Kengo Imai1, Tatsuya Morita2, Tatsuo Akechi3, Mika Baba4, Takashi Yamaguchi5, Hiroko Sumi6, Shimon Tashiro7, Kaoruko Aita8, Tetsuro Shimizu9, Jun Hamano10, Go Sekimoto11, Isseki Maeda12, Takuya Shinjo13, Jun Nagayama14, Eriko Hayashi15, Yukie Hisayama16, Kazuto Inaba17, Hirofumi Abo18, Akihiko Suga19, Masayuki Ikenaga20. 1. Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan. 2. Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan. 3. Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 4. Department of Palliative Medicine, Suita Tokushukai Hospital, Suita, Japan. 5. Division of Palliative Care, Konan Medical Center, Kobe, Japan. 6. Nursing Department, Kyoto University Hospital, Kyoto, Japan. 7. Department of Sociology, Graduate School of Arts and Letters, Tohoku University, Sendai, Japan. 8. Uehiro Division, The Center for Death and Life Studies and Practical Ethics, Graduate School of Humanities and Sociology, The University of Tokyo, Tokyo, Japan. 9. Iwate University of Health and Medical Sciences, Morioka, Japan. 10. Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 11. Home Palliative Care, Sekimoto Home Care Clinic, Kobe, Japan. 12. Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan. 13. Palliative Medicine, Shinjo Clinic, Kobe, Japan. 14. Division of Palliative Medicine, Hamanomachi Hospital, Fukuoka, Japan. 15. Department of Nursing, Fujisawa Shounandai Hospital, Kanagawa, Japan. 16. Patient Family Support Center, Shizuoka Cancer Center, Shizuoka, Japan. 17. Law Institute, Chukyo University, Nagoya, Japan. 18. Department of Palliative Medicine, Rokko Hospital, Kobe, Japan. 19. Nakanogo Clinic, Shizuoka, Japan. 20. Department of Palliative Medicine, Yodogawa Christian Hospital, Osaka, Japan.
Abstract
Background: When the suffering of a terminally ill patient is intolerable and refractory, sedatives are sometimes used for symptom relief. Objective: To describe the main principles of revised Japanese clinical guidelines about palliative sedation therapy. Design: Consensus methods using the Delphi technique were used. Results: The main principles of the guidelines that were newly defined or developed are as follows: (1) palliative sedation was defined as "administration of sedatives for the purpose of alleviating refractory suffering" (excluding the aim of reducing patient consciousness); (2) palliative sedation was classified according to the method of administration of sedatives: respite sedation versus continuous sedation (including (continuous) proportional sedation and continuous deep sedation); (3) a description of state-of-the-art recommended treatments for difficult symptoms such as delirium, dyspnea, and pain before the symptom was determined as refractory was included; (4) the principle of proportionality was newly defined from an ethical point of view; and (5) families' consent was regarded as being desirable (mandatory in the previous version). Conclusions: We described the main principles of revised Japanese clinical guidelines about palliative sedation therapy. Further consensus building is necessary.
Background: When the suffering of a terminally ill patient is intolerable and refractory, sedatives are sometimes used for symptom relief. Objective: To describe the main principles of revised Japanese clinical guidelines about palliative sedation therapy. Design: Consensus methods using the Delphi technique were used. Results: The main principles of the guidelines that were newly defined or developed are as follows: (1) palliative sedation was defined as "administration of sedatives for the purpose of alleviating refractory suffering" (excluding the aim of reducing patient consciousness); (2) palliative sedation was classified according to the method of administration of sedatives: respite sedation versus continuous sedation (including (continuous) proportional sedation and continuous deep sedation); (3) a description of state-of-the-art recommended treatments for difficult symptoms such as delirium, dyspnea, and pain before the symptom was determined as refractory was included; (4) the principle of proportionality was newly defined from an ethical point of view; and (5) families' consent was regarded as being desirable (mandatory in the previous version). Conclusions: We described the main principles of revised Japanese clinical guidelines about palliative sedation therapy. Further consensus building is necessary.
Authors: Alexander Kremling; Claudia Bausewein; Carsten Klein; Eva Schildmann; Christoph Ostgathe; Kerstin Ziegler; Jan Schildmann Journal: J Palliat Med Date: 2022-01-21 Impact factor: 2.947