1. Continuous Deep Sedation for Psycho-Existential Suffering: A Multicenter Nationwide Study.
- Author
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Maeda, Sayaka, Morita, Tatsuya, Yokomichi, Naosuke, Imai, Kengo, Tsuneto, Satoru, Maeda, Isseki, Miura, Tomofumi, Ishiki, Hiroto, Otani, Hiroyuki, Hatano, Yutaka, and Mori, Masanori
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RESEARCH , *ANESTHESIA , *NURSING practice , *CANCER patients , *COMPARATIVE studies , *SURVIVAL analysis (Biometry) , *DESPAIR , *PALLIATIVE treatment , *PSYCHOLOGICAL stress , *DEPENDENCY (Psychology) , *LONGITUDINAL method - Abstract
Background: There is ongoing debate on whether continuous deep sedation (CDS) for psycho-existential suffering is appropriate. Objective: We aimed to (1) clarify clinical practice of CDS for psycho-existential suffering and (2) assess its impact on patients' survival. Methods: Advanced cancer patients admitted to 23 palliative care units in 2017 were consecutively enrolled. We compared patients' characteristics, CDS practices, and survival between those receiving CDS for psycho-existential suffering ± physical symptoms and only for physical symptoms. Results: Of 164 patients analyzed, 14 (8.5%) received CDS for psycho-existential suffering ± physical symptoms and only one of them (0.6%) solely for psycho-existential suffering. Patients receiving CDS for psycho-existential suffering, compared with those only for physical symptoms, were likely to have no specific religion (p = 0.025), and desired (78.6% vs. 22.0%, respectively; p < 0.001) and requested a hastened death more frequently (57.1% vs. 10.0%, respectively; p < 0.001). All of them had a poor physical condition with limited estimated survival, and mostly (71%) received intermittent sedation before CDS. CDS for psycho-existential suffering caused greater physicians' discomfort (p = 0.037), and lasted for longer (p = 0.029). Dependency, loss of autonomy, and hopelessness were common reasons for psycho-existential suffering that required CDS. The survival time after CDS initiation was longer in patients receiving it for psycho-existential suffering (log-rank, p = 0.021). Conclusion: CDS was applied to patients who suffered from psycho-existential suffering, which often associated with desire or request for a hastened death. Further studies and debate are warranted to develop feasible treatment strategies for psycho-existential suffering. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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