Evidence map›Paper›PMID 37880650›Full record

ArticleBMC palliative care2023

Continuous deep sedation at the end of life: a qualitative interview-study among health care providers on an evolving practice.

Madelon T Heijltjes, Ghislaine Jmw van Thiel, Judith Ac Rietjens, Agnes van der Heide, Geeske Hendriksen, Johannes Jm van Delden

Open access · goldAbstract read
In one paragraph

Article in BMC palliative care, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
2.3field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 8 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 2 countries.

Madelon T HeijltjesDepartment of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, UMC Utrecht, PO Box 85500, Utrecht, 3508 GA, The Netherlands. m.t.heijltjes-2@umcutrecht.nl.
Ghislaine Jmw van ThielDepartment of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, UMC Utrecht, PO Box 85500, Utrecht, 3508 GA, The Netherlands.
Judith Ac RietjensDepartment of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
Agnes van der HeideDepartment of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
Geeske HendriksenDepartment of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, UMC Utrecht, PO Box 85500, Utrecht, 3508 GA, The Netherlands.
Johannes Jm van DeldenDepartment of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, UMC Utrecht, PO Box 85500, Utrecht, 3508 GA, The Netherlands.
University Medical Center Utrecht · NLErasmus MC · NL

Funding

ZonMw 844001502
6 · The paper itself

Abstract

backgroundContinuous deep sedation (CDS) can be used for patients at the end of life who suffer intolerably from severe symptoms that cannot be relieved otherwise. In the Netherlands, the use of CDS is guided by an national guideline since 2005. The percentage of patients for whom CDS is used increased from 8% of all patients who died in 2005 to 18% in 2015. The aim of this study is to explore potential causes of the rise in the use of CDS in the Netherlands according to health care providers who have been participating in this practice.

methodsSemi-structured interviews were conducted and thematically analysed. Participants were Dutch health care providers (HCPs), working at patients' homes, hospices, elderly care facilities and in hospitals and experienced in providing CDS, who were recruited via purposeful sampling.

results41 Health care providers participated in an interview. For these HCPs the reason to start CDS is often a combination of symptoms resulting in a refractory state. HCPs indicated that symptoms of non-physical origin are increasingly important in the decision to start CDS. Most HCPs felt that suffering at the end of life is less tolerated by patients, their relatives, and sometimes by HCPs; they report more requests to relieve suffering by using CDS. Some HCPs in our study have experienced increasing pressure to perform CDS. Some HCPs stated that they more often used intermittent sedation, sometimes resulting in CDS.

conclusionsThis study provides insight into how participating HCPs perceive that their practice of CDS changed over time. The combination of a broader interpretation of refractory suffering by HCPs and a decreased tolerance of suffering at the end of life by patients, their relatives and HCPs, may have led to a lower threshold to start CDS.

trial registrationThe Research Ethics Committee of University Medical Center Utrecht assessed that the study was exempt from ethical review according to Dutch law (Protocol number 19-435/C).

Indexed as

Deep SedationHospicesTerminal CareDeathHealth PersonnelHumansPalliative CareContinuous sedationDeep sedationEnd of lifeHealth care professionalPalliative sedationQualitative researchTerminal sedation

Identifiers

PMID37880650
PMCPMC10601190
OpenAlexW4387949723

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.