Biomedical subjects

J Tsunoda

Publications and source records attributed to J Tsunoda.

39 records · Page 3Linked to original sources

PubMedDate not supplied

Terminal sedation for existential distress.

Although sedation for existential distress has been actively discussed in the palliative care literature, empirical reports are limited. A retrospective cohort study was performed to clarify the physical conditions of terminally ill cancer patients who expressed existential distress and received sedation. Of 248 consecutive hospice inpatients, 20 patients expressed a belief that their lives were meaningless and received sedation. The target symptoms for sedation were dyspnea (n = 10), agitated delirium (n = 8), and pain (n = 1). Only one patient received sedation for psychological distress alone, although physical symptoms were acceptably relieved. The Palliative Performance Scale just before sedation was 10 (n = 7), 20 (n = 11), 30(n = 1), and 40(n = 1). All but one patient could take nourishment orally of only mouthfuls or less. Edema, dyspnea at rest, and delirium were observed in 10, 13, and 14 cases, respectively. The Palliative Prognostic Index was greater than 6.0 in all but one case with a mean of 12 +/- 3.3. In conclusion, in our practice, sedation was principally performed for physical symptoms of cancer patients in very late stages. Further research is encouraged to establish standard therapy for existential distress of the terminally ill.

Cohort Studies↗

PubMedDate not supplied

A prospective study on the dying process in terminally ill cancer patients.

To determine the physical and medical change in the dying process, a prospective study was performed on 100 terminally ill cancer patients. The mean (median) time from the onset of death rattle, respiration with mandibular movement (RMM), cyanosis on extremities, and pulselessness on the radial artery to death was 57 (23) hours, 7.6 (2.5) hours, 5.1 (1.0) hours, and 2.6 (1.0) hours respectively. Death rattle preceded the other three conditions in 74 percent of the subjects, while RMM preceded cyanosis and pulselessness in 63 percent. The ratio of awake-drowsy-comatose patients was 56-44-0 percent one week before death, 26-62-12 percent in the last 24 hours, and 8-42-50 percent in the final six hours. The number of opioid users and average dose increased significantly as death approached, from 42 percent and 49 mg/day (parental morphine equivalent) four weeks before death to 87 percent and 139 mg/day in the final 48 hours. The frequency of extra dosage also increased significantly, from 32 percent (opioid) and 40 percent (non-opioid) one week before death to 68 percent and 66 percent in the last 48 hours, respectively. The change of physical signs and medical intervention when death is impending has a common pathway in spite of large individual variations; thus, understanding this nature can help clinicians to offer better palliative care to terminal cancer patients.

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PubMedDate not supplied

Perceptions and decision-making on rehydration of terminally ill cancer patients and family members.

Although the appropriateness of forced rehydration for terminally ill cancer patients has been actively discussed, few studies have investigated its psychological aspects. To clarify patients' and family members' perceptions about rehydration and identify contributing factors for decision-making, a prospective structured survey was performed on 121 hospice inpatients with insufficient oral intake. Physicians did not recommend rehydration in 78 percent of patients, and 75 percent decided not to receive artificial fluid therapy. Various concerns affected decision-making: 76 percent of patients and 85 percent of family members believed patients could not get appropriate nutrition without artificial rehydration. Some 56 percent of patients and 84 percent of family members said that withholding rehydration would cause premature death, while more than half agreed that forced rehydration might worsen the patients' suffering. Patients' performance status, fluid retention signs, denial, physicians' recommendations, patients' and family members' beliefs about the effect of hydration on patients' distress, and family members' anxiety about withholding rehydration were significantly associated with decision-making. Multiple regression analyses revealed patients' denial, physicians' recommendations determined by patients' performance status and fluid retention symptoms, and family members' belief that rehydration could worsen patients' distress as independent determinants for rehydration. In conclusion, hospice care receivers had various concerns about rehydration, related to patients' nutrition, survival, and distress. The main determinants for rehydration therapy were patients' performance status, fluid retention symptoms, denial, and care receivers' beliefs about the effect of hydration on the patients' distress.

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