Differences in physician-reported practice in palliative sedation therapy.

Abstract

Although palliative sedation therapy is often required in terminally ill cancer patients, little is known about actual practice. The aims of this study were to clarify the physician-reported sedation practices and the factors influencing the sedation rates. A questionnaire was sent to 105 representative physicians of all certified palliative care units in Japan. A total of 81 responses were analyzed (effective response rate, 80%). The prevalence of continuous-deep sedation for physical symptoms was <10% in 33 institutions (41%), 10-50% in 43 institutions (53%), and >50% in 5 institutions (6.2%). The prevalence of continuous-deep sedation for psychoexistential suffering was 0% in 52 institutions (64%), 0.5-5% in 26 institutions (32%) and more than 10% in 3 institutions (3.6%). Continuous-deep sedation was more frequently performed by physicians who did not believe clear consciousness was necessary for a good death, who did not believe that sedation often shortened patient life, who worked with nurses specializing in cancer/palliative care, who judged the symptoms as refractory without actual trials of treatments, who performed continuous sedation first rather than intermittent sedation, and who used phenobarbitones frequently. Physician-reported practice in palliative sedation therapy varied widely among institutions. The differences were mainly associated with the physicians' philosophy about a good death, physicians' belief about the effects of sedation on patient survival, and physicians' medical practice. Discussion should be focused on these divergent areas, and clear clinical guidelines are urgently needed to provide valid end-of-life care.