Changing Practices in the Use of Continuous Sedation at the End of Life: A Systematic Review of the Literature

Madelon T Heijltjes, Ghislaine J M W van Thiel, Judith A C Rietjens, Agnes van der Heide, Alexander de Graeff, Johannes J M van Delden

Research output: Contribution to journalReview articlepeer-review

20 Citations (Scopus)
10 Downloads (Pure)


Context: The use of continuous sedation until death (CSD) has been highly debated for many years. It is unknown how the use of CSD evolves over time. Reports suggest that there is an international increase in the use of CSD for terminally ill patients. Objective: To gain insight in developments in the use of CSD in various countries and subpopulations. Methods: We performed a search of the literature published between January 2000 and April 2020, in PubMed, Embase, CINAHL, PsycInfo, and the Cochrane Library by using the Preferred reporting items for systematic review and meta-analysis protocols guidelines. The search contained the following terms: continuous sedation, terminal sedation, palliative sedation, deep sedation, end-of-life sedation, sedation practice, and sedation until death. Results: We found 23 articles on 16 nationwide studies and 38 articles on 37 subpopulation studies. In nationwide studies on frequencies of CSD in deceased persons varied from 3% in Denmark in 2001 to 18% in The Netherlands in 2015. Nationwide studies indicate an increase in the use of CSD. Frequencies of CSD in the different subpopulations varied too widely to observe time trends. Over the years, more studies reported on the use of CSD for nonphysical symptoms including fear, anxiety, and psycho-existential distress. In some studies, there was an increase in requests for sedation of patients from their families. Conclusions: The frequency of CSD seems to increase over time, possibly partly because of an extension of indications for sedation, from mainly physical symptoms to also nonphysical symptoms.

Original languageEnglish
Pages (from-to)828-846.e3
JournalJournal of Pain and Symptom Management
Issue number4
Early online date26 Jun 2020
Publication statusPublished - Oct 2020


  • Continuous sedation
  • deep sedation
  • end-of-life sedation
  • palliative sedation
  • terminal sedation


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