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.

Thèmes
Disciplines
Mots-clés
  • Sédation profonde
  • Soins palliatifs
  • Phase terminale
  • Prévalence
  • Etudes transversales
Publications issues de ce projet

En cours de reviewing

Acronyme
PREVAL-S2P
N° de projet (ANR, clinical trials…)
NCT04333719
Date de début
2020
Statut
en cours de valorisation
Financeurs
  • CHU de Bordeaux
  • Fondation APICIL
  • SFAP - Société Française d'Accompagnement et de soins Palliatifs
Établissement porteur du projet
  • Centre Hospitalier​ Universitaire de Bordeaux
Responsable(s) du projet
BURUCOA Benoît
Équipe projet
Structures partenaires
Université de Bordeaux
Contact
Matthieu FRASCA
matthieu.frasca@chu-bordeaux.fr
05 56 79 58 58