Continuous Palliative Sedation for Cancer and Noncancer Patients

Abstract

Context Palliative care is often focused on cancer patients. Palliative sedation at the end of life is an intervention to address severe suffering in the last stage of life. Objectives To study the practice of continuous palliative sedation for both cancer and noncancer patients. Methods In 2008, a structured questionnaire was sent to 1580 physicians regarding their last patient receiving continuous sedation until death. Results A total of 606 physicians (38%) filled out the questionnaire, of whom 370 (61%) reported on their last case of continuous sedation (cancer patients: n = 282 [76%] and noncancer patients: n = 88 [24%]). More often, noncancer patients were older, female, and not fully competent. Dyspnea (odds ratio [OR] = 2.13; 95% confidence interval [CI]: 1.22, 3.72) and psychological exhaustion (OR = 2.64; 95% CI: 1.26, 5.55) were more often a decisive indication for continuous sedation for these patients. A palliative care team was consulted less often for noncancer patients (OR = 0.45; 95% CI: 0.21, 0.96). Also, preceding sedation, euthanasia was discussed less often with noncancer patients (OR = 0.42; 95% CI: 0.24, 0.73), whereas their relatives more often initiated discussion about euthanasia than relatives of cancer patients (OR = 3.75; 95% CI: 1.26, 11.20). Conclusion The practice of continuous palliative sedation in patients dying of cancer differs from patients dying of other diseases. These differences seem to be related to the less predictable course of noncancer diseases, which may reduce physicians’ awareness of the imminence of death. Increased attention to noncancer diseases in palliative care practice and research is, therefore, crucial as is more attention to the potential benefits of palliative care consultation.