Morita Tatsuya, Ikenaga Masayuki, Adachi Isamu, Narabayashi Itaru, Kizawa Yoshiyuki, Honke Yoshifumi, Kohara Hiroyuki, Mukaiyama Taketo, Akechi Tatsuo, Kurihara Yukie, Uchitomi Yosuke
Palliative Care Team and Seirei Hospice, Seirei Mikatabara Hospital, 3453 Mikatabara-cho, 433-8558 Hamamatsu, Shizuoka, Japan.
Support Care Cancer. 2004 Dec;12(12):885-9. doi: 10.1007/s00520-004-0678-2. Epub 2004 Sep 15.
Symptomatic sedation is often required in terminally ill cancer patients and could cause significant distress to their families. The aim of this study was to gather vivid family descriptions about their experiences in palliative sedation therapy.
This report is an additional analysis of a multicenter questionnaire survey. We performed content analysis on 48 statements described by 185 bereaved family members of patients who received palliative sedation therapy.
Family members reported guilt, helplessness, and physical and emotional exhaustion when patients received palliative sedation therapy. They were concerned about whether sedated patients experienced distress, wished to know that the maximum efforts had been made, wished to prepare for patient death, wished to tell important things to patients before sedation, wished to understand patients' suffering, and wanted medical professionals to treat patients with dignity.
To alleviate family distress, clinicians should understand families' emotional distress, ensure that unconscious patients feel no distress, reassure family members that the symptoms are truly refractory despite maximum efforts for symptom relief, give information and coordinate the situation to enable families to prepare for patient death and to tell important things to patients before sedation, help families to share patients' suffering, and treat patients the same as when they remained conscious.
晚期癌症患者常常需要进行症状性镇静,这可能会给其家人带来极大痛苦。本研究的目的是收集家人关于姑息性镇静治疗经历的生动描述。
本报告是对一项多中心问卷调查的补充分析。我们对接受姑息性镇静治疗患者的185名丧亲家属所描述的48条陈述进行了内容分析。
家属报告称,患者接受姑息性镇静治疗时,他们感到内疚、无助以及身心疲惫。他们担心接受镇静的患者是否感到痛苦,希望知道已尽了最大努力,希望为患者的死亡做好准备,希望在镇静前告知患者重要的事情,希望了解患者的痛苦,并且希望医疗专业人员给予患者有尊严的治疗。
为减轻家属的痛苦,临床医生应了解家属的情绪困扰,确保无意识的患者不会感到痛苦,向家属保证尽管已尽最大努力缓解症状,但症状确实难以控制,提供信息并协调相关情况,以使家属能够为患者的死亡做好准备,并在镇静前告知患者重要的事情,帮助家属分担患者的痛苦,并且像对待有意识的患者一样对待患者。