EAPC - ipac

432 EAPC Abstracts
Joris Gielen K.U. Leuven Leuven BELGIUM
Stef Van den Branden K.U. Leuven Leuven BELGIUM
Background: Several studies have already investigated attitudes of medical
professionals towards end-of-life issues. Less research has been conducted
concerning the attitudes of palliative care professionals, especially regarding
palliative sedation. In 2006 we undertook a quantitative study of attitudes of
pallitive care physicians and nurses towards palliative sedation. Methods: An
anonymous questionnaire was sent to all physicians (147) and nurses (589)
employed in palliative care teams and institutions in Flanders (Belgium). The
questionnaire contained a demographic part, and an attitudinal part, consisting
of a long series of ethical statements using a five-point Likert-scale. To
divide physicians and nurses into different attitudinal groups a latent class
analysis was fitted with an EM-algorithm. Results: 70.5% of the nurses
(n=415) and 67.3% of the physicians (n=99) responded. Only 7% of the
respondents prefers euthanasia to palliative sedation. Yet, most physicians
and nurses (64%) think palliative sedation does not render euthanasia
superfluous. 94% is convinced that artificial nutrition and hydration is not a
proper treatment in the case of deep continuous sedation. 75% agrees that
palliative sedation can only be administered safely when a specialised palliative
care team is involved in the decision making process. Two clusters were
found: advocates of deep sedation (43.8%, n=215) and respondents restricting
the application of deep sedation (56.2%, n=276). There were no statistically
significant differences between both clusters regarding gender, age,
profession and years of experience in palliative care. Conclusions: The
respondents’ attitudes toward palliative sedation are balanced. Although they
consider palliative sedation a good treatment, they do not believe palliative
sedation offers a satisfactory solution in all circumstances. They are cautious
about applying deep sedation. Funding: Research Foundation Flanders.
110 Oral Presentation
Palliative Sedation
Palliative sedation (PS): comparison of practice between 2001
and 2006
Authors: Karine Moynier-Vantieghem Réhabilitation et Gériatrie Service
de Médecine Palliative – CESCO SWITZERLAND
Gilbert B Zulian Service de Médecine Palliative – CESCO Collonge-
Bellerive SWITZERLAND
Sophie Pautex Service de Médecine Palliative – CESCO Collonge-
Bellerive SWITZERLAND
Yolanda Eespolio Desbaillet Service de Médecine Palliative – CESCO
Collonge-Bellerive SWITZERLAND
Catherine Weber Service de Médecine Palliative – CESCO Collonge-
Bellerive SWITZERLAND
Background: The aim of this study is to compare practice between 2001
and 2006. Is PS more frequent Are situations more complex Are indications
different Are guidelines useful Methods: Files from all deceased
patients during the years 2001 and 2006 were retrospectively analyzed. PS
performed with either midazolam, diazepam and/or levopromazine were
identified. Indications, route of administration, duration of PS were determined
according to the following definition: PS = administration of sedative
drugs to adequately relieve one or more refractory symptoms of
patients with advanced disease and limited life expectancy and to reduce
consciousness either temporarily or permanently. Results: In 2001, 309 persons
died, 8 (5 females) received PS (2.5%), mean age was 67.8 years.
6 had advanced cancer and 2 cardio-pulmonary failures. Refractory dyspnoea,
insomnia and psychomotor agitation indicated intravenous/subcutaneous
midazolam or intrarectal diazepam PS which was terminal in 5 cases
and transitory in 3. Sleep induction failed in one midazolam case. In 2006,
297 persons died, 12 (4 females) received PS (4%). Indication for PS was
refractory symptoms: dyspnoea, psychomotor agitation, epilepsy, anxiety.
Data will be reported as above. Differences of practice will be analysed.
Conclusions: Number of PS has not increase as much as expected over the
past years despite higher complexity of patients. However, misinterpretation
of PS, which is performed after strict indications under careful supervision,
with euthanasia may persist among caregivers. Carefully monitor
our practice appears an appropriate way to avoid the risk of confusion.
111 Oral Presentation
Palliative Sedation
Palliative sedation therapy does not hasten death
Presenting author: Luigi Montanari
Authors: Marco Maltoni Palliative Care Unit Valerio Grassi Hospice,
AUSL Forlì ITALY
Emanuela Scarpi Istituto Scientifico Romagnolo per lo Studio e la Cura dei
Tumori, Unit of Biostatistics Meldola (FC) ITALY
Oriana Nanni Istituto Scientifico Romagnolo per lo Studio e la Cura dei
Tumori, Unit of Biostatistics Meldola (FC) ITALY
Lino Piccinini Hospice Ospedaliero, Cancer Center Modena ITALY
Francesca Martini Valerio Grassi Hospice, Palliative Care Unit
Forlimpopoli (FC) ITALY
Cristina Pittureri Hospice Savignano sul Rubicone, Palliative Care Unit
Savignano sul Rubicone (FC) ITALY
Paola Turci Hospice Savignano sul Rubicone, Palliative Care Unit
Savignano sul Rubicone (FC) ITALY
Dino Amadori Istituto Scientifico Romagnolo per lo Studio e la Cura dei
Tumori Meldola (FC) ITALY
Luigi Montanari San Domenico Hospice, Palliative Care Unit Lugo (RA)
ITALY
Background: Palliative Sedation Therapy (PST) is indicated for and used to
control refractory symptoms in cancer patients who have been inserted into
a palliative care programme. PST is often considered to be responsible for
speeding up death and has been defined by some as slow euthanasia.
Methods: The primary objective of this multi-centre, observational study is
to evaluate the overall survival of two cohorts of patients prospectively
recruited in several Hospices, one given palliative sedation and the other
managed as per routine hospice practice. The patients were matched for sex,
age class (¡Ü65, >65 years), reason for admission (psychosocial, uncontrolled
symptom, terminal phase), Karnofsky Performance Status (10–20,
30–40, ¡Ý50), and outcome of admission. Overall Survival was estimated
using the Kaplan-Meier method and the comparison of survival curves was
performed by log-rank test. Results: From March 2005 to December 2006,
518 patients of either sex and any age were recruited; 267 belonged to the
cohort of sedated patients (A) and 251 to the cohort of non sedated patients
(B). The percentage of sedated patients out of the entire population assisted
during the period of the study was 25.1%. The mean duration of sedation
was 4 days, while the median duration was 2 days. Median survival from the
time of admission to the hospice for cohort A patients was 12 days (95% CI:
10–14), while that of cohort B patients was 9 days (95% CI: 8–11)
(logrank=0.95, p=0.330) (unadjusted HR=0.92, 95% CI: 0.77–1.09).
Conclusions: Our results indicate that PST does not shorten survival when
carried out in an appropriate manner and that it does not require the principle
of double effect to be justified ethically. Supported by Istituto Scientifico
Romagnolo per lo Studio e la Cura dei Tumori, Meldola (FC), Italy.
112 Oral Presentation
Palliative Sedation
The use of continuous deep sedation for patients nearing death
in the netherlands: a descriptive study
Authors: Judith Rietjens Public Health Erasmus MC NETHERLANDS
Agnes van der Heide Department of Public Health, Erasmus MC Rotterdam
NETHERLANDS
Bregje Onwuteaka-Philipsen Department of Public and Occupational
Health, Institute for Research in Extramural Medicine, VUMC Amsterdam
NETHERLANDS
Johannes van Delden· Julius Centre for Health Sciences and Primary Care,
University Medical Centre Utrecht Utrecht NETHERLANDS
Paul van der Maas Department of Public Health, Erasmus MC Rotterdam
NETHERLANDS
Hilde Buiting Department of Public Health, Erasmus MC Rotterdam
NETHERLANDS