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Varying Practices Among Dutch Medical Specialists, General Practitioners, and Nursing Home Physicians

Jeroen G. J. Hasselaar, MSc; Rob P. B. Reuzel, PhD; Maria E. T. C. van den Muijsenbergh, MD, PhD; Raymond T. C. M. Koopmans, MD, PhD; Carlo J. W. Leget, PhD; Ben J. P. Crul, MD, PhD; Kris C. P. Vissers, MD, PhD, FIPP

Arch Intern Med. 2008;168(5):537-543.

Background  This article examines delicate issues in continuous deep sedation (CDS) from the perspectives of different types of physicians. The following sensitive issues involved in CDS were investigated: artificial hydration, sedation for nonphysical discomfort, the relationship between CDS and euthanasia, and patient involvement in decision making for CDS.

Methods  A structured retrospective questionnaire concerning the most recent case of CDS during the past 12 months was sent to a sample of medical specialists (n = 727), general practitioners (n = 626), and nursing home physicians (n = 111).

Results  Response rates were 26.4% for medical specialists, 37.4% for general practitioners, and 59.5% for nursing home physicians. Indications for CDS differed among the types of physicians. General practitioners (25.0%) were most often confronted with a patient request for euthanasia before starting CDS compared with medical specialists (8.9%) and nursing home physicians (6.5%). A decision to forgo artificial hydration in CDS was more often made by nursing home physicians (91.3%) compared with medical specialists (53.7%) and general practitioners (51.2%). Shorter survival was found for patients sedated for nonphysical discomfort (vs other patients) by general practitioners. Among all patients, 74.5% were involved in decision making before the start of CDS.

Conclusions  The present study demonstrates notable differences in CDS practice among various types of physicians. To what extent this is related to different patient populations or to different expertise requires further investigation. The use of CDS for nonphysical discomfort calls for critical examination to avoid ambiguous practice.

Author Affiliations: Departments of Anesthesiology, Pain, and Palliative Medicine (Mr Hasselaar and Drs Crul and Vissers), Medical Technology Assessment (Dr Reuzel), General Practice/Family Medicine (Dr van den Muijsenbergh), Nursing Home Medicine (Dr Koopmans), and Ethics, Philosophy, and History of Medicine (Dr Leget), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.