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Increase in palliative sedation and reasons in cancer patients in Dutch general practice 2005–2014.

Donker, G.A., Dijk, C.E. van. Increase in palliative sedation and reasons in cancer patients in Dutch general practice 2005–2014. European Journal of Public Health: 2015, 25(spl. 3) 244. Abstract: 8th European Public Health Conference: "Health in Europe - from global to local policies, methods and practices". 14-17 oktober 2015 in Milan.
Background
Little is known about the quantity and reasons for use of palliative sedation in cancer patients in general practice and the reason to apply palliative sedation when a request for euthanasia was pending.

Aim
To gain more insight into the reasons for palliative sedation at the end of life, also when a request for euthanasia was pending in cancer patients in Dutch general practice.

Design and setting
Dynamic cohort study using registrations and questionnaire data of Dutch GPs.

Method
Trends and reasons for use of palliative sedation in cancer patients were analysed using multilevel analyses in the years from 2005 until 2014 in the Sentinel Practices of NIVEL Primary Care database.

Results
From 2005–2014, 220 cancer cases dying after palliative sedation were reported from 62 general practices. The incidence of palliative sedation increased in 2014 threefold compared to the nine years before (P < 0.001). Patient involvement in decision making before the start of palliative sedation (91%) was less frequently present in patients with delirium and in older patients (>75 years, 87%) than in the group <75 years of age (94%, P < 0.05). Pending euthanasia requests were present in 20% of cases; the choice for palliative sedation in these cases was: rapid progression of the disease and/or short life expectancy (55%), preference of patient and/or relatives (23%), adequate communication impossible (17%).

Conclusion
Palliative sedation showed a threefold increase in 2014 compared to the nine years before. There is no indication that palliative sedation is performed to avoid euthanasia.

Key messages
A sudden threefold increase in palliative sedation in cancer patients in 2014
No indication that palliative sedation is used to avoid the application of euthanasia