Changes in opinions on palliative sedation of palliative care specialists over 16 years and their effects on clinical practice.
PURPOSES
Despite 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.


METHODS
In 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.


RESULTS
Of 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.


CONCLUSIONS
Recently, 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.
['Maeda|Sayaka|S|', 'Morita|Tatsuya|T|', 'Ikenaga|Masayuki|M|', 'Abo|Hirofumi|H|', 'Kizawa|Yoshiyuki|Y|', 'Tsuneto|Satoru|S|']
D000328:Adult D001290:Attitude D054810:Deep Sedation D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D010166:Palliative Care D065126:Palliative Medicine D011795:Surveys and Questionnaires D013997:Time Factors
Palliative sedation Continuous deep sedation Good death End of life Legal framework Patients’ rights