• Florien B van Heest, I G Finlay, J J E Kramer, R Otter, and B Meyboom-de Jong.
• Department for Palliative Medicine, Integraal Kankercentrum Noord Oost, 9700 AH Groningen, The Netherlands. f.vanheest@ikno.nl
• Fam Pract. 2009 Dec 1; 26 (6): 481-7.

BackgroundGPs with a special interest and with specific training in palliative medicine (GP advisors) supported professional carers (mostly GPs) through a telephone advisory service. Each telephone call was formally documented on paper and subsequently evaluated.ObjectiveData from 2003 were analysed independently to reveal how often and in what way palliative sedation and euthanasia were discussed.MethodsThe telephone documentation forms and corresponding evaluation forms of two GP advisors were systematically analysed for problems relating to the role of sedation and/or euthanasia both quantitatively and qualitatively.ResultsIn 87 (21%) of 415 analysed consultations, sedation and/or euthanasia were discussed either as the presenting question (sedation 26 times, euthanasia 37 times and both 10 times) or arising during discussion (sedation 11 times and euthanasia three times). Qualitative analysis revealed that GPs telephoned to explore therapeutic options and/or wanted specific information. Pressure on the GP (either internal or external) to relieve suffering (including shortening life by euthanasia) had often precipitated the call. On evaluation, 100% of the GPs reported that the advice received was of value in the patient's care.ConclusionGPs caring for patients dying at home encountered complex clinical dilemmas in end-of-life care (including palliative sedation therapy and euthanasia). They valued practical advice from, and open discussion with, GP advisors. The advice often helped the GP find solutions to the patient's problems that did not require deliberately foreshortening life.

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