• Evangelia Evie Papavasiliou, Kenneth Chambaere, Luc Deliens, Sarah Brearley, Sheila Payne, Judith Rietjens, Robert Vander Stichele, Lieve Van den Block, and on behalf of EURO IMPACT.
• International Observatory on End of Life Care, Lancaster University, Lancaster, UK e.papavasiliou@lancaster.ac.uk.
• Palliat Med. 2014 Jun 1; 28 (6): 491-500.

BackgroundResearch on continuous deep sedation until death has focused on estimating prevalence and describing clinical practice across care settings. However, evidence on sedation practices by physician specialty is scarce.AimsTo compare and contrast physician-reported practices on continuous deep sedation until death between general practitioners and medical specialists.Design/ParticipantsA secondary analysis drawing upon data from a large-scale, population-based, retrospective survey among physicians in Flanders, Belgium in 2007. Symptom prevalence and characteristics of sedation (drugs used, artificial nutrition and hydration administered, intentions, and decision-making) were measured.ResultsResponse rate was 58.4%. The frequency of continuous deep sedation until death among all deaths was 11.3% for general practitioners and 18.4% for medical specialists. General practitioners reported significantly higher rates of severity and mean intensity of pain, delirium, dyspnea, and nausea in the last 24 h of life for sedated patients and a higher number of severe symptoms than medical specialists. No differences were found between groups in the drugs used, except in propofol, reported only by medical specialists (in 15.8% of all cases). Artificial nutrition and hydration was withheld or withdrawn in 97.2% of general practitioner and 36.2% of medical specialist cases. Explicit life-shortening intentions were reported by both groups (for 3%-4% of all cases). Continuous deep sedation until death was initiated without consent or request of either the patient or the family in 27.9% (medical specialists) and 4.7% (general practitioners) of the cases reported.ConclusionConsiderable variation, often largely deviating from professional guidelines, was observed in physician-reported performance and decision-making, highlighting the importance of providing clearer guidance on the specific needs of the context in which continuous deep sedation until death is to be performed.© The Author(s) 2014.

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