A Nationwide Survey About Palliative Sedation Involving Japanese Palliative Care Specialists: Intentions and Key Factors Used to Determine Sedation as Proportionally Appropriate
A Nationwide Survey About Palliative Sedation Involving Japanese Palliative Care Specialists: Intentions and Key Factors Used to Determine Sedation as Proportionally Appropriate
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DOI：
10.1016/j.jpainsymman.2017.10.006
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发表时间：
2018-03-01
影响因子：
4.7
通讯作者：
Tunetou, Satoru
中科院分区：
文献类型：
--
作者：
Hamano, Jun;Morita, Tatsuya;Tunetou, Satoru
上下文虽然长期以来一直存在关于医生的意图和医生认为什么是适当的比例时，进行姑息性镇静的争论，很少有大规模的研究已经进行。确定医生在开始持续深度镇静时的意图，并阐明哪些因素决定医生是否认为镇静与预期生存率、患者意愿和难治性相关。2016年8月至12月，对日本姑息治疗专家进行了全国范围的问卷调查。我们将持续深度镇静定义为持续使用镇静剂来缓解无法忍受的和顽固性的症状并伴有意识丧失直至死亡。在695名姑息治疗专家中，有440名接受了分析（应答率为69%）。共有95%和87%的医生报告说，他们明确打算进行症状缓解和降低意识水平，分别。此外，38%的人回答说，他们明确打算保持无意识状态，直到死亡，11%的人报告说，他们打算在一定程度上缩短生存时间。被访者认为持续深度镇静在预期生存期较短、患者意愿一致且明确、对症状难治性的信心较高时更合适。日本姑息治疗专家明确表示，在进行持续深度镇静时，他们的目的是控制症状并降低意识水平，但在维持无意识状态直至死亡方面，他们的目的存在差异。预测的生存率、患者的意愿和对难治性的信心与医生对镇静比例适当性的判断有关。(C)2017年美国临终关怀和姑息医学学会。爱思唯尔公司出版All rights reserved.
Context. Although there has long been debate about physicians' intentions and what physicians consider to be proportionally appropriate when performing palliative sedation, few large studies have been performed.Objectives. To identify physicians' intentions when starting continuous deep sedation and to clarify what factors determine whether physicians regard sedation as proportionally appropriate in relation to expected survival, the patients' wishes, and refractoriness.Methods. A nationwide questionnaire survey of Japanese palliative care specialists was performed from August to December 2016. We defined continuous deep sedation as the continuous use of sedatives to relieve intolerable and refractory symptoms with the loss of consciousness until death.Results. Of the 695 palliative care specialists enrolled, 440 were analyzed (response rate, 69%). A total of 95% and 87% of the physicians reported that they explicitly intended to perform symptom palliation and decrease consciousness levels, respectively. Moreover, 38% answered that they explicitly intended to maintain unconsciousness until death, and 11% reported that they intended to shorten survival to some extent. The respondents considered that continuous deep sedation is more appropriate when the predicted survival is shorter, the patients' wishes are consistent and clear, and confidence in the refractoriness of symptoms is higher.Conclusions. Japanese palliative care specialists explicitly intend to control symptoms and reduce the level of consciousness when performing continuous deep sedation, but there are differences in their intentions with regard to maintaining unconsciousness until death. Predicted survival, patients' wishes, and confidence in refractoriness are associated with physicians' judgment that sedation is proportionally appropriate. (C) 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.