TY - JOUR
T1 - Cross-cultural comparison of continuous deep sedation for advanced cancer patients in East Asian countries
T2 - prospective cohort study
AU - Yang, Chiu Hsien
AU - Chen, Ping Jen
AU - Mori, Masanori
AU - Morita, Tatsuya
AU - Cheng, Shao Yi
AU - Suh, Sang Yeon
AU - Kim, Sun Hyun
AU - Yokomichi, Naosuke
AU - Imai, Kengo
AU - Ito, Satoko
AU - Yamaguchi, Takashi
AU - Hiratsuka, Yusuke
AU - Tsuneto, Satoru
AU - Maeda, Sayaka
N1 - Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press. All rights reserved.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - Objective: Cultural, social, and legal factors have been known to affect physicians' practice of continuous deep sedation. There have been few quantitative studies to compare continuous deep sedation practice in Asian countries. We aimed to describe and compare clinical characteristics of continuous deep sedation in Japan, Korea and Taiwan. Methods: Patients with advanced cancer admitted to participating palliative care units were enrolled from January 2017 to September 2018. We evaluated and compared (i) the prevalence of continuous deep sedation, (ii) the characteristics of sedated and non-sedated groups in each country, and (iii) continuous deep sedation administration patterns among the three countries. Results: A total of 2158 participants were included in our analysis, and 264 received continuous deep sedation. The continuous deep sedation prevalence was 10, 16 and 22% in Japan, Korea and Taiwan, respectively. Delirium was the most frequent target symptom in all countries, along with dyspnoea (in Japan) and psychological symptoms (in Korea). Midazolam was most frequently used in Japan and Taiwan, but not in Korea (P < 0.001). Among the patients receiving continuous deep sedation, the hydration amount on the final day was significantly different, with median volumes of 200, 500 and 0 mL in Japan, Korea and Taiwan, respectively (P < 0.001). In Korea, 33% of the continuous deep sedation administration caused a high degree of physicians' discomfort, but 3% in Japan and 5% in Taiwan (P < 0.001). Conclusions: Clinical practices of continuous deep sedation and physicians' discomfort related to continuous deep sedation initiation highly varied across countries. We need to develop optimal decision-making models of continuous deep sedation and hydration during continuous deep sedation in each country.
AB - Objective: Cultural, social, and legal factors have been known to affect physicians' practice of continuous deep sedation. There have been few quantitative studies to compare continuous deep sedation practice in Asian countries. We aimed to describe and compare clinical characteristics of continuous deep sedation in Japan, Korea and Taiwan. Methods: Patients with advanced cancer admitted to participating palliative care units were enrolled from January 2017 to September 2018. We evaluated and compared (i) the prevalence of continuous deep sedation, (ii) the characteristics of sedated and non-sedated groups in each country, and (iii) continuous deep sedation administration patterns among the three countries. Results: A total of 2158 participants were included in our analysis, and 264 received continuous deep sedation. The continuous deep sedation prevalence was 10, 16 and 22% in Japan, Korea and Taiwan, respectively. Delirium was the most frequent target symptom in all countries, along with dyspnoea (in Japan) and psychological symptoms (in Korea). Midazolam was most frequently used in Japan and Taiwan, but not in Korea (P < 0.001). Among the patients receiving continuous deep sedation, the hydration amount on the final day was significantly different, with median volumes of 200, 500 and 0 mL in Japan, Korea and Taiwan, respectively (P < 0.001). In Korea, 33% of the continuous deep sedation administration caused a high degree of physicians' discomfort, but 3% in Japan and 5% in Taiwan (P < 0.001). Conclusions: Clinical practices of continuous deep sedation and physicians' discomfort related to continuous deep sedation initiation highly varied across countries. We need to develop optimal decision-making models of continuous deep sedation and hydration during continuous deep sedation in each country.
KW - clinical decision-making
KW - end-of-life care
KW - hydration
KW - palliative sedation
KW - refractory symptoms
UR - http://www.scopus.com/inward/record.url?scp=85166391822&partnerID=8YFLogxK
U2 - 10.1093/jjco/hyad037
DO - 10.1093/jjco/hyad037
M3 - Article
C2 - 37114920
AN - SCOPUS:85166391822
SN - 0368-2811
VL - 53
SP - 714
EP - 721
JO - Japanese Journal of Clinical Oncology
JF - Japanese Journal of Clinical Oncology
IS - 8
ER -