Dealing with delicate issues in continuous deep sedation. Varying practices among Dutch medical specialists, general practitioners, and nursing home physicians.
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Publication year
2008Source
Archives of Internal Medicine, 168, 5, (2008), pp. 537-43ISSN
Publication type
Article / Letter to editor
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Organization
Anesthesiology
Health Evidence
Primary and Community Care
IQ Healthcare
Former Organization
Epidemiology, Biostatistics & HTA
Centre for Quality of Care Research
Journal title
Archives of Internal Medicine
Volume
vol. 168
Issue
iss. 5
Page start
p. 537
Page end
p. 43
Subject
EBP 2: Effective Hospital Care; EBP 3: Effective Primary Care and Public Health; EBP 4: Quality of Care; NCEBP 11: Alzheimer Centre; NCEBP 2: Evaluation of complex medical interventions; NCEBP 5: Health care ethics; NCEBP 7: Effective primary care and public health; ONCOL 4: Quality of CareAbstract
BACKGROUND: This article examines delicate issues in continuous deep sedation (CDS) from the perspectives of different types of physicians. The following sensitive issues involved in CDS were investigated: artificial hydration, sedation for nonphysical discomfort, the relationship between CDS and euthanasia, and patient involvement in decision making for CDS. METHODS: A structured retrospective questionnaire concerning the most recent case of CDS during the past 12 months was sent to a sample of medical specialists (n = 727), general practitioners (n = 626), and nursing home physicians (n = 111). RESULTS: Response rates were 26.4% for medical specialists, 37.4% for general practitioners, and 59.5% for nursing home physicians. Indications for CDS differed among the types of physicians. General practitioners (25.0%) were most often confronted with a patient request for euthanasia before starting CDS compared with medical specialists (8.9%) and nursing home physicians (6.5%). A decision to forgo artificial hydration in CDS was more often made by nursing home physicians (91.3%) compared with medical specialists (53.7%) and general practitioners (51.2%). Shorter survival was found for patients sedated for nonphysical discomfort (vs other patients) by general practitioners. Among all patients, 74.5% were involved in decision making before the start of CDS. CONCLUSIONS: The present study demonstrates notable differences in CDS practice among various types of physicians. To what extent this is related to different patient populations or to different expertise requires further investigation. The use of CDS for nonphysical discomfort calls for critical examination to avoid ambiguous practice.
This item appears in the following Collection(s)
- Academic publications [245131]
- Electronic publications [132467]
- Faculty of Medical Sciences [93207]
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