Heijltjes Madelon T, Morita Tatsuya, Mori Masanori, Heckel Maria, Klein Carsten, Stiel Stephanie, Miccinesi Guido, Deliens Luc, Robijn Lenzo, Stone Patrick, Sykes Nigel, Hui David, Krishna Lalit, van Delden Johannes J M, van der Heide Agnes, Rietjens Judith A C
Department of Medical Humanities, Julius Center for Health Sciences and Primary Care (M.T.H., J.J.M.V.D.), UMC Utrecht, Utrecht, The Netherlands.
Palliative and Supportive Care Division (T.M., M.M.), Seirei Mikatahara General Hospital, Shizuoka, Japan.
J Pain Symptom Manage. 2022 Jan;63(1):78-87. doi: 10.1016/j.jpainsymman.2021.07.012. Epub 2021 Jul 29.
There are few international studies about the continuous use of sedatives (CUS) in the last days of life.
We aim to describe the experiences and opinions regarding CUS of physicians caring for terminally ill patients in seven countries.
Questionnaire study about practices and experiences with CUS in the last days of life among physicians caring for terminally ill patients in Belgium (n = 175), Germany (n = 546), Italy (n = 214), Japan (n = 513), the Netherlands (n = 829), United Kingdom (n = 114) and Singapore (n = 21).
The overall response rate was 22%. Of the respondents, 88-99% reported that they had clinical experience of CUS in the last 12 months. More than 90% of respondents indicated that they mostly used midazolam for sedation. The use of sedatives to relieve suffering in the last days of life was considered acceptable in cases of physical suffering (87%-99%). This percentage was lower but still substantial in cases of psycho-existential suffering in the absence of physical symptoms (45%-88%). These percentages were lower when the prognosis was at least several weeks (22%-66% for physical suffering and 5%-42% for psycho-existential suffering). Of the respondents, 10% or less agreed with the statement that CUS is unnecessary because suffering can be alleviated with other measures. A substantial proportion (41%-95%) agreed with the statement that a competent patient with severe suffering has the right to demand the use of sedatives in the last days of life.
Many respondents in our study considered CUS acceptable for the relief of physical and psycho-existential suffering in the last days of life. The acceptability was lower regarding CUS for psycho-existential suffering and regarding CUS for patients with a longer life expectancy.
关于在生命末期持续使用镇静剂（CUS）的国际研究较少。
我们旨在描述七个国家中照料临终患者的医生对CUS的经验和看法。
对比利时（n = 175）、德国（n = 546）、意大利（n = 214）、日本（n = 513）、荷兰（n = 829）、英国（n = 114）和新加坡（n = 21）照料临终患者的医生进行关于生命末期CUS实践和经验的问卷调查研究。
总体回复率为22%。在受访者中，88% - 99%报告称在过去12个月中有CUS的临床经验。超过90%的受访者表示他们大多使用咪达唑仑进行镇静。在身体疼痛的情况下（87% - 99%），在生命末期使用镇静剂缓解痛苦被认为是可以接受的。在没有身体症状的心理 - 生存痛苦的情况下，这一比例较低但仍然可观（45% - 88%）。当预后至少还有几周时，这些比例更低（身体疼痛为22% - 66%，心理 - 生存痛苦为5% - 42%）。在受访者中，10%或更少的人同意“CUS不必要，因为痛苦可以通过其他措施缓解”这一说法。相当大比例（41% - 95%）的人同意“患有严重痛苦的有行为能力的患者有权在生命末期要求使用镇静剂”这一说法。
我们研究中的许多受访者认为CUS对于缓解生命末期的身体和心理 - 生存痛苦是可以接受的。对于心理 - 生存痛苦的CUS以及对于预期寿命较长患者的CUS，可接受性较低。
