Cross-cultural comparison of continuous deep sedation for advanced cancer patients in East Asian countries: prospective cohort study

Chiu Hsien Yang, Ping Jen Chen, Masanori Mori, Tatsuya Morita, Shao Yi Cheng, Sang Yeon Suh, Sun Hyun Kim, Naosuke Yokomichi, Kengo Imai, Satoko Ito, Takashi Yamaguchi, Yusuke Hiratsuka, Satoru Tsuneto, Sayaka Maeda

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)714-721
Number of pages8
JournalJapanese Journal of Clinical Oncology
Volume53
Issue number8
DOIs
StatePublished - 1 Aug 2023

Keywords

  • clinical decision-making
  • end-of-life care
  • hydration
  • palliative sedation
  • refractory symptoms

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