), Sint Laurens Fonds (St. Laurens Fund), Rotterdam and the Stichting Palliatieve Zorg Dirksland-Calando (Dirksland-Calando Palliative Care Foundation). Dr. R.S.G.M. Perez received reimbursement from BSL for lecturing.