TY - JOUR
T1 - Sedation at the end of life - a nation-wide study in palliative care units in Austria
AU - AUPACS (Austrian Palliative Care Study) Group
AU - Schur, Sophie
AU - Weixler, Dietmar
AU - Gabl, Christoph
AU - Kreye, Gudrun
AU - Likar, Rudolf
AU - Masel, Eva Katharina
AU - Mayrhofer, Michael
AU - Reiner, Franz
AU - Schmidmayr, Barbara
AU - Kirchheiner, Kathrin
AU - Watzke, Herbert Hans
N1 - Funding Information:
The authors thank all participating palliative care units for their cooperation and support. No financial support was received from the public, commercial or non-profit sector.
Publisher Copyright:
© 2016 Schur et al.
PY - 2016/5/14
Y1 - 2016/5/14
N2 - BACKGROUND: Sedation is used to an increasing extent in end-of-life care. Definitions and indications in this field are based on expert opinions and case series. Little is known about this practice at palliative care units in Austria.METHODS: Patients who died in Austrian palliative care units between June 2012 and June 2013 were identified. A predefined set of baseline characteristics and information on sedation during the last two weeks before death were obtained by reviewing the patients' charts.RESULTS: The data of 2414 patients from 23 palliative care units were available for analysis. Five hundred two (21 %) patients received sedation in the last two weeks preceding their death, 356 (71 %) received continuous sedation until death, and 119 (24 %) received intermittent sedation. The median duration of sedation was 48 h (IQR 10-72 h); 168 patients (34 %) were sedated for less than 24 h. Indications for sedation were delirium (51 %), existential distress (32 %), dyspnea (30 %), and pain (20 %). Midazolam was the most frequently used drug (79 %), followed by lorazepam (13 %), and haloperidol (10 %). Sedated patients were significantly younger (median age 67 years vs. 74 years, p ≤ 0.001, r = 0.22), suffered more often from an oncological disease (92 % vs. 82 %, p ≤ 0.001, φ = 0.107), and were hospitalized more frequently (94 % vs. 76 %, p ≤ 0.001, φ = 0.175). The median number of days between admission to a palliative care ward/mobile palliative care team and death did not differ significantly in sedated versus non-sedated patients (10 vs. 9 days; p = 0.491).CONCLUSION: This study provides insights into the practice of end-of-life sedation in Austria. Critical appraisal of these data will serve as a starting point for the development of nation-wide guidelines for palliative sedation in Austria.
AB - BACKGROUND: Sedation is used to an increasing extent in end-of-life care. Definitions and indications in this field are based on expert opinions and case series. Little is known about this practice at palliative care units in Austria.METHODS: Patients who died in Austrian palliative care units between June 2012 and June 2013 were identified. A predefined set of baseline characteristics and information on sedation during the last two weeks before death were obtained by reviewing the patients' charts.RESULTS: The data of 2414 patients from 23 palliative care units were available for analysis. Five hundred two (21 %) patients received sedation in the last two weeks preceding their death, 356 (71 %) received continuous sedation until death, and 119 (24 %) received intermittent sedation. The median duration of sedation was 48 h (IQR 10-72 h); 168 patients (34 %) were sedated for less than 24 h. Indications for sedation were delirium (51 %), existential distress (32 %), dyspnea (30 %), and pain (20 %). Midazolam was the most frequently used drug (79 %), followed by lorazepam (13 %), and haloperidol (10 %). Sedated patients were significantly younger (median age 67 years vs. 74 years, p ≤ 0.001, r = 0.22), suffered more often from an oncological disease (92 % vs. 82 %, p ≤ 0.001, φ = 0.107), and were hospitalized more frequently (94 % vs. 76 %, p ≤ 0.001, φ = 0.175). The median number of days between admission to a palliative care ward/mobile palliative care team and death did not differ significantly in sedated versus non-sedated patients (10 vs. 9 days; p = 0.491).CONCLUSION: This study provides insights into the practice of end-of-life sedation in Austria. Critical appraisal of these data will serve as a starting point for the development of nation-wide guidelines for palliative sedation in Austria.
KW - Age Factors
KW - Aged
KW - Aged, 80 and over
KW - Austria
KW - Deep Sedation/methods
KW - Delirium/drug therapy
KW - Dyspnea
KW - Female
KW - Humans
KW - Hypnotics and Sedatives/therapeutic use
KW - Male
KW - Middle Aged
KW - Pain/drug therapy
KW - Palliative Care/methods
KW - Patient Comfort
KW - Retrospective Studies
KW - Sex Factors
KW - Stress, Psychological/drug therapy
KW - Terminal Care/methods
KW - Time Factors
KW - Sedation
KW - Symptom management
KW - Palliative care
UR - http://www.scopus.com/inward/record.url?scp=84969256081&partnerID=8YFLogxK
U2 - 10.1186/s12904-016-0121-8
DO - 10.1186/s12904-016-0121-8
M3 - Journal article
C2 - 27180238
SN - 1472-684X
VL - 15
SP - 50
JO - BMC Palliative Care
JF - BMC Palliative Care
IS - 1
M1 - 50
ER -