Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-23T05:08:59.788Z Has data issue: false hasContentIssue false
  • English
  • Français

Effectiveness of multidisciplinary team conference on decision-making surrounding the application of continuous deep sedation for terminally ill cancer patients

Published online by Cambridge University Press:  04 November 2013

Kazuhiko Koike ,
Takeshi Terui ,
Yuji Takahashi ,
Yasuo Hirayama ,
Naomi Mizukami ,
Michiaki Yamakage ,
Junji Kato  and
Kunihiko Ishitani
Kazuhiko Koike*
Affiliation:
Division of Palliative Medicine, Higashi Sapporo Hospital, Sapporo, Hokkaido, Japan
Takeshi Terui
Affiliation:
Division of Internal Medicine, Higashi Sapporo Hospital, Sapporo, Hokkaido, Japan
Yuji Takahashi
Affiliation:
Division of Palliative Medicine, Higashi Sapporo Hospital, Sapporo, Hokkaido, Japan
Yasuo Hirayama
Affiliation:
Division of Internal Medicine, Higashi Sapporo Hospital, Sapporo, Hokkaido, Japan
Naomi Mizukami
Affiliation:
Department of Anesthesiology, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
Michiaki Yamakage
Affiliation:
Department of Anesthesiology, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
Junji Kato
Affiliation:
Department of Medical Oncology and Hematology, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
Kunihiko Ishitani
Affiliation:
Division of Palliative Medicine, Higashi Sapporo Hospital, Sapporo, Hokkaido, Japan
*
Address correspondence and reprint requests to: Kazuhiko Koike, Higashi Sapporo Hospital, Division of Palliative Medicine, 3-3-7-35, Higashi Sapporo, Shiroishi-ku Sapporo Hokkaido 003-8585, Japan. E-mail: kkoike@hsh.or.jp
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Continuous deep sedation (CDS) is a way to reduce conscious experience of symptoms of severe suffering in terminally ill cancer patients. However, there is wide variation in the frequency of its reported. So we conducted a retrospective analysis to assess the prevalence and features of CDS in our palliative care unit (PCU).

Methods:

We performed a systemic retrospective analysis of the medical and nursing records of all 1581 cancer patients who died at the PCU at Higashi Sapporo Hospital between April 2005 and August 2011. Continuous deep sedation can only be administered safely and appropriately when a multidisciplinary team is involved in the decision-making process. Prior to administration of CDS, a multidisciplinary team conference (MDTC) was held with respect to all the patients considered for CDS by an attending physician. The main outcome measures were the frequency and characteristics of CDS (patient background, all target symptoms, medications used for sedation, duration, family's satisfaction, and distress). We mailed anonymous questionnaires to bereaved families in August 2011.

Results:

Of 1581 deceased patients, 22 (1.39%) had received CDS. Physical exhaustion 8 (36.4%), dyspnea 7 (31.8%), and pain 5 (22.7%) were the most frequently mentioned indications. Continuous deep sedation had a duration of less than 1 week in 17 (77.3%). Six patients (0.38%) did not meet the appropriate criteria for CDS according to the MDTC and so did not receive it. Although bereaved families were generally comfortable with the practice of CDS, some expressed a high level of emotional distress.

Significance of results:

Our results indicate that the prevalence of CDS will be decreased when it is carried out solely for appropriate indications. Continuity of teamwork, good coordination, exchange of information, and communication between the various care providers are essential. A lack of any of these may lead to inadequate assessment, information discrepancies, and unrest.

Keywords

Palliative sedationContinuous deep sedationMultidisciplinary team conferenceFamily experiencesRefractory symptoms
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 2 , April 2015 , pp. 157 - 164
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Billings, J.A. & Block, S.D. (1996). Slow euthanasia. Journal of Palliative Care, 12, 21–30.CrossRefGoogle ScholarPubMed
Bilsen, J., Cohen, J., Chambaere, K., et al. (2009). Medical end-of-life practices under euthanasia law in Belgium. The New England Journal of Medicine, 361, 1119–1121.CrossRefGoogle ScholarPubMed
Boxer, M.M., Vinod, S.K., Shafiq, J., et al. (2011). Do multidisciplinary team meetings make a difference in the management of lung cancer? Cancer, 117, 5112–5120.CrossRefGoogle ScholarPubMed
Breitbart, W., Gibson, C. & Tremblay, A. (2002). The delirium experience: Delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses. Psychosomatics, 43, 183–194.CrossRefGoogle ScholarPubMed
Broeckaert, B. & Leuven, K.U. (2011). Palliative sedation, physician-assisted suicide, and euthanasia: “Same, same but different?” The American Journal of Bioethics, 11, 62–64.CrossRefGoogle Scholar
Bruera, E. (2012). Palliative sedation: When and how? Journal of Clinical Oncology, 30, 1258–1259.Google Scholar
Bruinsma, S.M., Rietjens, J.A.C., Seymour, J.E., et al. (2012). The experiences of relatives with the practice of palliative sedation: A systematic review. Journal of Pain and Symptom Management, 44, 431–445.CrossRefGoogle ScholarPubMed
Cherny, N.I. & Portenoy, R.K. (1994). Sedation in the management of refractory symptoms: Guidelines for evaluation and treatment. Journal of Palliative Care, 10, 31–38.CrossRefGoogle ScholarPubMed
Cherny, N.I. & Radbruch, L. (2009). European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliative Medicine, 23, 581–593.CrossRefGoogle ScholarPubMed
Claessens, P., Menten, J., Schotsmans, P., et al. (2008). Palliative sedation: A review of the research literature. Journal of Pain and Symptom Management, 36, 310–333.CrossRefGoogle ScholarPubMed
Claessens, P., Menten, J., Schotsmans, P., et al. (2011). Palliative sedation, not slow euthanasia: A prospective, longitudinal study of sedation in Flemish palliative care units. Journal of Pain and Symptom Management, 41, 14–24.CrossRefGoogle Scholar
Committee on National Guideline for Palliative Sedation, Royal Dutch Medical Association (2009). Guidelines for palliative sedation. Accessed in English on July 7 from http://knmg.artsennet.nl/Diensten/knmgpublicaties/KNMGpublicatie/Guideline-for-palliative-sedation-2009.htm.Google Scholar
Cowan, J.D. & Palmer, T. (2002). Practical guide to palliative sedation. Current Oncology Reports, 4, 242–249.CrossRefGoogle ScholarPubMed
Fainsinger, R.L., Walker, A., Bercovici, M., et al. (2000). A multicentre international study of sedation for uncontrolled symptoms in terminally ill patients. Palliative Medicine, 14, 257–265.CrossRefGoogle Scholar
Hunt, R. (2002). Existential suffering and palliative sedation in terminal illness: A comment. Progress in Palliative Care, 10, 225–226.CrossRefGoogle Scholar
Kohara, H., Ueoka, J., Takeyama, H., et al. (2005). Sedation for terminally ill patients with cancer with uncontrollable physical distress. Journal of Palliative Medicine, 8, 20–25.CrossRefGoogle ScholarPubMed
Lo, B. & Rubenfeld, G. (2005). Palliative sedation in dying patients: “We turn to it when everything else hasn't worked.” The Journal of the American Medical Association, 294, 1810–1816.CrossRefGoogle Scholar
Maltoni, M., Scarpi, E., Rosati, M., et al. (2012). Palliative sedation in end-of-life care and survival: A systemic review. Journal of Clinical Oncology, 30, 1378–1383.CrossRefGoogle Scholar
Menten, J. (2003). Cancer pain: Interdisciplinary and comprehensive management. Doctoral dissertation. Catholic University of Leuven, Belgium.Google Scholar
Morita, T. (2004). Palliative sedation to relieve psycho-existential suffering of terminally ill cancer patients. Journal of Pain and Symptom Management, 28, 445–450.CrossRefGoogle ScholarPubMed
Morita, T., Ikenaga, M., Adachi, I., et al. (2004). Family experience with palliative sedation therapy for terminally ill cancer patients. Journal of Pain and Symptom Management, 28, 557–565.CrossRefGoogle ScholarPubMed
Rousseau, P. (2000). The ethical validity and clinical experience of palliative sedation. Mayo Clinic Proceedings, 75, 1064–1069.CrossRefGoogle ScholarPubMed
Rousseau, P. (2001). Existential suffering and palliative sedation: A brief commentary with a proposal for clinical guidelines. American Journal of Hospice & Palliative Care, 18, 151–153.CrossRefGoogle ScholarPubMed
Rietjens, J.A., van Zuylen, L., van Veluw, H, et al. (2008 a). Palliative sedation in a specialized unit for acute palliative care in a cancer hospital: Comparing patients dying with and without palliative sedation. Journal of Pain and Symptom Management, 36, 228–234.CrossRefGoogle Scholar
Rietjens, J., van Delden, J., Onwuteaka-Philipsen, B., et al. (2008 b). Continuous deep sedation for patients nearing death in the Netherlands: Descriptive study. British Medical Journal, 336, 810–813.CrossRefGoogle ScholarPubMed
Ventafridda, V., Ripamonti, C., De Connno, F., et al. (1990). Symptom prevalence and control during cancer patients' last days of life. Journal of Palliative Care, 6, 7–11.CrossRefGoogle ScholarPubMed