Table 2

Comparisons of physician opinions about continuous use of sedatives among UK, Japan, Ital and Germany

QuestionsGermany*Italy*Japan*UK*Overall†Germany–
Italy‡		Germany–
Japan‡		Germany–
UK‡		Italy– Japan‡Italy–
UK‡		Japan–
UK‡
Physician approval as medical indications of continuous use of sedatives
 Physical suffering/hours to days273,
4.66 (0.61)		198,
4.86 (0.49)		333,
4.40 (0.69)		101,
4.07 (1.01)		<0.001−0.36,<0.0010.39,<0.0010.79,<0.0010.74,<0.0011.11,<0.0010.43,<0.001
 Psychoexistential suffering/ hours to days272,
3.86 (1.04)		198,
4.44 (0.85)		334,
3.35 (1.07)		101,
3.83 (1.02)		<0.001−0.61,<0.0010.48,<0.0010.02, 0.8361.10,<0.0010.68,<0.001−0.45,<0.001
 Physical suffering/weeks or more273,
3.58 (1.13)		198,
3.38 (1.12)		333,
2.63 (1.02)		101,
2.28 (1.18)		<0.0010.17, 0.0700.88,<0.0011.14,<0.0010.71,<0.0010.97,<0.0010.34, 0.003
 Psychoexistential suffering/weeks or more272,
3.12 (1.14)		198,
3.11 (1.12)		334,
2.11 (0.95)		101,
2.08 (1.08)		<0.0010.01, 0.9130.96,<0.0010.92,<0.0010.98,<0.0010.93,<0.0010.04, 0.757
Intention of continuous use of sedatives
 To relieve suffering264,
4.98 (0.15)		196,
4.97 (0.20)		330,
4.93 (0.27)		96,
4.93 (0.26)		0.0490.05, 0.6290.19, 0.0190.27, 0.0240.15, 0.1080.19, 0.1270.02, 0.842
 To decrease consciousness256,
3.13 (1.01)		195,
3.37 (1.17)		329,
3.18 (1.10)		96,
2.40 (0.90)		<0.001−0.22, 0.019−0.04, 0.5980.75,<0.0010.17, 0.0560.90,<0.0010.74,<0.001
 To induce unconsciousness254,
2.34 (0.88)		194,
2.80 (1.25)		329,
2.30 (1.13)		96,
1.49 (0.78)		<0.001−0.44,<0.0010.04, 0.6281.00,<0.0010.43,<0.0011.18,<0.0010.77,<0.001
 To shorten the dying process259,
1.30 (0.69)		194,
1.13 (0.47)		329,
1.06 (0.32)		96,
1.01 (0.10)		<0.0010.27, 0.0050.47,<0.0010.49,<0.0010.20, 0.0280.32, 0.0110.17, 0.156
Treatment goal of continuous use of sedatives
 Comfortable for the patient260,
3.64 (0.88)		196,
4.16 (0.84)		328,
4.39 (0.86)		96,
3.92 (1.37)		<0.001−0.61,<0.001−0.87,<0.001−0.27, 0.025−0.27, 0.0030.24, 0.0580.48,<0.001
 Unconsciousness256,
3.14 (1.02)		193,
3.79 (1.19)		318,
2.67 (1.20)		96,
2.44 (1.20)		<0.001−0.60,<0.0010.42,<0.0010.65,<0.0010.94,<0.0011.14,<0.0010.19, 0.097
Opinions about continuous use of sedatives
 A competent patient has the right to demand CUS273,
4.04 (1.05)		198,
4.64 (0.72)		334,
4.43 (0.65)		101,
2.77 (1.36)		<0.001−0.65,<0.001−0.46,<0.0011.11,<0.0010.31,<0.0011.90,<0.0011.91,<0.001
 Dying in a sleep through CUS can be a good death270,
4.25 (0.72)		198,
4.28 (0.89)		334,
3.13 (0.76)		101,
3.78 (0.87)		<0.001−0.04, 0.6901.51,<0.0010.61,<0.0011.42,<0.0010.56,<0.001−0.83,<0.001
 CUS cannot sufficiently alleviate suffering even in unresponsiveness270,
3.52 (1.02)		198,
2.96 (1.24)		333,
3.28 (1.01)		101,
3.10 (1.13)		<0.0010.50,<0.0010.24, 0.0030.40,<0.001−0.28, 0.002−0.11, 0.3610.17, 0.133
 CUS shortens the duration of the dying process266,
2.82 (1.00)		198,
1.63 (0.86)		334,
2.22 (0.86)		101,
2.20 (0.79)		<0.0011.26,<0.0010.65,<0.0010.66,<0.001−0.68,<0.001−0.68,<0.0010.02, 0.854
 CUS can be difficult to distinguish from euthanasia267,
2.07 (1.07)		198,
1.44 (0.88)		334,
2.36 (1.11)		101,
1.71 (1.02)		<0.0010.63,<0.001−0.27, 0.0010.34, 0.004−0.89,<0.001−0.29, 0.0170.59,<0.001
 CUS is unnecessary, as suffering can always be relieved with other measures270,
1.66 (0.72)		198,
1.75 (0.89)		334,
1.83 (0.92)		101,
1.93 (0.89)		0.021−0.11, 0.256−0.20, 0.014−0.35, 0.003−0.09, 0.298−0.21, 0.092−0.11, 0.343

  • *N, mean (SD).

  • †Analysis of variance.

  • ‡Effect size p value (t-test).

  • CUS, continuous use of sedatives.