Prevalence of deep sedation for terminally ill patients in palliative care services

Background: Terminally ill patients may require sedation to relieve refractory suffering. However, the prevalence of this practice remains unclear.

Aim: This study aimed to estimate the prevalence of deep sedation, whether proportional or not, for terminally ill patients in palliative care and home-based hospitalization services.

Design: We conducted a national, multicenter, observational, prospective cross-sectional study.

Setting/participants: A scientific committee contacted all institutions registered with the national federation. In total, 331 centers participated, including academic/non-academic and public/private institutions. The participating institutions provided hospital- or home-based care for 5,714 terminally ill patients during the study.

Results: In total, 156 patients received deep sedation (prevalence of 2.7%; 95% confidence interval, 2.3-3.2); these patients were equally distributed between "transitory", "undetermined duration" and "maintained until death" sedation types. The median age of the sedated patients was 70 years (Q1-Q3: 61-83 years), and 51% of them were women. Almost 80% of the patients had cancers. Nine of ten sedation events occurred at an institution (90.4%), mostly in acute care services (84.6%). In total, 39.1% of patients were unable to provide consent; only two had written advance directives. A collegial procedure was implemented in more than half of the sedations (53.2%). Midazolam was widely used (85.9%), regardless of the sedation type.

Conclusions: This nationwide study provides insight into deep-sedation practices in palliative-care institutions. Our data will help clinicians in their practice, inform future recommendations, and provide essential epidemiological data for biomedical and psychosocial studies on this topic.