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Supportive Care in Cancer
Published in: Supportive Care in Cancer 6/2019

01-06-2019 | Original Article

Changes in opinions on palliative sedation of palliative care specialists over 16 years and their effects on clinical practice

Authors: Sayaka Maeda, Tatsuya Morita, Masayuki Ikenaga, Hirofumi Abo, Yoshiyuki Kizawa, Satoru Tsuneto

Published in: Supportive Care in Cancer | Issue 6/2019

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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.
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Literature
1.
Beller EM, van Driel ML, McGregor L, Truong S, Mitchell G (2015) Palliative pharmacological sedation for terminally ill adults. Cochrane Database Syst Rev 1:CD010206PubMed
2.
Claessens P, Menten J, Schotsmans P, Broeckaert B (2008) Palliative sedation: a review of the research literature. J Pain Symptom Manag 36:310–333CrossRef
3.
Papavasiliou EE, Payne S, Brearley S, EUROIMPACT (2014) Current debates on end-of-life sedation: an international expert elicitation study. Support Care Cancer 22:2141–2149CrossRefPubMed
4.
Gurschick L, Mayer DK, Hanson LC (2015) Palliative sedation: an analysis of international guidelines and position statements. Am J Hosp Palliat Care 32:660–671CrossRefPubMed
5.
Papavasiliou ES, Brearley SG, Seymour JE, Brown J, Payne SA, EUROIMPACT (2013) From sedation to continuous sedation until death: how has the conceptual basis of sedation in end-of-life care changed over time? J Pain Symptom Manag 46:691–706CrossRef
6.
Quill TE, Lo B, Brock DW, Meisel A (2009) Last-resort options for palliative sedation. Ann Intern Med 151:421–424CrossRefPubMed
7.
Schildmann EK, Schildmann J, Kiesewetter I (2015) Medication and monitoring in palliative sedation therapy: a systematic review and quality assessment of published guidelines. J Pain Symptom Manag 49:734–746CrossRef
8.
Maeda I, Morita T, Yamaguchi T, Inoue S, Ikenaga M, Matsumoto Y, Sekine R, Yamaguchi T, Hirohashi T, Tajima T, Tatara R, Watanabe H, Otani H, Takigawa C, Matsuda Y, Nagaoka H, Mori M, Tei Y, Kikuchi A, Baba M, Kinoshita H (2016) Effect of continuous deep sedation on survival in patients with advanced cancer (J-Proval): a propensity score-weighted analysis of a prospective cohort study. Lancet Oncol 17:115–122CrossRefPubMed
9.
Maltoni M, Pittureri C, Scarpi E, Piccinini L, Martini F, Turci P, Montanari L, Nanni O, Amadori D (2009) Palliative sedation therapy does not hasten death: results from a prospective multicenter study. Ann Oncol 20:1163–1169CrossRefPubMed
10.
Rys S, Deschepper R, Mortier F, Deliens L, Atkinson D, Bilsen J (2012) The moral difference or equivalence between continuous sedation until death and physician-assisted death: word games or war games? A qualitative content analysis of opinion pieces in the indexed medical and nursing literature. J Bioeth Inq 9:171–183CrossRefPubMed
11.
Radbruch L, Leget C, Bahr P, Müller-Busch C, Ellershaw J, de Conno F, vanden Berghe P, on behalf of the board members of the EAPC; Board Members of EAPC (2016) Euthanasia and physician-assisted suicide: a white paper from the European Association for Palliative Care. Palliat Med 30:104–116CrossRefPubMed
12.
Mastersvedt LJ, Bosshard G (2009) Deep and continuous palliative sedation (terminal sedation): clinical-ethical and philosophical aspects. Lancet Oncol 10:622–627CrossRef
13.
ten Have H, Welie JV (2014) Palliative sedation versus euthanasia: an ethical assessment. J Pain Symptom Manag 47:123–136CrossRef
14.
Schildmann J, Schildmann E (2013) Clinical and ethical challenges of palliative sedation therapy. The need for clear guidance and professional competencies. Int J Clin Pract 67:1086–1088CrossRefPubMed
15.
Seymour J, Rietjens J, Bruinsma S, Deliens L, Sterckx S, Mortier F, Brown J, Mathers N, van der Heide A, on behalf of the UNBIASED consortium, Addington-Hall J, Anquinet L, Brown J, Bruinsma S, Deliens L, Mathers N, Mortier F, Payne S, Raus K, Rietjens J, Seale C, Seymour J, Smithson WH, Sterckx S, Janssens R, van der Heide A (2015) UNBIASED consortium. Using continuous sedation until death for cancer patients: a qualitative interview study of physicians' and nurses' practice in three European countries. Palliat Med 29:48–59CrossRefPubMedPubMedCentral
16.
Raus K, Brown J, Seale C, Rietjens JA, Janssens R, Bruinsma S et al (2014) Continuous sedation until death: the everyday moral reasoning of physicians, nurses and family caregivers in the UK, the Netherlands and Belgium. BMC Med Ethics 15:14CrossRefPubMedPubMedCentral
17.
Morita T, Akechi T, Sugawara Y, Chihara S, Uchitomi Y (2002) Practices and attitudes of Japanese oncologists and palliative care physicians concerning terminal sedation: a nationwide survey. J Clin Oncol 20:758–764CrossRefPubMed
18.
Morita T, Bito S, Kurihara Y, Uchitomi Y (2005) Development of a clinical guideline for palliative sedation therapy using the Delphi method. J Palliat Med 8:716–729CrossRefPubMed
19.
van Deijck RH, Hasselaar JG, Verhagen SC, Vissers KC, Koopmans RT (2013) Determinants of the administration of continuous palliative sedation: a systematic review. J Palliat Med 16:1624–1632CrossRefPubMed
20.
Morita T, Oyama Y, Cheng SY, Suh SY, Koh SJ, Kim HS, Chiu TY, Hwang SJ, Shirado A, Tsuneto S (2015) Palliative care physicians’ attitudes toward patient autonomy and a good death in east Asian countries. J Pain Symptom Manag 50:190–199CrossRef
21.
Miyashita M, Sanjo M, Morita T, Hirai K, Uchitomi Y (2007) Good death in cancer care: a nationwide quantitative study. Ann Oncol 18:1090–1097CrossRefPubMed
22.
Steinhauser KE, Christakis NA, Clipp EC, McNeilly M, McIntyre L, Tulsky JA (2000) Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA 284:2476–2482CrossRefPubMed
23.
24.
25.
Deschepper R, Laureys S, Hachimi-Idrissi S, Poelaert J, Distelmans W, Bilsen J (2013) Palliative sedation: why we should be more concerned about the risks that patients experience an uncomfortable death. Pain 154:1505–1508CrossRefPubMed
26.
Anquinet L, Rietjens JA, Seale C, Seymour J, Deliens L, van der Heide A (2012) The practice of continuous deep sedation until death in Flanders (Belgium), the Netherlands, and the U.K.: a comparative study. J Pain Symptom Manag 44:33–43CrossRef
27.
Rousseau PC (2006) Palliative sedation and the fear of legal ramifications. J Palliat Med 9:246–247CrossRefPubMed
28.
Bito S, Asai A (2007) Attitudes and behaviors of Japanese physicians concerning withholding and withdrawal of life-sustaining treatment for end-of-life patients: results from an Internet survey. BMC Med Ethics 8:7CrossRefPubMedPubMedCentral
29.
Kai K (2006) Euthanasia and death with dignity in Japanese law. Waseda Bull Comp Law 27:1–14
30.
Boulanger A, Chabal T, Fichaux M, Destandau M, La Piana JM, Auquier P et al (2017) Opinions about the new law on end-of-life issues in a sample of french patients receiving palliative care. BMC Palliat Care 16:7CrossRefPubMedPubMedCentral
31.
Onwuteaka-Philipsen BD, Brinkman-Stoppelenburg A, Penning C, de Jong-Krul GJ, van Delden JJ, van der Heide A (2012) Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey. Lancet 380:908–915CrossRefPubMed
32.
Anquinet L, Rietjens JAC, Van den Block L, Bossuyt N, Deliens L (2011) General practitioners’ report of continuous deep sedation until death for patients dying at home: a descriptive study from Belgium. Eur J Gen Pract 17:5–13CrossRefPubMed
33.
Morita T, Imai K, Yokomichi N, Mori M, Kizawa Y, Tsuneto S (2017) Continuous deep sedation: a proposal for performing more rigorous empirical research. J Pain Symptom Manag 53:146–152CrossRef
34.
Mori M, Morita T (2016) Advances in hospice and palliative care in Japan: a review paper. Korean J Hosp Palliat Care 19:283–291CrossRef
Metadata
Title
Changes in opinions on palliative sedation of palliative care specialists over 16 years and their effects on clinical practice
Authors
Sayaka Maeda
Tatsuya Morita
Masayuki Ikenaga
Hirofumi Abo
Yoshiyuki Kizawa
Satoru Tsuneto
Publication date
01-06-2019
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 6/2019
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-018-4497-2

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