Changes in opinions on palliative sedation of palliative care specialists over 16 years and their effects on clinical practice

  • Sayaka MaedaEmail author
  • Tatsuya Morita
  • Masayuki Ikenaga
  • Hirofumi Abo
  • Yoshiyuki Kizawa
  • Satoru Tsuneto
Original Article



Despite extensive debate on palliative sedation over the last few decades, no studies have explored longitudinal changes in physicians’ opinion. Moreover, little is known about how physicians’ opinions affect their practice. This study aimed to clarify (1) changes in palliative care specialists’ opinions on palliative sedation and (2) the effects of these opinions on clinical practice.


In 2000 and 2016, nationwide questionnaire surveys involving Japanese palliative care specialists were performed: measurement was based on agreement with opinions on palliative sedation. In 2016, the physicians reported their practice of continuous deep sedation (CDS) and answered their thoughts on what factors lead to a good death as factors potentially affecting their practice.


Of the 695 physicians enrolled in the 2016 survey, 469 responded (67%) and 417 were analyzed (60%). Compared with 54 physicians in 2000, the present respondents were more likely to consider palliative sedation is difficult to perform based on appropriate indications (ES = 0.84, P < 0.001), is unnecessary if conventional palliative care is performed sufficiently (ES = 0.30, P = 0.013), and may result in legal action (ES = 0.35, P = 0.003). The physicians’ opinions more strongly affected their practice than their characteristics or thoughts on good death components.


Recently, palliative care specialists in Japan tend to encounter more difficulties determining what conventional palliative care is and what palliative sedation is. They also fear legal ramifications. It is necessary to standardize methods of alleviating patients’ suffering, to make CDS criteria clearer, and to create a legal basis that respects patients’ rights at their end of life.


Palliative sedation Continuous deep sedation Legal framework Patients’ rights Good death End of life 



The authors would like to thank all of the participants and participating institutions for taking part in this study.

Funding information

This study was supported by the Japanese Society for Palliative Medicine and JSPS KAKENHI Grant Number 16H05212.

Compliance with ethical standards

The Institutional Review Board of Seirei Mikatahara General Hospital approved the ethical and scientific validity of this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

520_2018_4497_MOESM1_ESM.xlsx (17 kb)
ESM 1 (XLSX 17 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sayaka Maeda
    • 1
    Email author
  • Tatsuya Morita
    • 2
  • Masayuki Ikenaga
    • 3
  • Hirofumi Abo
    • 4
  • Yoshiyuki Kizawa
    • 5
  • Satoru Tsuneto
    • 6
  1. 1.Department of Palliative MedicineKyoto University HospitalKyotoJapan
  2. 2.Palliative Care Team, Department of Palliative and Supportive CareSeirei Mikatahara General HospitalHamamatsuJapan
  3. 3.Department of Palliative MedicineYodogawa Christian HospitalOsakaJapan
  4. 4.Department of Palliative MedicineRokko HospitalKobeJapan
  5. 5.Department of Palliative MedicineKobe University Graduate School of MedicineKobeJapan
  6. 6.Department of Human Health Sciences, Graduate School of MedicineKyoto UniversityKyotoJapan

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