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Estimating the potential life-shortening effect of continuous sedation until death: a comparison between two approaches
  1. Sophie M Bruinsma1,
  2. Judith A C Rietjens1,
  3. Siebe J Swart1,
  4. Roberto S G M Perez2,
  5. Johannes J M van Delden3,
  6. Agnes van der Heide1
  1. 1Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
  2. 2Department of Anesthesiology, EMGO+ Institute for Health and Care Research, VU University Medical Center, and Hospice Kuria, Amsterdam, The Netherlands
  3. 3Julius Centre for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
  1. Correspondence to Sophie M Bruinsma, Department of Public Health, Erasmus MC, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands; s.m.bruinsma{at}erasmusmc.nl

Abstract

Context In some cases, physicians estimate that continuous sedation until death may have a life-shortening effect. The accuracy of these estimations can be questioned.

Aim The aim of this study is to compare two approaches to estimate the potential life-shortening effect of continuous sedation until death.

Methods In 2008, 370 Dutch physicians filled out a questionnaire and reported on their last patient who received continuous sedation until death. The potential life-shortening effect of continuous sedation was estimated through a direct approach (question: Did continuous sedation, according to your estimation, hasten the patient’s death? If yes: by how much time?) and an indirect approach (estimated life expectancy minus duration of sedation). The intrarater agreement between both approaches was determined with a weighted κ.

Results According to the direct approach, sedation might have had a life-shortening effect in 51% of the cases and according to the indirect approach in 84%. The intrarater agreement between both approaches was fair (weighted κ=0.38). In 10% of all cases, the direct approach yielded higher estimates of the extent to which life had been shortened; in 58% of the cases, the indirect approach yielded higher estimates.

Conclusions The results show a discrepancy between different approaches to estimate the potential life-shortening effect of continuous sedation until death.

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