Continuous Deep Sedation for psycho-existential suffering: a multi-center nation-wide study

Purpose: There is ongoing debate on whether continuous deep sedation (CDS) for psycho-existential suffering is appropriate. We aimed to: 1) to clarify clinical practice of CDS for psycho-existential suffering, and 2) assess its impact on patients’ survival. Methods Advanced cancer patients admitted to 23 palliative care units in 2017 were consecutively enrolled. We compared patients’ characteristics, CDS practices, and survival between those receiving CDS for psycho-existential suffering +/- physical symptoms and only for physical symptoms. Results Of 164 patients analyzed, 14 (8.5%) received CDS for psycho-existential suffering +/- physical symptoms and only one (0.6%) solely for psycho-existential suffering. Patients receiving CDS for psycho-existential suffering, compared with those only for physical symptoms, were likely to have no specific religion (p = 0.025), and desired (78.6 vs. 22.0%, respectively, p < 0.001) and requested a hastened death more frequently (57.1 vs. 10.0%, respectively, p  < 0.001). All of them had a poor physical condition with limited estimated survival, and mostly (71%) received intermittent sedation prior to CDS. CDS for psycho-existential suffering caused greater physicians’ discomfort ( p  = 0.037), and lasted for longer ( p  = 0.029). Dependency, loss of autonomy, and hopelessness were common reasons for psycho-existential suffering that required CDS. The survival time after CDS initiation was longer in patients receiving it for psycho-existential suffering (log-rank, p  = 0.021). Conclusion Further studies and debate are warranted to develop feasible treatment strategies for psycho-existential suffering and make the indication and procedure of CDS for psycho-existential sufferingclearer for both international and each culturally-adapted consensus.