Palliatieve sedatie in Nederlandse huisartspraktijken*

Objective

To gain more insight into the trends of and reasons for palliative sedation in Dutch general practice.

Design

Dynamic cohort study using registrations and questionnaire data of Dutch GPs.

Method

Data collected in the years from 2005 until 2011 in the Dutch Sentinel General Practice Network were analyzed. Trends and reasons for use of palliative sedation were analyzed using multilevel analyses to control for clustering of observations within general practices.

Results

From 2005-2011, 183 cases were reported from 56 general practices. The incidence of palliative sedation fluctuated between 33.7 per 100,000 patients in 2006 and 15.2 in 2011. No rise or decline during the period was observed. Palliative sedation was applied in 5.7% of all deaths and most frequently used in younger patients with cancer. The mean number of refractory symptoms was 2.6 (SD 1.2); pain (69.4%), dyspnoea (53.0%) and fear (39.3%). Patient involvement in decision making before the start of palliative sedation (87.4%) was less frequently present in patients suffering from cardiovascular or chronic pulmonary disease and in older patients compared to cancer patients (P<0.05). Pending euthanasia requests were present in 20.8% of cases; the choice for palliative sedation in these cases was clearly motivated.

Conclusion

Palliative sedation is performed in a small proportion of dying patients with refractory symptoms in Dutch general practice, without a rise or decline observed from 2005 to 2011. Timely discussion of end of life issues including palliative sedation deserves extra attention in non-cancer patients and elderly with anticipated cognitive decline.

Conflict of interest: none declared. Financial support: none declared.