Physicians' Opinion and Practice With the Continuous Use of Sedatives in the Last Days of Life.

Autor: Heijltjes MT; Department of Medical Humanities, Julius Center for Health Sciences and Primary Care (M.T.H., J.J.M.V.D.), UMC Utrecht, Utrecht, The Netherlands. Electronic address: m.t.heijltjes-2@umcutrecht.nl., Morita T; Palliative and Supportive Care Division (T.M., M.M.), Seirei Mikatahara General Hospital, Shizuoka, Japan., Mori M; Palliative and Supportive Care Division (T.M., M.M.), Seirei Mikatahara General Hospital, Shizuoka, Japan., Heckel M; Department of Palliative Medicine (M.H., C.K.), CCC Erlangen - EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany., Klein C; Department of Palliative Medicine (M.H., C.K.), CCC Erlangen - EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany., Stiel S; Hannover Medical School (S.S.), Institute for General Practice and Palliative Care, Düsseldorf, Germany., Miccinesi G; Oncological network (G.M.), Prevention and Research Institute-ISPRO, Firenze, Italy., Deliens L; Vrije Universiteit Brussel (L.D.), Ixelles, Belgium., Robijn L; Department of Public Health and Primary Care (L.R.), Ghent University, Ghent, Belgium., Stone P; Marie Curie Palliative Care Research Department (P.S., N.S.), University College London, London, United Kingdom., Sykes N; Marie Curie Palliative Care Research Department (P.S., N.S.), University College London, London, United Kingdom., Hui D; MD Anderson Cancer Center (D.H.), University of Texas, Texas, USA., Krishna L; National Cancer Center Singapore (L.K.), Singapore., van Delden JJM; Department of Medical Humanities, Julius Center for Health Sciences and Primary Care (M.T.H., J.J.M.V.D.), UMC Utrecht, Utrecht, The Netherlands., van der Heide A; Erasmus MC (A.V.D.H., J.A.C.R.), University Medical Center Rotterdam, Rotterdam, The Netherlands., Rietjens JAC; Erasmus MC (A.V.D.H., J.A.C.R.), University Medical Center Rotterdam, Rotterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Journal of pain and symptom management [J Pain Symptom Manage] 2022 Jan; Vol. 63 (1), pp. 78-87. Date of Electronic Publication: 2021 Jul 29.
DOI: 10.1016/j.jpainsymman.2021.07.012
Abstrakt: Context: There are few international studies about the continuous use of sedatives (CUS) in the last days of life.
Objectives: We aim to describe the experiences and opinions regarding CUS of physicians caring for terminally ill patients in seven countries.
Methods: Questionnaire study about practices and experiences with CUS in the last days of life among physicians caring for terminally ill patients in Belgium (n = 175), Germany (n = 546), Italy (n = 214), Japan (n = 513), the Netherlands (n = 829), United Kingdom (n = 114) and Singapore (n = 21).
Results: The overall response rate was 22%. Of the respondents, 88-99% reported that they had clinical experience of CUS in the last 12 months. More than 90% of respondents indicated that they mostly used midazolam for sedation. The use of sedatives to relieve suffering in the last days of life was considered acceptable in cases of physical suffering (87%-99%). This percentage was lower but still substantial in cases of psycho-existential suffering in the absence of physical symptoms (45%-88%). These percentages were lower when the prognosis was at least several weeks (22%-66% for physical suffering and 5%-42% for psycho-existential suffering). Of the respondents, 10% or less agreed with the statement that CUS is unnecessary because suffering can be alleviated with other measures. A substantial proportion (41%-95%) agreed with the statement that a competent patient with severe suffering has the right to demand the use of sedatives in the last days of life.
Conclusion: Many respondents in our study considered CUS acceptable for the relief of physical and psycho-existential suffering in the last days of life. The acceptability was lower regarding CUS for psycho-existential suffering and regarding CUS for patients with a longer life expectancy.
(Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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