精神的存在的苦しみの終末期鎮静における願望と実践の間の知覚のギャップ

Sayaka Maeda¹, Tatsuya Morita², Kengo Imai³

¹Department of Palliative Medicine, Kyoto University Hospital, Kyoto, Japan.

Journal of pain and symptom management

|August 24, 2025

まとめ

多くの癌患者は継続的な深い鎮静療法 (CDS) を必要としていますが稀に投与されます深い心理的苦痛を管理するための終末期ケアにギャップがあることを示しています

科学分野:

緩和ケア
腫瘍学
医学の倫理

背景:

継続的な深い鎮静 (CDS) は,精神的存在の苦しみを終えるための議論の余地のある治療法です.
この文脈でのCDSの利用と患者の願望は十分に理解されていません.

研究の目的:

日本の緩和ケアにおける精神的存在的苦痛のためにCDSを望む癌患者の流行を決定する.
患者の状態や苦しみを調査し,CDSを望む時に介入する.

主な方法:

日本における認定ホスピスと緩和ケアユニット (PCU) の全国的なアンケート調査
CDSの投与,CDSに対する患者の願望,および患者の状態について収集されたデータ

主要な成果:

死んだ患者の0.2%は精神的存在的苦痛のためにCDSを受け,2%はそれを望んでいた.
PCUの4分の3はCDSを望む患者が報告され,しばしば存在的苦痛と早期死亡の願望に関連しています.
PCUの4分の1だけが,この症候群でCDSを投与した.

結論:

CDSに対する患者の願望と,心理的存在的苦痛に対する臨床的実施の間には大きな格差がある.
緩和ケアチームは複雑な患者のニーズに対応し倫理的な決定を下す上で課題に直面しています
生命の終わりの介護のギャップを埋めるためにさらなる研究と臨床ガイドラインが必要です.

キーワード:

死に至るまで継続的な深い鎮静死を早めようとする.寿命の終わり倫理について安楽死早く死ぬことを願って

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