Open Access Open Badges Research article

Pressure during decision making of continuous sedation in end-of-life situations in Dutch general practice

Marco H Blanker1*, Marlies Koerhuis-Roessink1, Siebe J Swart2, Wouter WA Zuurmond34, Agnes van der Heide2, Roberto SGM Perez34 and Judith AC Rietjens2

Author Affiliations

1 University of Groningen, University Medical Center Groningen, Department of General Practice, P.O.Box 30.001, 9700, Groningen, the Netherlands

2 Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands

3 EMGO Institute for Health and Care Research, and Departments of Anesthesiology and Palliative Care Centre of Expertise, VU University Medical Center, Amsterdam, the Netherlands

4 Hospice Kuria, Amsterdam, the Netherlands

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BMC Family Practice 2012, 13:68  doi:10.1186/1471-2296-13-68

Published: 3 July 2012



Little is known about pressure from patients or relatives on physician’s decision making of continuous palliative sedation. We aim to describe experienced pressure by general practitioners (GPs) in cases of continuous sedation after the introduction of the Dutch practice guideline, using a questionnaire survey.


A sample of 918 Dutch GPs were invited to fill out a questionnaire about their last patient under continuous sedation. Cases in which GPs experienced pressure from the patient, relatives or other persons were compared to those without pressure.


399 of 918 invite GPs (43%) returned the questionnaire and 250 provided detailed information about their most recent case of continuous sedation. Forty-one GPs (16%) indicated to have experienced pressure from the patient, relatives or colleagues. In GPs younger than 50, guideline knowledge was not related to experienced pressure, whereas in older GPs, 15% with and 36% without guideline knowledge reported pressure. GPs experienced pressure more often when patients had psychological symptoms (compared to physical symptoms only) and when patients had a longer estimated life expectancy. A euthanasia request of the patient coincided with a higher prevalence of pressure for GPs without, but not for GPs with previous experience with euthanasia. GPs who experienced pressure had consulted a palliative consultation team more often than GPs who did not experience pressure.


One in six GPs felt pressure from patients or relatives to start sedation. This pressure was related to guideline knowledge, especially in older GPs, longer life expectancy and the presence of a euthanasia request, especially for GPs without previous experience of euthanasia.

Conscious sedation; Palliative care; General practice; Patient preference