Changes in Opinions on Palliative Sedation of Palliative Care Specialists over 16 years and Their Effects on Clinical Practice

Overview

Journal Support Care Cancer

Specialties Critical Care
Oncology

Date 2018 Oct 14

PMID 30315426

Citations 3

Authors

Sayaka Maeda

Tatsuya Morita

Masayuki Ikenaga

Hirofumi Abo

Yoshiyuki Kizawa

Satoru Tsuneto

Affiliations

Soon will be listed here.

Abstract

Purposes: Despite extensive debate on palliative sedation over the last few decades, no studies have explored longitudinal changes in physicians' opinion. Moreover, little is known about how physicians' opinions affect their practice. This study aimed to clarify (1) changes in palliative care specialists' opinions on palliative sedation and (2) the effects of these opinions on clinical practice.

Methods: In 2000 and 2016, nationwide questionnaire surveys involving Japanese palliative care specialists were performed: measurement was based on agreement with opinions on palliative sedation. In 2016, the physicians reported their practice of continuous deep sedation (CDS) and answered their thoughts on what factors lead to a good death as factors potentially affecting their practice.

Results: Of the 695 physicians enrolled in the 2016 survey, 469 responded (67%) and 417 were analyzed (60%). Compared with 54 physicians in 2000, the present respondents were more likely to consider palliative sedation is difficult to perform based on appropriate indications (ES = 0.84, P < 0.001), is unnecessary if conventional palliative care is performed sufficiently (ES = 0.30, P = 0.013), and may result in legal action (ES = 0.35, P = 0.003). The physicians' opinions more strongly affected their practice than their characteristics or thoughts on good death components.

Conclusions: Recently, palliative care specialists in Japan tend to encounter more difficulties determining what conventional palliative care is and what palliative sedation is. They also fear legal ramifications. It is necessary to standardize methods of alleviating patients' suffering, to make CDS criteria clearer, and to create a legal basis that respects patients' rights at their end of life.

Citing Articles

Practices of and Perspectives on Palliative Sedation Among Palliative Care Physicians in Ontario, Canada: A Mixed-Methods Study.

Nolen A, Selby D, Qureshi F, Mills A Palliat Med Rep. 2024; 5(1):94-103.

PMID: 38415075 PMC: 10898238. DOI: 10.1089/pmr.2023.0081.

Current Status and Future Directions of Research on Palliative Sedation.

Hwang I J Hosp Palliat Care. 2023; 25(4):193-197.

PMID: 37674671 PMC: 10179994. DOI: 10.14475/jhpc.2022.25.4.193.

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

Park S, Ahn H, Ahn H, Han K, Hwang I Support Care Cancer. 2020; 29(1):525-531.

PMID: 32415383 DOI: 10.1007/s00520-020-05516-8.

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