Preferences for Palliative Sedation Therapy in the Japanese General Population

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Abstract
Objectives: To elucidate which types of palliative sedation therapy are preferred by the Japanese general population, what factors influence these preferences, and how the general population thinks clinicians should inform patients about sedation therapy. Methods: A cross-sectional questionnaire survey using a convenient sample of 457 Japanese people (effective response rate, 53.2%). Results: For refractory intractable physical distress, intermittent deep sedation was chosen as "probably want" or "strongly want" by 86% of the respondents, and mild sedation was chosen by 82%. For refractory intractable psychological distress, intermittent deep sedation was chosen as "probably want" or "strongly want" by 76%, and mild sedation was chosen by 68%. Continuous deep sedation was chosen as "absolutely not want" or "probably not want" by 72% for physical distress and 71% for psychological distress. The respondents who did not want continuous deep sedation were significantly younger, more educated, and more likely to perceive the importance of dignity and preparation for death. Eighty-five percent wanted clear information about reduction in consciousness, and 92% were positive with "in advance" information about sedation therapy. When family members did not agree with the patient's decision, 71% stated that physicians should follow the patient's wishes. Conclusions: The Japanese general population preferred intermittent deep or mild sedation to continuous deep sedation in alleviation of intractable and refractory distress. Many required explicit information about the serious consequences of sedation and wanted physicians to respect their wishes. We recommend that clinicians recognize the importance of both symptom alleviation and maintenance of intellectual activities, and to facilitate direct patient involvement in the decision-making process.