Resumen de The practice of continuous sedation until death in nursing homes in flanders, belgium: a nationwide study
Sam Rys-, Freddy Mortier, Luc Deliens, Johan Bilsen
Objectives: To investigate how continuous sedation until death (CSD), the reduction or removal of consciousness of an incurably ill individual until death to relieve refractory suffering, is practiced in nursing homes.
Design: Nationwide cross-sectional retrospective survey.
Setting: Nursing homes in Flanders, Belgium.
Participants: Palliative care nurses (N = 660) in all nursing homes in Flanders.
Measurements: Nurse reports of their most recent patient treated with CSD.
Results: The response rate was 65.5%, and 249 nurses reported a case of CSD (57.6%). Most individuals had cancer (33.6%) or dementia (32.8%); lacked competence (65.7%); and had severe pain (71.2%), fatigue (62.3%), loss of dignity (59%), anxiety (58.4%), and longing for death (58.4%). Intractable pain (70.7%) and physical exhaustion (63.9%) were the most decisive symptoms for initiating CSD. Life expectancy was generally limited to 1 week (64.9%), and 88.4% had insufficient nutritional oral intake before the start of CSD. CSD was rarely combined with artificial nutrition or hydration. Benzodiazepines were most frequently used (84.8%). Overall, according to the reporting nurses, CSD provided adequate symptom relief and good quality of dying.
Conclusion: In nursing homes, CSD is typically used in residents with cancer or dementia and severe, intractable physical symptoms. Lack of competence prevents most residents from being involved in the decision-making process, which illustrates the importance of advance care planning in nursing homes in Flanders.
