Sarah Ziegler1, Margareta Schmid2, Matthias Bopp2, Georg Bosshard3,4,5, Milo Alan Puhan2. 1. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland. sarah.ziegler@uzh.ch. 2. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland. 3. Clinic for Geriatric Medicine, Zurich University Hospital, Zurich, Switzerland. 4. Center on Aging and Mobility, University of Zurich, Zurich, Switzerland. 5. City Hospital Waid, Zurich, Switzerland.
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.
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.
Entities:
Keywords:
deep sedation; general internal medicine; primary care; symptom alleviation; withholding treatment
Authors: Jeroen G J Hasselaar; Rob P B Reuzel; Stans C A H H V M Verhagen; Alexander de Graeff; Kris C P Vissers; Ben J P Crul Journal: Arch Intern Med Date: 2007-06-11
Authors: Ebun Abarshi; Judith Rietjens; Lenzo Robijn; Augusto Caraceni; Sheila Payne; Luc Deliens; Lieve Van den Block Journal: BMJ Support Palliat Care Date: 2017-04-20 Impact factor: 3.568
Authors: Andrea Jutta Loizeau; Simon M Cohen; Susan L Mitchell; Nathan Theill; Stefanie Eicher; Mike Martin; Florian Riese Journal: Neurodegener Dis Date: 2019-04-23 Impact factor: 2.977
Authors: Stijn Vissers; Sigrid Dierickx; Lenzo Robijn; Joachim Cohen; Luc Deliens; Freddy Mortier; Kenneth Chambaere Journal: Int J Environ Res Public Health Date: 2022-04-30 Impact factor: 4.614
Authors: Sandra Kurkowski; Maria Heckel; Larissa Pfaller; Joachim Peters; Jeremias Bazata; Eva Schildmann; Christoph Ostgathe Journal: BMC Palliat Care Date: 2022-05-13 Impact factor: 3.113