Advances in Modern Medicine

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Advances in Modern Medicine introduces recent advanced medical practices performed at the Kure Medical Center and Chugoku Cancer Center (KMCCCC) - one of the leading hospitals in Japan - to those ...
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End-of-Life Care

Pp. 376-389 (14)

Shoji Sunada, Naomi Sanemori, Kei Itagaki, Nobutaka Hatanaka, Yosuke Shimizu and Kikuo Nakano

Abstract

We describe the significance of the end-of-life care for cancer patients based on our experience. During the terminal phase of cancer, particularly within the final two months, physical function rapidly declines and various symptoms appear; therefore, a prompt response is required to alleviate symptoms. Treatment must be selected in accordance with the patient’s wishes to reduce their symptoms. Advance care planning (ACP) is primarily done by the patient and their family, and is sustained collaboratively by the supporting medical team, and not the unilateral “elicitation of a commitment” from the patient by the medical staff. ACP increases patient and family satisfaction during the end-of-life stage, and alleviates anxiety and depression among survivors after the death of a patient. Performing symptom control during the end-oflife stage of the patient is important with no demand for explanations. The use of morphine is recommended as drug therapy for dyspnea. Treatment of death rattle involves administering anticholinergic drugs and reducing intravenous (IV) infusions. It is important to provide families with explanations and make considerations for their inquiries. Routine assessments and corrections must be conducted using a guideline for intravenous infusions of 1,000 ml or less per day. Unbearable pain can remain in the end-of-life stage, even after palliative treatment has been performed. In these cases, sedation is performed after sufficient assessment of pain and after obtaining agreement from the medical team and consent from the patient and family following an explanation.

Keywords:

Advance care planning, End-of-life care, Sedation, Survival prediction, Symptom control.

Affiliation:

Department of Palliative Care, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure 737-0023, Japan.