Physicians' and Nurses' Experiences With Continuous Palliative Sedation in the Netherlands

Abstract

At 4 years, 155 subjects in both groups were still in the program. The median (interquartile range) of plasma adiponectin concentration was 6.1 (3.5-9.1) µg/mL. The Figure shows the numbers of subjects who achieved the goals in each group, as well as the percentage of subjects in each category with adiponectin concentrations of 1 µg/mL or more above the median. The figures were adjusted for weight changes. Absolute numbers of people at goals were significantly lower in the control group; however, percentage values did not show any difference between groups, suggesting that achievement of the goal resulted in raised adiponectin levels independent of the group assignment. Comment. This study provides evidence that circulating adiponectin levels, in the range of those suggested to offer protection from type 2 diabetes, can be obtained by successful lifestyle changes. Our estimate of the effect of the intervention can be considered conservative, since all subjects in the control group also had benefits from the general health advice. The recent results of the longterm Women's Antioxidant Cardiovascular Study, 6 which showed no effect from generous doses supplement intake of vitamins A and C and beta carotene on primary prevention of type 2 diabetes, further stress the importance of lifestyle changes for diabetes prevention. Successful lifestyle changes are associated with increased circulating levels of adiponectin in overweight subjects.

Considerations of physicians about the depth of palliative sedation at the end of life

“…We have reported elsewhere that physicians and nurses sometimes feel pressure to start continuous sedation. 15,16 The results of our study indicate that relatives' fears about the patient waking up contribute to physicians' decisionmaking.…”

“…15 For the quantitative part of the study, we enrolled by random sampling physicians working in general practice, nursing homes and hospitals (n = 1580); of these, 370 reported about their most recent case of continuous palliative sedation. Frequent indications for sedation were dyspnea, pain and physical exhaustion.…”

“…Details of this study are described elsewhere. [15][16][17] Of the 370 respondents, 51 (22 general practitioners, 22 nursing home physicians and 7 clinical specialists) indicated that they were willing to participate in an additional qualitative interview. We also included the pilot interviews with one physician from each of the settings.…”

Opinions of the Dutch public on palliative sedation: a mixed-methods approach

“…8 In the Netherlands, continuous deep sedation until death was found to be used in 12% of all deaths in 2010. 9 International research regarding palliative sedation is increasing rapidly and has been mainly focused on practices, 10,11 experiences, 12,13 and attitudes of professionals. 14,15 There is concern about the potential of palliative sedation to hasten death.…”

Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia

“…(2,18) Later studies by Rietjens and colleagues reaffi rm that underpinning the fears voiced by the four nurses in the 2007 study by Rietjens et al was a lack of clarity on the practice of CSD. (35,36) …”