Withdrawal of life-sustaining treatment in Japanese home care: A cross-sectional survey

Abstract

Background

In Japan, legal and social concerns exist about withdrawing life-sustaining treatment (LST) even at the end of life. This study aimed to investigate the experience of physicians and nurses involved in home care with LST withdrawal.

Methods

A web-based questionnaire survey was conducted among physicians and nurses who were members of the Japanese Association for Home Care Medicine in 2020. The survey collected data on the experience of respondents with withdrawing LST, the decision-making processes involved in withdrawing treatment, and their experience with patients attempting voluntarily stopping eating and drinking (VSED).

Results

Results from 203 respondents, including 150 physicians and 53 nurses, showed that the most commonly withdrawn LSTs were intravenous infusions (115 respondents), tube feeding (69 respondents), and oral administration of medicine (74 respondents). A few respondents withdrew respiratory management, such as mechanical ventilation (11 respondents) or home oxygen therapy (12 respondents). The main diagnoses of patients who had LSTs withdrawn were malignancy, senility, and dementia. Many respondents made decisions through discussions with the families of patients (117 respondents) or multidisciplinary discussions at their facilities (80 respondents). There were 23 respondents who made the decision alone, and they were all physicians. Thirty-two respondents had experience with patients who had completed VSED.

Conclusion

It was found that many Japanese home care physicians and nurses had experienced withdrawal of LSTs, and a significant number among them had experienced patients attempting VSED. Given this situation, there is an urgent need to provide ethics support in Japanese home care.