Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams

<div><p>Main Objective</p><p>Since palliative sedation is considered a complex intervention, consultation teams are increasingly established to support general practice. This study aims to offer insight into the frequency and characteristics of expert consultations regarding palliative sedation.</p><p>Methods</p><p>We performed a retrospective analysis of a longitudinal database. This database contained all patient-related consultations by Dutch Palliative Care Consultation teams, that were requested between 2004 and 2011. We described the frequency and characteristics of these consultations, in particular of the subgroup of consultations in which palliative sedation was addressed (i.e. PSa consultations). We used multivariate regression analysis to explore consultation characteristics associated with a higher likelihood of PSa consultations.</p><p>Main Results and Their Significance</p><p>Of the 44,443 initial consultations, most were requested by general practitioners (73%) and most concerned patients with cancer (86%). Palliative sedation was addressed in 18.1% of all consultations. Palliative sedation was relatively more often discussed during consultations for patients with a neurologic disease (OR 1.79; <i>95% CI</i>: <i>1</i>.<i>51–2</i>.<i>12</i>) or COPD (OR 1.39; <i>95% CI</i>: <i>1</i>.<i>15–1</i>.<i>69)</i> than for patients with cancer. We observed a higher likelihood of PSa consultations if the following topics were also addressed during consultation: dyspnoea (OR 1.30; <i>95% CI</i>: <i>1</i>.<i>22–1</i>.<i>40</i>), agitation/delirium (OR 1.57; <i>95% CI</i>: <i>1</i>.<i>47–1</i>.<i>68</i>), exhaustion (OR 2.89; <i>95% CI</i>: <i>2</i>.<i>61–3</i>.<i>20</i>), euthanasia-related questions (OR 2.65; <i>95% CI</i>: <i>2</i>.<i>37–2</i>.<i>96</i>) or existential issues (OR 1.55; <i>95% CI</i>: <i>1</i>.<i>31–1</i>.<i>83</i>).</p><p>Conclusion</p><p>In conclusion, PSa consultations accounted for almost one-fifth of all expert consultations and were associated with several case-related characteristics. These characteristics may help clinicians in identifying patients at risk for a more complex disease trajectory at the end of life.</p></div

Number of all consultations by Dutch PCC teams over the period 2004–2011.

<p><b>PCC teams</b>: Palliative Care Consultation Teams; <b>AMN</b>: Annual Mortality Number; <b>PS</b>: palliative sedation; <b>PSa consultation</b>: palliative sedation addressed during consultation; <b>95% CI</b>: 95% confidence interval.</p><p>Number of all consultations by Dutch PCC teams over the period 2004–2011.</p

Characteristics of all consultations by Dutch PCC teams (2004–2011).

<p><b>PCC teams</b>: Palliative Care Consultation Team; <b>PS</b>: palliative sedation; <b>PSa consultation</b>: palliative sedation addressed during consultation; <b>95% CI</b>: 95% confidence interval.</p><p>^a Proportion = (PSa consultations / total consultations)*100%, per single variable.</p><p>^b Total of variables for “Symptoms” and “Issues” exceeds 100% due to more than one symptom / issue registered per consultation.</p><p>Characteristics of all consultations by Dutch PCC teams (2004–2011).</p

Univariate and multivariate analysis of all consultations by Dutch PCC teams (2004–2011)–Characteristics associated with PSa consultations.

<p><b>PCC teams</b>: Palliative Care Consultation Teams; <b>PS</b>: palliative sedation; <b>PSa consultation</b>: palliative sedation addressed during consultation; <b>95% CI</b>: 95% confidence interval.</p><p>Univariate and multivariate analysis of all consultations by Dutch PCC teams (2004–2011)–Characteristics associated with PSa consultations.</p