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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
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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 

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