Changing Practices in the Use of Continuous Sedation at the End of Life: A Systematic Review of the Literature

The use of continuous sedation until death (CSD) has been highly debated for many years. It is unknown how the use of CSD evolves over time. Reports suggest that there is an international increase in the use of CSD for terminally ill patients. To gain insight in developments in the use of CSD in var...

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Veröffentlicht in:Journal of pain and symptom management 2020-10, Vol.60 (4), p.828-846.e3
Hauptverfasser: Heijltjes, Madelon T., van Thiel, Ghislaine J.M.W., Rietjens, Judith A.C., van der Heide, Agnes, de Graeff, Alexander, van Delden, Johannes J.M.
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container_end_page 846.e3
container_issue 4
container_start_page 828
container_title Journal of pain and symptom management
container_volume 60
creator Heijltjes, Madelon T.
van Thiel, Ghislaine J.M.W.
Rietjens, Judith A.C.
van der Heide, Agnes
de Graeff, Alexander
van Delden, Johannes J.M.
description The use of continuous sedation until death (CSD) has been highly debated for many years. It is unknown how the use of CSD evolves over time. Reports suggest that there is an international increase in the use of CSD for terminally ill patients. To gain insight in developments in the use of CSD in various countries and subpopulations. We performed a search of the literature published between January 2000 and April 2020, in PubMed, Embase, CINAHL, PsycInfo, and the Cochrane Library by using the Preferred reporting items for systematic review and meta-analysis protocols guidelines. The search contained the following terms: continuous sedation, terminal sedation, palliative sedation, deep sedation, end-of-life sedation, sedation practice, and sedation until death. We found 23 articles on 16 nationwide studies and 38 articles on 37 subpopulation studies. In nationwide studies on frequencies of CSD in deceased persons varied from 3% in Denmark in 2001 to 18% in The Netherlands in 2015. Nationwide studies indicate an increase in the use of CSD. Frequencies of CSD in the different subpopulations varied too widely to observe time trends. Over the years, more studies reported on the use of CSD for nonphysical symptoms including fear, anxiety, and psycho-existential distress. In some studies, there was an increase in requests for sedation of patients from their families. The frequency of CSD seems to increase over time, possibly partly because of an extension of indications for sedation, from mainly physical symptoms to also nonphysical symptoms.
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It is unknown how the use of CSD evolves over time. Reports suggest that there is an international increase in the use of CSD for terminally ill patients. To gain insight in developments in the use of CSD in various countries and subpopulations. We performed a search of the literature published between January 2000 and April 2020, in PubMed, Embase, CINAHL, PsycInfo, and the Cochrane Library by using the Preferred reporting items for systematic review and meta-analysis protocols guidelines. The search contained the following terms: continuous sedation, terminal sedation, palliative sedation, deep sedation, end-of-life sedation, sedation practice, and sedation until death. We found 23 articles on 16 nationwide studies and 38 articles on 37 subpopulation studies. In nationwide studies on frequencies of CSD in deceased persons varied from 3% in Denmark in 2001 to 18% in The Netherlands in 2015. Nationwide studies indicate an increase in the use of CSD. Frequencies of CSD in the different subpopulations varied too widely to observe time trends. Over the years, more studies reported on the use of CSD for nonphysical symptoms including fear, anxiety, and psycho-existential distress. In some studies, there was an increase in requests for sedation of patients from their families. 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subjects Anesthesia
Continuous sedation
Death
Death & dying
Deep Sedation
End of life decisions
end-of-life sedation
Euthanasia
Humans
Hypnotics and Sedatives - therapeutic use
Literature reviews
Netherlands
Palliative Care
palliative sedation
Physical symptoms
Psychological distress
Sedation
Systematic review
Terminal Care
terminal sedation
title Changing Practices in the Use of Continuous Sedation at the End of Life: A Systematic Review of the Literature
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