title: Effectiveness of multidisciplinary team conference on decision-making surrounding the application of continuous deep sedation for terminally ill cancer patients.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Palliative Medicine,Higashi Sapporo Hospital,Sapporo, Hokkaido,Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
authors.affiliation: Division of Internal Medicine,Higashi Sapporo Hospital,Sapporo, Hokkaido,Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Terui
authors.affiliation: Division of Palliative Medicine,Higashi Sapporo Hospital,Sapporo, Hokkaido,Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Division of Internal Medicine,Higashi Sapporo Hospital,Sapporo, Hokkaido,Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Hirayama
authors.affiliation: Department of Anesthesiology,Sapporo Medical University Hospital,Sapporo, Hokkaido,Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Mizukami
authors.affiliation: Department of Anesthesiology,Sapporo Medical University Hospital,Sapporo, Hokkaido,Japan.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Yamakage
authors.affiliation: Department of Medical Oncology and Hematology,Sapporo Medical University Hospital,Sapporo, Hokkaido,Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Kato
authors.affiliation: Division of Palliative Medicine,Higashi Sapporo Hospital,Sapporo, Hokkaido,Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Ishitani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D054810:Deep Sedation; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D059408:Pain Management / Q000379:methods*; D010148:Intractable Pain / Q000188:drug therapy*; D010166:Palliative Care / Q000379:methods*; D010348:Patient Care Team; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods*
keywords: Refractory symptoms