• Madelon T Heijltjes, van ThielGhislaine J M WGJMWJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands., RietjensJudith A CJACDepartment of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands., Agnes van der Heide, Alexander de Graeff, and van DeldenJohannes J MJJMJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands..
• Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: m.t.heijltjes-2@umcutrecht.nl.
• J Pain Symptom Manage. 2020 Oct 1; 60 (4): 828-846.e3.

ContextThe use of continuous sedation until death (CSD) has been highly debated for many years. It is unknown how the use of CSD evolves over time. Reports suggest that there is an international increase in the use of CSD for terminally ill patients.ObjectiveTo gain insight in developments in the use of CSD in various countries and subpopulations.MethodsWe performed a search of the literature published between January 2000 and April 2020, in PubMed, Embase, CINAHL, PsycInfo, and the Cochrane Library by using the Preferred reporting items for systematic review and meta-analysis protocols guidelines. The search contained the following terms: continuous sedation, terminal sedation, palliative sedation, deep sedation, end-of-life sedation, sedation practice, and sedation until death.ResultsWe found 23 articles on 16 nationwide studies and 38 articles on 37 subpopulation studies. In nationwide studies on frequencies of CSD in deceased persons varied from 3% in Denmark in 2001 to 18% in The Netherlands in 2015. Nationwide studies indicate an increase in the use of CSD. Frequencies of CSD in the different subpopulations varied too widely to observe time trends. Over the years, more studies reported on the use of CSD for nonphysical symptoms including fear, anxiety, and psycho-existential distress. In some studies, there was an increase in requests for sedation of patients from their families.ConclusionsThe frequency of CSD seems to increase over time, possibly partly because of an extension of indications for sedation, from mainly physical symptoms to also nonphysical symptoms.Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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