End-of-Life Medical Treatments in the Last Two Weeks of Life in Palliative Care Units in Japan, 2005-2006: A Nationwide Retrospective Cohort Survey.

Abstract

Comprehensive information on end-of-life care in specialized palliative care settings is needed to assess the quality of care. This study aimed to investigate medical treatments in the last two weeks of life in a national sample of palliative care units in Japan. Retrospective cohort study. Medical charts of 2802 consecutive cancer patients who died in 37 palliative care units were reviewed. Drug usage and treatments during the last two weeks of life were collected. A mixed-effect model was used to estimate the variations in care between institutions. Opioid administration increased from 68% (two weeks before death) to 80% (last 48 hours); during the same period, nonsteroidal anti-inflammatory drugs and acetaminophen administration decreased from 59% to 45%, and corticosteroid administration decreased from 62% to 51%. As death neared, parenteral opioid administration increased (41%-74%). Morphine use increased (45%-70%), fentanyl use remained about the same (47%-40%), and oxycodone use decreased (18%-5%). Two thirds of patients received artificial hydration; doses >1000 mL/day (15%) and intravenous hyperalimentation (7%) were relatively rare during the last 48 hours. Variations in end-of-life medical treatments increased between palliative care units as death neared, especially anticholinergic, artificial hydration, oxygen inhalation, and palliative sedation use. These findings regarding the general course of palliative treatments for dying cancer patients are useful for clinical audits in general wards, by comparing end-of-life care. Variations in some end-of-life medical treatments between institutions increased as death neared, even in palliative care settings.