title: Family experience with palliative sedation therapy for terminally ill cancer patients.
abstract: Symptomatic sedation is often required in terminally ill cancer patients, and could cause significant distress to their family. The aims of this study were to clarify the family experience during palliative sedation therapy, including their satisfaction and distress levels, and the determinants of family dissatisfaction and high-level distress. A multicenter questionnaire survey assessed 280 bereaved families of cancer patients who received sedation in 7 palliative care units in Japan. A total of 185 responses were analyzed(response rate, 73%). The families reported that 69% of the patients were considerably or very distressed before sedation. Fifty-five percent of the patients expressed an explicit wish for sedation, and 89% of families were clearly informed. Overall, 78% of the families were satisfied with the treatment, whereas 25% expressed a high level of emotional distress. The independent determinants of low levels of family satisfaction were: poor symptom palliation after sedation, insufficient information-giving, concerns that sedation might shorten the patient's life, and feelings that there might be other ways to achieve symptom relief The independent determinants of high levels of family distress were: poor symptom palliation after sedation, feeling the burden of responsibility for the decision, feeling unprepared for changes in the patient's condition, feeling that the physicians and nurses were not sufficiently compassionate, and shorter interval to patient death. Palliative sedation therapy was principally performed to relieve severe suffering based on family and patient consent. Although the majority of families were comfortable with this practice, clinicians should minimize family distress by regular monitoring of patient distress and timely modification of sedation protocols, providing sufficient information, sharing the responsibility of the decision, facilitating grief and providing emotional support.
authors.affiliation: Seirei Hospice, Seirei Mikatabara Hospital, Hamamatsu, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ikenaga
authors.forename: Isamu
authors.initials: I
authors.lastname: Adachi
authors.forename: Itaru
authors.initials: I
authors.lastname: Narabayashi
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kizawa
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Honke
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kohara
authors.forename: Taketo
authors.initials: T
authors.lastname: Mukaiyama
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Akechi
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Uchitomi
mesh_terms: D015897:Comorbidity; D003258:Consumer Behavior / Q000706:statistics & numerical data; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000453:epidemiology*; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology*; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives