Intercountry and intracountry variations in opinions of palliative care specialist physicians in Germany, Italy, Japan and UK about continuous use of sedatives: an international cross-sectional survey.

Autor:	Morita T; Palliative and Supportive Care Division, Seirei Mikatahara Hospital, Hamamatsu, Shizuoka, Japan tmorita@sis.seirei.or.jp., Kawahara T; Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan., Stone P; Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK., Sykes N; Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK., Miccinesi G; Department of Oncological Network, Prevention and Research Institute-ISPRO, Firenze, Italy., Klein C; Department of Palliative Medicine, CCC Erlangen - EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Nürnberg, Germany., Stiel S; Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany., Hui D; Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer Center, University of Texas, Austin, Texas, USA., Deliens L; End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium., Heijltjes MT; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands., Mori M; Palliative and Supportive care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan., Heckel M; Department of Palliative Medicine, CCC Erlangen - EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany., Robijn L; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium., Krishna L; The Division of Supportive and Palliative Care, National Cancer Center Singapore, National Cancer Center Singapore, Singapore., Rietjens J; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2022 Apr 22; Vol. 12 (4), pp. e060489. Date of Electronic Publication: 2022 Apr 22.
DOI:	10.1136/bmjopen-2021-060489
Abstrakt:	Objectives: To explore intercountry and intracountry differences in physician opinions about continuous use of sedatives (CUS), and factors associated with their approval of CUS. Settings: Secondary analysis of a questionnaire study. Participants: Palliative care physicians in Germany (N=273), Italy (N=198), Japan (N=334) and the UK (N=111). Primary and Secondary Outcome Measures: Physician approval for CUS in four situations, intention and treatment goal, how to use sedatives and beliefs about CUS. Results: There were no significant intercountry or intracountry differences in the degree of agreement with statements that (1) CUS is not necessary as suffering can always be relieved with other measures (mostly disagree); (2) intention of CUS is to alleviate suffering and (3) shortening the dying process is not intended. However, there were significant intercountry differences in agreement with statements that (1) CUS is acceptable for patients with longer survival or psychoexistential suffering; (2) decrease in consciousness is intended and (3) choice of neuroleptics or opioids. Acceptability of CUS for patients with longer survival or psychoexistential suffering and whether decrease in consciousness is intended also showed wide intracountry differences. Also, the proportion of physicians who agreed versus disagreed with the statement that CUS may not alleviate suffering adequately even in unresponsive patients, was approximately equal. Regression analyses revealed that both physician-related and country-related factors were independently associated with physicians' approval of CUS. Conclusion: Variations in use of sedatives is due to both physician- and country-related factors, but palliative care physicians consistently agree on the value of sedatives to aid symptom control. Future research should focus on (1) whether sedatives should be used in patients with longer survival or with primarily psychoexistential suffering, (2) understanding physicians' intentions and treatment goals, (3) efficacy of different drugs and (4) understanding the actual experiences of patients receiving CUS. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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