Continuous Deep Sedation Until Death-a Swiss Death Certificate Study

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2018 Mar 22

PMID 29560568

Citations 11

Authors

Sarah Ziegler

Margareta Schmid

Matthias Bopp

Georg Bosshard

Milo Alan Puhan

Affiliations

Soon will be listed here.

Abstract

Background: In the last decade, the number of patients continuously deeply sedated until death increased up to fourfold. The reasons for this increase remain unclear.

Objective: To identify socio-demographic and clinical characteristics of sedated patients, and concurrent possibly life-shortening medical end-of-life decisions.

Design: Cross-sectional death certificate study in German-speaking Switzerland in 2001 and 2013.

Participants: Non-sudden and expected deaths (2001: N = 2281, 2013: N = 2256) based on a random sample of death certificates and followed by an anonymous survey on end-of-life practices among attending physicians.

Main Measures: Physicians' reported proportion of patients continuously deeply sedated until death, socio-demographic and clinical characteristics, and possibly life-shortening medical end-of life decisions.

Key Results: In 2013, physicians sedated four times more patients continuously until death (6.7% in 2001; 24.5.5% in 2013). Four out of five sedated patients died in hospitals, outside specialized palliative care units, or in nursing homes. Sedation was more likely among patients younger than 65 (odds ratio 2.24, 95% CI 1.6 to 3.2) and those dying in specialized palliative care (OR 2.2, 95% CI 1.3 to 3.8) or in hospitals (1.7, 95% CI 1.3 to 2.3). Forgoing life-prolonging treatment with the explicit intention to hasten or not to postpone death combined with intensified alleviation of symptoms was very strongly associated with continuous deep sedation (OR 6.8, 95% CI 4.7 to 9.8).

Conclusions: In Swiss clinical practice, continuously deeply sedated patients predominantly died outside specialized palliative care. The increasing trend over time appears to be related to changes in medical end-of-life practice rather than to patient's clinical characteristics.

Citing Articles

Practices of and Perspectives on Palliative Sedation Among Palliative Care Physicians in Ontario, Canada: A Mixed-Methods Study.

Nolen A, Selby D, Qureshi F, Mills A Palliat Med Rep. 2024; 5(1):94-103.

PMID: 38415075 PMC: 10898238. DOI: 10.1089/pmr.2023.0081.

Defining "Continuous Deep Sedation" Using Treatment Protocol: A Proposal Article.

Morita T, Imai K, Mori M, Yokomichi N, Tsuneto S Palliat Med Rep. 2022; 3(1):8-15.

PMID: 36262550 PMC: 8900204. DOI: 10.1089/pmr.2021.0058.

Physicians' Experiences and Perceptions of Environmental Factors Affecting Their Practices of Continuous Deep Sedation until Death: A Secondary Qualitative Analysis of an Interview Study.

Vissers S, Dierickx S, Robijn L, Cohen J, Deliens L, Mortier F Int J Environ Res Public Health. 2022; 19(9).

PMID: 35564867 PMC: 9104501. DOI: 10.3390/ijerph19095472.

Kurkowski S, Heckel M, Pfaller L, Peters J, Bazata J, Schildmann E BMC Palliat Care. 2022; 21(1):71.

PMID: 35550117 PMC: 9101857. DOI: 10.1186/s12904-022-00963-y.

How should health care providers inform about palliative sedation? A qualitative study with palliative care professionals.

Cocker A, Singy P, Jox R Eur J Cancer Care (Engl). 2022; 31(5):e13602.

PMID: 35488398 PMC: 9541839. DOI: 10.1111/ecc.13602.

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