Continuous deep sedation practices vary across Europe
MedWire News: Between-country differences are more marked than between-patient differences for use of continuous deep sedation before death in the UK, the Netherlands, and Flanders in Belgium, report researchers.
The findings suggest that "cultural, social, legal, and organizational factors probably play a role," write Livia Anquinet, from Ghent University and Vrije Universiteit in Brussels, Belgium, and colleagues in the Journal of Pain and Symptom Management.
Anquinet et al assessed frequency, indication, and location (ie, home vs hospital) of continuous deep sedation use between 2005 and 2008 in the UK, the Netherlands, and Flanders. A total of 11,704 deaths in these countries during the period were put forward for inclusion in the study, and 1517 involved continuous deep sedation.
Sedation was more common in Flanders and the UK than in the Netherlands, at 15% and 17%, compared with 8%, respectively, and it was significantly less frequently performed in Dutch hospitals compared with those in Flanders and the UK, at 11% compared with 20% and 17%.
Interestingly, palliative sedation was more common in the hospital than in the home setting in every country, with patients 3% less likely to experience it in the home. But its use was also more common in the home in the UK than in the Netherlands or Flanders, at 19% versus 8% and 10%, respectively.
"There is a need for more detailed intercountry comparative studies to understand these variations and see how they relate to the quality of end-of-life care," conclude Anquinet and co-workers. They suggest there may be fewer barriers to the use of sedation in the home setting in the UK than the Netherlands or Flanders.
Multivariate analysis revealed several other significant factors associated with the likelihood of receiving continuous deep sedation prior to death. Women were 3% less likely to receive it than men, and patients aged 80 years and above were 22% less likely than those aged up to 64 years to receive it.
Patients with malignancies, rather than cardiovascular, respiratory, nervous system, or other causes of death were most likely to receive it, and those who died in the home were 46% less likely than those who died in a hospital to be sedated before death.
By Sarah Guy