ArticlePloS one2016
Trends in Continuous Deep Sedation until Death between 2007 and 2013: A Repeated Nationwide Survey.
Article in PloS one, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it, 98 citations in OpenAlex.
- [Palliative sedation : Development and consensus of a German language documentation template].Der Anaesthesist · 2018Guideline
- The impact of the inpatient practice of continuous deep sedation until death on healthcare professionals' emotional well-being: a systematic review.BMC palliative care · 2017Pooled it
- Variability of sedation practices in palliative care unit in France: a six units retrospective analysis.BMC palliative care · 2025Article
- The development of a core outcome set for evaluating and enhancing palliative sedation in clinical research and practice: The COSEDATION study protocol.Palliative care and social practice · 2025Article
- General practitioners and palliative care practices: a better knowledge of specific services is still needed.BMC health services research · 2024Article
- Practices of and Perspectives on Palliative Sedation Among Palliative Care Physicians in Ontario, Canada: A Mixed-Methods Study.Palliative medicine reports · 2024Article
- Monitoring the clinical practice of palliative sedation (PALSED) in patients with advanced cancer: an international, multicentre, non-experimental prospective observational study protocol.BMC palliative care · 2023Article
- Should continuous deep sedation until death be legally regulated in Switzerland? An exploratory study with palliative care physicians.Palliative care and social practice · 2023Article
- Medicalisation, suffering and control at the end of life: The interplay of deep continuous palliative sedation and assisted dying.Health (London, England : 1997) · 2022Article
- Sedatives and Sedation at the End of Life in the Hospital.Deutsches Arzteblatt international · 2022Article
- Physicians' Experiences and Perceptions of Environmental Factors Affecting Their Practices of Continuous Deep Sedation until Death: A Secondary Qualitative Analysis of an Interview Study.International journal of environmental research and public health · 2022Article
- Article
- Defining "Continuous Deep Sedation" Using Treatment Protocol: A Proposal Article.Palliative medicine reports · 2022Article
- How to reveal disguised paternalism: version 2.0.BMC medical ethics · 2021Article
- Trends in Swedish physicians' attitudes towards physician-assisted suicide: a cross-sectional study.BMC medical ethics · 2021Article
- Midazolam sedation in palliative medicine: retrospective study in a French center for cancer control.BMC palliative care · 2020Article
- Continuous Deep Sedation Until Death-a Swiss Death Certificate Study.Journal of general internal medicine · 2018Article
- Involvement of palliative care in euthanasia practice in a context of legalized euthanasia: A population-based mortality follow-back study.Palliative medicine · 2018Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundContinuous deep sedation until death is a highly debated medical practice, particularly regarding its potential to hasten death and its proper use in end-of-life care. A thorough analysis of important trends in this practice is needed to identify potentially problematic developments. This study aims to examine trends in the prevalence and practice characteristics of continuous deep sedation until death in Flanders, Belgium between 2007 and 2013, and to study variation on physicians' degree of palliative training.
methodsPopulation-based death certificate study in 2007 and 2013 in Flanders, Belgium. Reporting physicians received questionnaires about medical practices preceding the patient's death. Patient characteristics, clinical characteristics (drugs used, duration, artificial nutrition/hydration, intention and consent), and palliative care training of attending physician were recorded. We posed the following question regarding continuous deep sedation: 'Was the patient continuously and deeply sedated or kept in a coma until death by the use of one or more drugs'.
resultsAfter the initial rise of continuous deep sedation to 14.5% in 2007 (95%CI 13.1%-15.9%), its use decreased to 12.0% in 2013 (95%CI 10.9%-13.2%). Compared with 2007, in 2013 opioids were less often used as sole drug and the decision to use continuous deep sedation was more often preceded by patient request. Compared to non-experts, palliative care experts more often used benzodiazepines and less often opioids, withheld artificial nutrition/hydration more often and performed sedation more often after a request from or with the consent of the patient or family.
conclusionWorldwide, this study is the first to show a decrease in the prevalence of continuous deep sedation. Despite positive changes in performance and decision-making towards more compliance with due care requirements, there is still room for improvement in the use of recommended drugs and in the involvement of patients and relatives in the decision-making process.
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