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General practitioners' report of continuous deep sedation until death for patients dying at home: a descriptive study from Belgium

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Abstract
Background: Palliative sedation is increasingly used at the end of life by general practitioners (GPs). Objectives: To study the characteristics of one type of palliative sedation, 'continuous deep sedation until death', for patients dying at home in Belgium. Methods: SENTI-MELC, a large-scale mortality follow-back study of a representative surveillance network of Belgian GPs was conducted in 2005-2006. Out of 415 non-sudden home deaths registered, we identified all 31 cases of continuous deep sedation until death as reported by the GPs. GPs were interviewed face-to-face about patient characteristics, the decision-making process and characteristics of each case. Results: 28 interviews were conducted (response rate 28/31). 19 patients had cancer. 19 patients suffered persistently and unbearably. Pain was the main indication for continuous deep sedation (15 cases). In 6 cases, the patient was competent but was not involved in decision making. Relatives and care providers were involved in 23 cases and 18 cases, respectively. Benzodiazepines were used in 21 cases. During sedation, 11/28 of patients awoke, mostly due to insufficient medication. In 13 cases, the GP partially or explicitly intended to hasten the patient's death. Conclusion: Continuous deep sedation until death, as practiced by Belgian GPs, is in most cases used for patients with unbearable suffering. Competent patients are not always involved in decision making while in most cases, the patient's family is.
Keywords
decision making, end-of-life care, general practitioners, TERMINALLY-ILL PATIENTS, PATIENTS NEARING DEATH, OF-LIFE DECISIONS, PALLIATIVE SEDATION, END, CARE, PHYSICIANS, EUTHANASIA, DUTCH, NETHERLANDS, Continuous deep sedation until death, palliative sedation

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Chicago
Anquinet, Livia, Judith AC Rietjens, Lieve Van den Block, Nathalie Bossuyt, and Luc Deliens. 2011. “General Practitioners’ Report of Continuous Deep Sedation Until Death for Patients Dying at Home: a Descriptive Study from Belgium.” European Journal of General Practice 17 (1): 5–13.
APA
Anquinet, Livia, Rietjens, J. A., Van den Block, L., Bossuyt, N., & Deliens, L. (2011). General practitioners’ report of continuous deep sedation until death for patients dying at home: a descriptive study from Belgium. EUROPEAN JOURNAL OF GENERAL PRACTICE, 17(1), 5–13.
Vancouver
1.
Anquinet L, Rietjens JA, Van den Block L, Bossuyt N, Deliens L. General practitioners’ report of continuous deep sedation until death for patients dying at home: a descriptive study from Belgium. EUROPEAN JOURNAL OF GENERAL PRACTICE. 2011;17(1):5–13.
MLA
Anquinet, Livia, Judith AC Rietjens, Lieve Van den Block, et al. “General Practitioners’ Report of Continuous Deep Sedation Until Death for Patients Dying at Home: a Descriptive Study from Belgium.” EUROPEAN JOURNAL OF GENERAL PRACTICE 17.1 (2011): 5–13. Print.
@article{5827088,
  abstract     = {Background: Palliative sedation is increasingly used at the end of life by general practitioners (GPs). Objectives: To study the characteristics of one type of palliative sedation, 'continuous deep sedation until death', for patients dying at home in Belgium. Methods: SENTI-MELC, a large-scale mortality follow-back study of a representative surveillance network of Belgian GPs was conducted in 2005-2006. Out of 415 non-sudden home deaths registered, we identified all 31 cases of continuous deep sedation until death as reported by the GPs. GPs were interviewed face-to-face about patient characteristics, the decision-making process and characteristics of each case. Results: 28 interviews were conducted (response rate 28/31). 19 patients had cancer. 19 patients suffered persistently and unbearably. Pain was the main indication for continuous deep sedation (15 cases). In 6 cases, the patient was competent but was not involved in decision making. Relatives and care providers were involved in 23 cases and 18 cases, respectively. Benzodiazepines were used in 21 cases. During sedation, 11/28 of patients awoke, mostly due to insufficient medication. In 13 cases, the GP partially or explicitly intended to hasten the patient's death. 
Conclusion: Continuous deep sedation until death, as practiced by Belgian GPs, is in most cases used for patients with unbearable suffering. Competent patients are not always involved in decision making while in most cases, the patient's family is.},
  author       = {Anquinet, Livia and Rietjens, Judith AC and Van den Block, Lieve and Bossuyt, Nathalie and Deliens, Luc},
  issn         = {1381-4788},
  journal      = {EUROPEAN JOURNAL OF GENERAL PRACTICE},
  keyword      = {decision making,end-of-life care,general practitioners,TERMINALLY-ILL PATIENTS,PATIENTS NEARING DEATH,OF-LIFE DECISIONS,PALLIATIVE SEDATION,END,CARE,PHYSICIANS,EUTHANASIA,DUTCH,NETHERLANDS,Continuous deep sedation until death,palliative sedation},
  language     = {eng},
  number       = {1},
  pages        = {5--13},
  title        = {General practitioners' report of continuous deep sedation until death for patients dying at home: a descriptive study from Belgium},
  url          = {http://dx.doi.org/10.3109/13814788.2010.536529},
  volume       = {17},
  year         = {2011},
}

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