Japanese physicians’ experiences of terminally ill patients voluntarily stopping eating and drinking: a national survey

Shinjo, Takuya; Morita, Tatsuya; Kiuchi, Daisuke; Ikenaga, Masakazu; Abo, Hirofumi; Maeda, Sayaka; Tsuneto, Satoru; Kizawa, Yoshiyuki

doi:10.1136/bmjspcare-2017-001426

Cited by 17 publications

(25 citation statements)

References 10 publications

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“…Similar results were obtained in international studies. 3 , 4 , 6 Furthermore, we found that 0.7% of all deaths in Switzerland in 2017 were owing to VSED, or 1.1% of all deaths that occurred at home or in a nursing home. In 2017, about one in eight family physicians in Switzerland had accompanied a patient who declared their wish to die by VSED.…”

Section: Discussionmentioning

confidence: 70%

“…4 , 7 , 8 , 11 In published studies, one- to two-thirds of participating healthcare professionals have accompanied at least one person during VSED. 3 – 8 The occurrence of deaths attributable to VSED in Europe is between 0.4% to 2.1%, and a high number of unreported cases can be expected. 4 , 7 , 8 , 11 …”

Section: Introductionmentioning

confidence: 99%

“…2 Besides assisted suicide, which is legal or prohibited depending on legal regulations, another option to end one's life prematurely is by voluntary stopping of eating and drinking (VSED), which has become the recent focus of end-of-life practices. [3][4][5][6][7][8] VSED is the act of a person who consciously refuses to eat or drink with the intention of dying. 9 Healthcare professionals are therefore not charged with providing a lethal drug to the patient but rather with caring for and accompanying the patient from the beginning of VSED until her or his death.…”

Section: Introductionmentioning

confidence: 99%

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Family physicians’ perspective on voluntary stopping of eating and drinking: a cross-sectional study

et al. 2020

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Objective We aimed to determine how often patients who choose voluntary stopping of eating and drinking (VSED) are accompanied by Swiss family physicians, how physicians classify this process, and physicians’ attitudes and professional stance toward VSED. Methods We conducted a cross-sectional study between August 2017 and July 2018 among 751 practicing family physicians in Switzerland (response rate 74%; 70.7% men; average age 58 (±9) years). We used a standardized evidence-based questionnaire for the survey. Results VSED is well-known among family physicians (81.9%), and more than one-third (42.8%) had accompanied at least one patient during VSED. In 2017, 1.1% of all deaths that occurred in Swiss nursing homes or in a private home were owing to VSED. This phenomenon was classified as a natural dying process (59.3%), passive euthanasia (32.0%), or suicide (5.3%). Conclusions Although about one in three Swiss family physicians have accompanied a person during VSED, family physicians lack sufficient in-depth knowledge to address patients and their relatives in an appropriate manner during the process. Further training and development of practice recommendations are needed to achieve more standardized accompaniment of VSED. International Registered Report Identifier: DERR1-10.2196/10358

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Family physicians’ perspective on voluntary stopping of eating and drinking: a cross-sectional study

et al. 2020

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“…In Switzerland, terminally ill people can choose physician-assisted suicide through the organizations EXIT (2016) and DIGNITAS (2016). Physicians and outpatient and long-term care nurses (Bolt, Hagens, Willems, & Onwuteaka-Philipsen, 2015; Ganzini et al., 2003; Hoekstra, Strack, & Simon, 2015; Shinjo et al., 2017) were asked about other options to end one’s life prematurely. One option is through “voluntary stopping of eating and drinking” (VSED).…”

Section: Review Of Literaturementioning

confidence: 99%

Development of a Questionnaire to Determine Incidence and Attitudes to “Voluntary Stopping of Eating and Drinking”

et al. 2019

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Background: ''Voluntary stopping of eating and drinking'' (VSED) is an option to hasten death at the end of life. There are no data available about incidence of either the explicit VSED or implicit (V)SED nor information about experiences and attitudes of health professionals about VSED in Switzerland. Aims: To develop, test, and translate a standardized questionnaire that measures the incidence of VSED, and physicians' and nurses' experiences about explicit VSED and implicit (V)SED. Methods: The development of the questionnaire was based on a systematic search, which were updated in 2016. The questionnaire was tested by palliative care specialists using standard pretest and content validity index (CVI). Subsequently, a forward/backward translation was made. Results: The questionnaire includes 38 items. Feedback of 15 participants in the standard pretest were positive in terms of intelligibility with an average time of 28 minutes. After adjustment, 27 experts validated the items in two rounds. The questionnaire achieves excellent item-CVI values between 0.91 and 1.00 and scale-CVI values of 0.97. The forward/ backward translations were each carried out by two independent translators with subsequent building of a consensus through a consultant. Conclusion: A mulitlingual questionnaire has been developed, which measures the incidence of explicit VSED and implicit (V)SED. This questionnaire is the basis for a Swiss-wide census of all physicians and nurses of outpatient and long-term care.

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“…We have previously demonstrated that the concept of collusion has been blurred in the palliative care literature (Stiefel et al, 2017a): 1) most often a definition of collusion is not provided; 2) collusion is erroneously conceived as a conscious phenomenon or 3) reduced to situations of information exchange; 4) the impact of collusion on the patient-clinician interaction and on clinical decision making is neglected; 5) no strategies for its detection and working through are proposed; and 6) the role of the clinician in collusion is not addressed (Stiefel et al, 2017a(Stiefel et al, , 2017b. In other words, in the current palliative care literature on collusion are listed phenomena that do not correspond to collusion.…”

Section: Introductionmentioning

confidence: 99%

Collusion in palliative care: an exploratory study with the Collusion Classification Grid

Stiefel

Nakamura²,

Ishitani³

et al. 2019

Pall Supp Care

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ObjectiveCollusion is a largely unconscious, dynamic bond, which may occur between patients and clinicians, between patients and family members, or between different health professionals. It is widely prevalent in the palliative care setting and provokes intense emotions, unreflective behavior, and negative impact on care. However, research on collusion is limited due to a lack of conceptual clarity and robust instruments to investigate this complex phenomenon. We have therefore developed the Collusion Classification Grid (CCG), which we aimed to evaluate with regard to its potential utility to analyze instances of collusion, be it for the purpose of supervision in the clinical setting or research.MethodSituations of difficult interactions with patients with advanced disease (N = 10), presented by clinicians in supervision with a liaison psychiatrist were retrospectively analyzed by means of the CCG.Result1) All items constituting the grid were mobilized at least once; 2) one new item had to be added; and 3) the CCG identified different types of collusion.Significance of resultsThis case series of collusions assessed with the CCG is a first step before the investigation of larger samples with the CCG. Such studies could search and identify setting-dependent and recurrent types of collusions, and patterns emerging between the items of the CCG. A better grasp of collusion could ultimately lead to a better understanding of the impact of collusion on the patient encounter and clinical decision-making.

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Japanese physicians’ experiences of terminally ill patients voluntarily stopping eating and drinking: a national survey

Abstract: In Japan, 32% of physicians surveyed replied that they had experience of caring for patients during VSED in a clinical setting and 15% considered CDS acceptable.

Cited by 17 publications

References 10 publications

Family physicians’ perspective on voluntary stopping of eating and drinking: a cross-sectional study

Family physicians’ perspective on voluntary stopping of eating and drinking: a cross-sectional study

Development of a Questionnaire to Determine Incidence and Attitudes to “Voluntary Stopping of Eating and Drinking”

Collusion in palliative care: an exploratory study with the Collusion Classification Grid

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