Quantitative evaluation of sedative practices in 2021 during the last three days of life in 6 palliative care units in metropolitan France

Deep and continuous sedation maintained until death introduced by the Claeys-Leonetti law in 2016 remains a subject of ethical questioning for many palliative care practitioners. Many involved in palliative care fear that this sedative practice is becoming commonplace, whereas it should remain the exception. To date, there are no quantitative studies describing sedative practices within palliative care units.

The aim of this study is to obtain an overview of the different sedative practices within 6 palliative care units during the last 3 days of life, for patients who died between July 1 and December 31, 2021 with the aim of observing inter-structure variability.

This is a national, multicenter, observational and retrospective study. We will study all medical records (IDE transmission, panel of administered molecules and clinical evaluation) of patients who died within 6 palliative care units from July 1 to December 31, 2021.

The study will be conducted in the context of a national, multicenter, observational and retrospective study

From the data collected, we will seek to find out the proportion of patients sedated at the time of death and the type of sedation. We will also look at the administration of potentially sedative molecules received during the last three days of life of patients hospitalized in palliative care units.

We will analyze for each center:

• The description of the population
• The proportion of patients who received deep and continuous sedation maintained until death
• The average time between the implementation of SPCMJD and death
• The proportion of patients who received another type of sedation in the last 3 days of life (among the total population, among patients finally deeply and continuously sedated and among patients not deeply and continuously sedated)
• The frequency of use of the SEDAPALL scale to qualify sedation
• The average number of sedative molecules administered per patient
• For each sedative molecule:
  • Proportion of patients who received these molecules
  • Average daily dosage.

This study will enable us to gain a better quantitative understanding of sedative practices in the USP. It will enable us to carry out group interviews when reporting the results to the participating structures, in order to understand any differences in practices highlighted by this study. (Quali-Sed'USP study)