Lindrende sedering til døende / Palliative sedation to the dying

Førde R / Forde R, Kongsgård U, Aasland OG. Tidsskr Nor Lægeforen 2006; 126: 471-4.

Article in Norwegian.

Abstract on Pubmed:

BACKGROUND: Guidelines for palliative sedation to dying patients were issued by the Council for Medical Ethics of the Norwegian Medical Association in 2001. This study is a follow up of these guidelines. MATERIAL AND METHODS: In 2002 an anonymous questionnaire was sent to 400 hospital departments. After two years, only 12 questionnaires had been returned. In addition to this survey we present data from a survey among a random sample of 1539 doctors. RESULTS: Ten of the 12 treatments which were registered in detail concerned patients with advanced cancer and in great discomfort. Average age was 49. Pain, nausea, convulsions and dyspnoea were the most common symptoms. Nine out of the 12 patients were in pain. In no case the sedation was assessed to have been avoidable with more health care resources. Relatively few patients had been examined psychologically. The decisions were taken by several caregivers, always in accordance with the family´s wish. Six of the patients whose conscience level was raised were sedated again. Midazolam and morphine were the two mostly-used drugs; doses used varied considerably. 12% of the surveyed physicians said that one or more dying patients had been given palliative sedation in their department during the last 12 months. INTERPRETATION: Palliative sedation for dying patients is probably used infrequently in Norway, and not to hasten death. In the cases which we have registered, palliative sedation was given to patients in great discomfort.

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Sammendrag:
Bakgrunn. I 2001 publiserte Rådet for legeetikk retningslinjer for lindrende sedering til døende. Denne studien er en oppfølging av dette.
Materiale og metode. I 2002 ble det sendt ut anonyme registreringsskjemaer til 400 aktuelle sykehusavdelinger. To år etter hadde vi fått tilbake 12 utfylte skjemaer. Vi presenterer dessuten data fra et spørreskjema sendt til et tilfeldig utvalg på 1 539 leger.
Resultater. Ti av de 12 behandlingene gjaldt pasienter med kreft, uttalt metastasering og store plager. Gjennomsnittsalderen var 49 år. Smerter, kvalme, kramper og pusteproblemer var de hyppigst oppgitte symptomene. Ni av de 12 pasientene hadde smerter. Ingen leger oppgav at behandlingen kunne vært unngått hvis man hadde hatt mer ressurser. Behandlingsbeslutningen ble tatt av flere, og i samforstand med familien. Seks av pasientene ble forsøkt vekket, og alle ble sedert på nytt. Midazolam og morfin var de to hyppigst brukte medikamentene. Det var store individuelle dosevariasjoner i medikamentbruken. 1 004 leger (65 %) besvarte spørreskjemaet. 12 % (116 leger) oppgav at pasienter ved deres avdeling hadde fått slik behandling i løpet av siste år.