Changes in opinions on palliative sedation of palliative care specialists over 16?years and their effects on clinical practice
Changes in opinions on palliative sedation of palliative care specialists over 16?years and their effects on clinical practice
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16年来姑息治疗专家对姑息镇静的看法变化及其对临床实践的影响
DOI：
10.1007/s00520-018-4497-2
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发表时间：
2018
影响因子：
3.1
通讯作者：
Tsuneto Satoru
中科院分区：
文献类型：
--
作者：
Maeda Sayaka;Morita Tatsuya;Ikenaga Masayuki;Abo Hirofumi;Kizawa Yoshiyuki;Tsuneto Satoru
尽管在过去的几十年里，关于姑息性镇静的争论广泛，但没有研究探讨医生意见的纵向变化。此外，人们对医生的意见如何影响他们的实践知之甚少。本研究旨在澄清(1)姑息治疗专家对姑息镇静看法的变化，以及(2)这些看法对临床实践的影响。方法于2000年和2016年在全国范围内对日本姑息治疗专家进行问卷调查。2016年，医生报告了他们的持续深度镇静（CDS）实践，并回答了他们对哪些因素导致良好死亡的想法，这些因素可能影响他们的实践。结果在2016年参与调查的695名医生中，469名回应（67%），417名分析（60%）。与2000年的54名医生相比，目前的受访者更倾向于认为姑息性镇静难以根据适当的适应症实施（ES = 0.84，P< 0.001），如果常规姑息治疗得到充分实施，则没有必要实施（ES = 0.30，P= 0.013），并可能导致法律诉讼（ES = 0.35，P= 0.003）。医生的意见比他们的特点或对善死成分的想法更强烈地影响他们的实践。最近，日本的姑息治疗专家在确定什么是传统姑息治疗和什么是姑息镇静方面遇到了更多的困难。他们还担心法律后果。有必要规范减轻患者痛苦的方法，使CDS标准更加明确，并建立尊重患者临终权利的法律基础。
PurposesDespite 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.MethodsIn 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.ResultsOf 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.ConclusionsRecently, 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.