Deep and continuous sedation maintained until death at home: State of play of general practitioners's practices in Maine-et-Loire

Introduction. The law of February 2, 2016 has created new rights for end-of-life patients, including deep and continuous sedation until death (DCSUD) at the patient's request, at home or in institutions. These legislative changes may modify the practices of general practitioners (GPs). Methods. The aim of this study was to determine the proportion of GPs from Maine-Et-Loire who had already used DCSUD at home and to describe their practices. An online survey was conducted anonymously between April and May 2018. Results. A total of 42% (n =45) of respondent GPs said that they had already implemented DCSUD at home; most often after a collegial decision in the context of informal discussions rather than organized meetings. The most common indication was refractory suffering: pain, anxiety, and dyspnea were the most common symptoms. Most of them respected the recommendations of good practice with a gradual introduction of sedation, usually with midazolam associated with an analgesic. In 27% (n = 11) of the cases, the nurse was alone at home during the initiation of the DCSUD. 58% (n=26) of physicians who started DCSUD reported that they weren't trained specifically in this area. Conclusion. In spite of a lack of training on this subject, GPs are numerous to set up SPCJD in order to go with their patients in an end-of-life approach at home. They are generally well aware of the recommendations regarding DCSUD. (C) 2019 Elsevier Masson SAS. All rights reserved.