Using sedative substances until death: A mortality follow-back study on the role of healthcare settings

Background:In the last decade, the use of sedative substances to keep a patient in deep sedation until death increased fourfold in German-speaking Switzerland, where every third patient admitted to hospital, palliative care unit or hospice died continuously deeply sedated.Aim:To investigate sedation practices across healthcare settings and to identify their associations with conventional symptom control.Design:National mortality follow-back study in Switzerland between 2013 and 2014. Questionnaires on medical end-of-life decisions were sent to attending physicians of a continuous random sample of all registered deaths aged 1 year or older.Setting/participants:Of all sampled deaths, 3678 individuals who died non-suddenly and not through an external cause were included.Results:Across settings, continuous deep sedation appeared more likely in patients aged younger than 65 years (odds ratio range: 1.53–2.34) and as part of or after intensified alleviation of pain and symptoms (odds ratio range: 1.90–10.27). I...