Demographic and clinical characteristics, practices, and outcomes of continuous palliative sedation: A multi-setting, province-wide retrospective cohort study.

Abstract

This study leverages the Province of Quebec (Canada)'s 2014 End-of-Life Care Act, which regulates the use of continuous palliative sedation and mandates its reporting, to describe its use at a population-based level. To describe the demographic and clinical characteristics of patients who received continuous palliative sedation, and to examine variabilities in clinical practice across diagnoses, indications, and care settings. Retrospective convenience cohort of patients who received continuous palliative sedation until death. A total of 1005 patients' reporting forms from academic and regional hospitals and hospices between January 1st, 2016 and March 31st, 2022 were analyzed, representing 12% of all reported continuous palliative sedations performed in the Province of Quebec. The sample was 51% male, median age of 73 years (IQR 64-81). Most (45%) received continuous palliative sedation in academic hospitals, 40% in hospices, and 15% in regional hospitals, but none in chronic care institutions or at home. Cancer was the most prevalent diagnosis (78%). The main indications were psychological/existential distress (57%), respiratory distress (34%), pain (28%), and delirium (24%); half had more than one form of distress. Overall median duration was 2 days (IQR 1-5), significantly longer in cases of psychological/existential distress (3 days, IQR 1-7; <i>p</i> < 0.0001). Medications commonly used were methotrimeprazine (74%), midazolam (69%), and lorazepam (48%), frequently in combination. 93% of patients died peacefully, while 6% experienced incomplete symptom relief, and 1%, complications. The study demonstrated that standardization in the practice of continuous palliative sedation can be achieved across diverse clinical settings.