[Frequency and characteristics of use of morphine at the end of life: a cross-sectional study].

Objective: Intensive use of morphine at the end of life sometimes seems to represent a grey area between active ending of life and regular alleviation of symptoms. We explored the most important characteristics of use of morphine at the end of life.

Design: Cross-sectional questionnaire study.

Continuous palliative sedation: not only a response to physical suffering.

Background: Palliative sedation is a medical intervention aimed at relieving symptoms that can no longer be controlled by conventional treatment. Ample knowledge is available regarding the nature of such symptoms, but there is no in-depth information regarding how health care workers decide about palliative sedation.

Objective: The study objective was to investigate considerations concerning the indications for continuous palliative sedation (CPS) and issues that influence these considerations.

Improving the quality of palliative and terminal care in the hospital by a network of palliative care nurse champions: the study protocol of the PalTeC-H project.

Background: The quality of care of patients dying in the hospital is often judged as insufficient. This article describes the protocol of a study to assess the quality of care of the dying patient and the contribution of an intervention targeted on staff nurses of inpatient wards of a large university hospital in the Netherlands.

Methods/design: We designed a controlled before and after study.

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

Background: Although guidelines advise titration of palliative sedation at the end of life, in practice the depth of sedation can range from mild to deep. We investigated physicians' considerations about the depth of continuous sedation.

Methods: We performed a qualitative study in which 54 physicians underwent semistructured interviewing about the last patient for whom they had been responsible for providing continuous palliative sedation.

Continuous palliative sedation for cancer and noncancer patients.

Context: Palliative care is often focused on cancer patients. Palliative sedation at the end of life is an intervention to address severe suffering in the last stage of life.

Objectives: To study the practice of continuous palliative sedation for both cancer and noncancer patients.

End-of-life decision making for cancer patients in different clinical settings and the impact of the LCP.

Differences in the general focus of care among hospitals, nursing homes, and homes may affect the adequacy of end-of-life decision making for the dying. We studied end-of-life decision-making practices for cancer patients who died in each of these settings and assessed the impact of the Liverpool Care Pathway for the Dying Patient (LCP), a template for care in the dying phase. Physicians and relatives of 311 deceased cancer patients completed questionnaires.

Awareness and use of practice guidelines on medical end-of-life decisions in Dutch hospitals.

Objective: To describe awareness, use and supportiveness for physicians of three practice guidelines on medical end-of-life decisions, and to identify factors associated with increased awareness of these guidelines.

Methods: Questionnaires were sent to 793 physicians from 12 hospitals in 2005 (response 52%).

Results: Most physicians were aware of the existence of the practice guidelines for euthanasia (75%) and do-not-resuscitate decisions (63%), and 35% were aware of the existence of the guidelines for palliative sedation.

A comparison of physicians' end-of-life decision making for non-western migrants and Dutch natives in the Netherlands.

Background: Non-western migrants have a different cultural background that influences their attitudes towards healthcare. As the first wave of this relatively young group is growing older, we investigated, for the first time, whether end-of-life decision-making practices for non-western migrants differ from Dutch natives.

Methods: In 2005, we sent questionnaires to physicians who attended deaths identified from the central death registry of Statistics Netherlands (n = 9651; non-western migrants: n = 627, total response: 78%).

Trends in the use of opioids at the end of life and the expected effects on hastening death.

The aim of our study was to describe trends in opioid use and perceptions of having hastened the end of life of a patient. In 2005, a questionnaire was sent to 6860 physicians in The Netherlands who had attended a death. The response rate was 78%.

Does recognition of the dying phase have an effect on the use of medical interventions?

During the dying phase, patients often receive interventions that are not aimed at promoting their comfort. We investigated how recognition of the dying phase affects the use of interventions by comparing patients for whom the dying phase had been recognized with patients for whom it had not been recognized. We included 489 of 613 patients (80%) who died either in a hospital, nursing home, or primary care setting between November 2003 and February 2006.

Using the LCP: bereaved relatives' assessments of communication and bereavement.

The Liverpool Care Pathway (LCP) is aimed at improving care and communication in the dying phase. The authors studied whether use of the LCP affects relatives' retrospective evaluation of communication and their level of bereavement. An intervention study was conducted.

The effect of the Liverpool Care Pathway for the dying: a multi-centre study.

We studied the effect of the Liverpool Care Pathway (LCP) on the documentation of care, symptom burden and communication in three health care settings. Between November 2003 and February 2005 (baseline period), the care was provided as usual. Between February 2005 and February 2006 (intervention period), the LCP was used for all patients for whom the dying phase had started.

Continuous deep sedation for patients nearing death in the Netherlands: descriptive study.

Objectives: To study the practice of continuous deep sedation in 2005 in the Netherlands and compare it with findings from 2001.

Design: Questionnaire study about random samples of deaths reported to a central death registry in 2005 and 2001.

Setting: Nationwide physician study in the Netherlands.

The way forward.

Good public-health decisionmaking is dependent on reliable and timely statistics on births and deaths (including the medical causes of death). All high-income countries, without exception, have national civil registration systems that record these events and generate regular, frequent, and timely vital statistics. By contrast, these statistics are not available in many low-income and lower-middle-income countries, even though it is in such settings that premature mortality is most severe and the need for robust evidence to back decisionmaking most critical.

Patient evaluation of end-of-life care.

The Dutch health care system is characterized by a strong emphasis on primary care. To get insight into the strengths and gaps in end-of-life care in the Netherlands, data are needed about use and patient evaluation of end-of-life care. We assessed the experiences of patients with end-of-life care during the last months of life.

Dying at home or in an institution: perspectives of Dutch physicians and bereaved relatives.

Introduction: Previous studies have shown that most people prefer to die at their own home. We investigated whether physicians or bereaved relatives in retrospect differently appreciate the dying of patients in an institution or at home.

Materials And Methods: Of 128 patients with incurable cancer who were followed in the last phase of their lives, 103 passed away during follow-up.

The last 3 days of life in three different care settings in The Netherlands.

Introduction: Little is known about the characteristics of dying in different care settings, such as the hospital, the nursing home, or the home-care setting.

Materials And Methods: We measured the burden of symptoms, medical and nursing interventions, and aspects of communication during the last 3 days of life within each of these settings. We included 239 of 321 patients (74%) who died in one of these settings in the southwest of The Netherlands, between November 2003 and February 2005.

Using drugs to end life without an explicit request of the patient.

A small proportion of deaths result from the use of drugs with the intention to hasten death without an explicit request of the patient. Additional insight into its characteristics is needed for evaluating this practice. In the Netherlands in 2001, questionnaires were mailed to physicians that addressed the decision making that preceded their patient's death.