Practices and Attitudes of Japanese Oncologists and Palliative Care Physicians Concerning Terminal Sedation: A Nationwide Survey

2002 ◽  
Vol 20 (3) ◽  
pp. 758-764 ◽  
Author(s):  
Tatsuya Morita ◽  
Tatsuo Akechi ◽  
Yuriko Sugawara ◽  
Satoshi Chihara ◽  
Yosuke Uchitomi
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Psychiatric Treatment ◽  
Deep Sedation ◽  
Terminally Ill ◽  
Palliative Sedation ◽  
Professional Burnout ◽  
Palliative Sedation Therapy ◽  
Continuous Deep Sedation ◽  
Psychologic Distress

PURPOSE: To clarify the frequency of practice of sedation therapy for terminally ill cancer patients and to identify physicians’ attitudes toward sedation. METHODS: Questionnaires were mailed to 1,436 Japanese oncologists and palliative care physicians with a request to report their practice of and attitudes toward palliative sedation therapy. RESULTS: A total of 697 physicians returned questionnaires (response rate, 49.6%). Use of mild, intermittent-deep, or continuous-deep sedation for physical and psychologic distress was reported by 89% and 64%, 70% and 46%, and 66% and 38%, respectively. In vignettes in which physicians were asked whether they would use sedation for a patient with refractory dyspnea or with existential distress, 14% and 15%, respectively, chose continuous-deep sedation as a strong possibility. Those physicians less confident with psychologic care and with higher levels of professional burnout were more likely to choose continuous-deep sedation. In vignettes in which they were asked whether they use sedation for a patient with depression or delirium, 39% and 31%, respectively, considered psychiatric treatment to be a strong possibility, and 42% and 50% regarded continuous-deep sedation as a potential treatment option. Physicians less involved in caring for the terminally ill and less specialized in palliative medicine were significantly less likely to choose psychiatric treatment. CONCLUSION: Sedation is frequently used for severe physical and psychologic distress of cancer patients. Physicians’ clinical experiences with the terminally ill and their levels of professional burnout influence the decisions. Training and education for physicians in regard to end-of-life care and valid clinical guidelines for palliative sedation therapy are necessary.

Japanese physicians’ experiences of terminally ill patients voluntarily stopping eating and drinking: a national survey

2017 ◽  
Vol 9 (2) ◽  
pp. 143-145 ◽  
Author(s):  
Takuya Shinjo ◽  
Tatsuya Morita ◽  
Daisuke Kiuchi ◽  
Masayuki Ikenaga ◽  
Hirofumi Abo ◽  
...  
Keyword(s):  
Palliative Care ◽  
National Survey ◽  
Clinical Setting ◽  
Deep Sedation ◽  
Terminally Ill ◽  
Treatment Decision ◽  
Mail Questionnaire ◽  
Terminally Ill Patients ◽  
Continuous Deep Sedation

ObjectivesVoluntarily stopping eating and drinking (VSED) could be regarded as a patients’ own non-treatment decision that hastens death, which involves patients voluntarily forgoing food and liquid until death. The aims of this study were to investigate the experience of home hospice physicians and palliative care specialists who care for patients during VSED in Japan, and their opinions on continuous deep sedation (CDS) as a means to relieve patient symptoms during VSED.Methods219 home hospice physicians and 695 palliative care specialists across Japan were surveyed by mail questionnaire in 2016.ResultsA total of 571 (62%) responses were analysed. A total of 185 (32%) had experience of patients who selected VSED. In response to questions about CDS to provide relief to patients during VSED, the number of physicians who replied that CDS was acceptable was 88 (15%).ConclusionsIn Japan, 32% of physicians surveyed replied that they had experience of caring for patients during VSED in a clinical setting and 15% considered CDS acceptable.

scholarly journals Reflections on palliative sedation

2019 ◽  
Vol 12 ◽  
pp. 117822421882351 ◽  
Author(s):  
Robert Twycross
Keyword(s):  
Palliative Care ◽  
Deep Sedation ◽  
Palliative Sedation ◽  
Palliative Care Team ◽  
Specific Symptom ◽  
Care Services ◽  
Continuous Deep Sedation ◽  
Continuous Sedation ◽  
Palliative Care Services ◽  
Intolerable Suffering

‘Palliation sedation’ is a widely used term to describe the intentional administration of sedatives to reduce a dying person’s consciousness to relieve intolerable suffering from refractory symptoms. Research studies generally focus on either ‘continuous sedation until death’ or ‘continuous deep sedation’. It is not always clear whether instances of secondary sedation (i.e. caused by specific symptom management) have been excluded. Continuous deep sedation is controversial because it ends a person’s ‘biographical life’ (the ability to interact meaningfully with other people) and shortens ‘biological life’. Ethically, continuous deep sedation is an exceptional last resort measure. Studies suggest that continuous deep sedation has become ‘normalized’ in some countries and some palliative care services. Of concern is the dissonance between guidelines and practice. At the extreme, there are reports of continuous deep sedation which are best described as non-voluntary (unrequested) euthanasia. Other major concerns relate to its use for solely non-physical (existential) reasons, the under-diagnosis of delirium and its mistreatment, and not appreciating that unresponsiveness is not the same as unconsciousness (unawareness). Ideally, a multiprofessional palliative care team should be involved before proceeding to continuous deep sedation. Good palliative care greatly reduces the need for continuous deep sedation.

Effectiveness of multidisciplinary team conference on decision-making surrounding the application of continuous deep sedation for terminally ill cancer patients

2013 ◽  
Vol 13 (2) ◽  
pp. 157-164 ◽  
Author(s):  
Kazuhiko Koike ◽  
Takeshi Terui ◽  
Yuji Takahashi ◽  
Yasuo Hirayama ◽  
Naomi Mizukami ◽  
...  
Keyword(s):  
Decision Making ◽  
Retrospective Analysis ◽  
Cancer Patients ◽  
Multidisciplinary Team ◽  
Deep Sedation ◽  
Conscious Experience ◽  
Terminally Ill ◽  
Care Providers ◽  
Terminally Ill Cancer Patients ◽  
Continuous Deep Sedation

AbstractObjective:Continuous deep sedation (CDS) is a way to reduce conscious experience of symptoms of severe suffering in terminally ill cancer patients. However, there is wide variation in the frequency of its reported. So we conducted a retrospective analysis to assess the prevalence and features of CDS in our palliative care unit (PCU).Methods:We performed a systemic retrospective analysis of the medical and nursing records of all 1581 cancer patients who died at the PCU at Higashi Sapporo Hospital between April 2005 and August 2011. Continuous deep sedation can only be administered safely and appropriately when a multidisciplinary team is involved in the decision-making process. Prior to administration of CDS, a multidisciplinary team conference (MDTC) was held with respect to all the patients considered for CDS by an attending physician. The main outcome measures were the frequency and characteristics of CDS (patient background, all target symptoms, medications used for sedation, duration, family's satisfaction, and distress). We mailed anonymous questionnaires to bereaved families in August 2011.Results:Of 1581 deceased patients, 22 (1.39%) had received CDS. Physical exhaustion 8 (36.4%), dyspnea 7 (31.8%), and pain 5 (22.7%) were the most frequently mentioned indications. Continuous deep sedation had a duration of less than 1 week in 17 (77.3%). Six patients (0.38%) did not meet the appropriate criteria for CDS according to the MDTC and so did not receive it. Although bereaved families were generally comfortable with the practice of CDS, some expressed a high level of emotional distress.Significance of results:Our results indicate that the prevalence of CDS will be decreased when it is carried out solely for appropriate indications. Continuity of teamwork, good coordination, exchange of information, and communication between the various care providers are essential. A lack of any of these may lead to inadequate assessment, information discrepancies, and unrest.

scholarly journals Continuous Deep Sedation Until Death Is Not an Alternative to Assisted Suicide in Palliative Care Units in the French-Speaking Part of Switzerland: A Multicentre Qualitative Study Based on Interviews With Physicians.

2021 ◽  
Author(s):  
Martyna TOMCZYK ◽  
Nathalie DIEUDONNÉ-RAHM ◽  
Ralf JOX
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
Assisted Suicide ◽  
Deep Sedation ◽  
Palliative Sedation ◽  
Continuous Deep Sedation ◽  
The Family ◽  
French Speaking ◽  
Palliative Care Units ◽  
Negative Impacts

Abstract Background: According to the European Association for Palliative Care, decisions regarding palliative sedation should not be made in response to a request for death. However, several studies show that continuous deep sedation until death (CDSUD) – a particular form of sedation – has been considered as an alternative to active assisted dying in some countries. In Switzerland, where assisted suicide is decriminalized and CDSUD is not legally regulated, no studies have comprehensively investigated if they might be correlated. Our study aimed to identify and describe the experience among palliative care physicians of CDSUD as an alternative to assisted suicide in the French-speaking part of Switzerland.Methods: We performed an exploratory multicentre qualitative study based on interviews with physicians working in palliative care institutions in the French-speaking part of Switzerland and conducted linguistic and thematic analysis of all interview transcripts. The study is described in accordance with COREQ criteria.Results: We included 10 interviews conducted in four palliative care institutions. Our linguistic analysis shows four main types of sedation, which we called ‘rapid CDSUD’, ‘gradual CDSUD’, ‘temporary sedation’ and ‘intermittent sedation’. CDSUD (rapid or gradual) is not considered an alternative to assisted suicide. In contrast, ‘temporary’ or ‘intermittent sedation’, although not medically indicated, is sometimes introduced in response to a request for assisted suicide. This is due to the impossibility of carrying out an assisted suicide at home (e.g., home transfer is impossible or the patient’s wish not to traumatize the family).Conclusion: These preliminary results can guide clinical, ethical, linguistic and legal reflection in this field and be used to explore this question more deeply at the national and international levels in a comparative, interdisciplinary and multiprofessional approach. They can also be useful to update Swiss clinical guidelines on palliative sedation in order to include specific frameworks on various sedation protocols and sedation as an alternative to assisted suicide. Potential negative impacts of considering palliative sedation as an alternative to assisted suicide should be nuanced by open and honest societal debate.

scholarly journals Association of the RASS Score With Intensity of Symptoms, Discomfort, and Communication Capacity in Terminally Ill Cancer Patients Receiving Palliative Sedation: Is RASS an Appropriate Outcome Measure?

2021 ◽  
Author(s):  
Kengo Imai ◽  
Tatsuya Morita ◽  
Naosuke Yokomichi ◽  
Masanori Mori ◽  
Akemi Shirado Naito ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Terminally Ill ◽  
Physical Symptoms ◽  
Palliative Sedation ◽  
Assessment Instrument ◽  
Terminally Ill Cancer Patients ◽  
Refractory Symptoms ◽  
Communication Capacity ◽  
Symptom Intensity

Abstract BackgroundPalliative sedation is sometimes needed for refractory symptoms, and the Richmond Agitation-Sedation Scale (RASS) is one of the key measures. The primary aim of this study was to explore the association between the RASS score and degree of distress quantified by other measures: Support Team Assessment Schedule, item 2 (STAS), Discomfort Scale for Dementia of Alzheimer Type (Discomfort Scale), and Non-communicative Patient’s Pain Assessment Instrument (NOPPAIN), as well as a communication capacity measured by the Communication Capacity Scale, item 4 (CCS).MethodsThis was a prospective observational study on terminally ill cancer patients who received continuous infusion of midazolam to relieve refractory symptoms in a palliative care unit of a designated cancer hospital. Primarily responsible palliative care physicians rated RASS, Discomfort Scale, NOPPAIN, and CCS just before starting infusion, and 1 hour, 4 hours, 24 hours, and 48 hours after midazolam infusion, and ward nurses rated STAS at the same time. Since the ward nurses regularly evaluated STAS to titrate midazolam during palliative sedation as routine work, we regarded STAS rated by ward nurses as a standard of distress measure.ResultsA total of 249 assessments were performed for 55 patients. The RASS score was moderately to highly associated with symptom intensity measured by STAS, discomfort measured by the Discomfort Scale, and pain measured by NOPPAIN (r = 0.63 to 0.73). On the other hand, communication capacity measured by CCS is not parallel with the RASS score, and demonstrated a valley-shape. In 82 assessments with RASS of -1 to -3, 11 patients (13%) were regarded as having physical symptoms of STAS of 2 or more.ConclusionsRASS can roughly estimate physical distress in patients receiving palliative sedation, but a measure to more precisely quantify the symptom experience is needed.

Association between continuous deep sedation and survival time in terminally ill cancer patients

2020 ◽  
Vol 29 (1) ◽  
pp. 525-531
Author(s):  
So-Jung Park ◽  
Hee Kyung Ahn ◽  
Hong Yup Ahn ◽  
Kyu-Tae Han ◽  
In Cheol Hwang
Keyword(s):  
Survival Time ◽  
Cancer Patients ◽  
Deep Sedation ◽  
Terminally Ill ◽  
Terminally Ill Cancer Patients ◽  
Continuous Deep Sedation

scholarly journals Family experience with palliative sedation therapy for terminally ill cancer patients

2004 ◽  
Vol 28 (6) ◽  
pp. 557-565 ◽  
Author(s):  
Tatsuya Morita ◽  
Masayuki Ikenaga ◽  
Isamu Adachi ◽  
Itaru Narabayashi ◽  
Yoshiyuki Kizawa ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Terminally Ill ◽  
Palliative Sedation ◽  
Family Experience ◽  
Terminally Ill Cancer Patients ◽  
Palliative Sedation Therapy

scholarly journals A qualitative study on continuous deep sedation until death as an alternative to assisted suicide in Switzerland

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Martyna Tomczyk ◽  
Nathalie Dieudonné-Rahm ◽  
Ralf J. Jox
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
Assisted Suicide ◽  
Deep Sedation ◽  
Palliative Sedation ◽  
Continuous Deep Sedation ◽  
French Speaking ◽  
Potential Alternative ◽  
Palliative Care Units ◽  
Negative Impacts

Abstract Background According to the European Association for Palliative Care, decisions regarding palliative sedation should not be made in response to requests for assisted dying, such as euthanasia or assisted suicide. However, several studies show that continuous deep sedation until death (CDSUD) – a particular form of sedation – has been considered as an alternative to these practices in some countries. In Switzerland, where assisted suicide is decriminalized and CDSUD is not legally regulated, no studies have comprehensively investigated their relation. Our study aimed to identify and describe the experience among palliative care physicians of CDSUD as a potential alternative to assisted suicide in the French-speaking part of Switzerland. Methods We performed an exploratory multicentre qualitative study based on interviews with palliative care physicians in the French-speaking part of Switzerland and conducted linguistic and thematic analysis of all interview transcripts. The study is described in accordance with COREQ guidelines. Results We included 10 interviews conducted in four palliative care units. Our linguistic analysis shows four main types of sedation, which we called ‘rapid CDSUD’, ‘gradual CDSUD’, ‘temporary sedation’ and ‘intermittent sedation’. CDSUD (rapid or gradual) was not considered an alternative to assisted suicide, even if a single situation has been reported. In contrast, ‘temporary’ or ‘intermittent sedation’, although not medically indicated, was sometimes introduced in response to a request for assisted suicide. This was the fact when there were barriers to an assisted suicide at home (e.g., when transfer home was impossible or the patient wished not to burden the family). Conclusion These preliminary results can guide clinical, ethical, linguistic and legal reflection in this field and be used to explore this question more deeply at the national and international levels in a comparative, interdisciplinary and multiprofessional approach. They can also be useful to update Swiss clinical guidelines on palliative sedation in order to include specific frameworks on various sedation protocols and sedation as an alternative to assisted suicide. Potential negative impacts of considering palliative sedation as an alternative to assisted suicide should be nuanced by open and honest societal debate.

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