Prescribing of pain medication in palliative care. A survey in general practice (original) (raw)
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Health science journal, 2018
Objective : To determine prescribing pattern on opioids analgesics and adjuvant medications among patients with last-stage cancer receiving palliative care. Drug related problems (DRPs) and their causes, and factors potentially associated with the DRPs were also investigated. Methods : In this retrospective descriptive study, patients with end-stage cancer were selected. Data were collected from inpatient medical records, outpatient medical record and home visit record for 1 year. That were explored and evaluated drug related problem by The PCNE classifications v.7.0 then summarized and analyzed by descriptive statistics and Chi - square test at a significance level of P -value < 0.05. Results: There are 35 inpatients, the majority were male (21 cases or 60% of all patients) with an average age of 61.46 ± 14.98 years. The most diagnosed disease was liver cancer. DRPs during in hospitalization were found with an average of 1.17 DRPs per patient. The most common DRP the effect of d...
Opioids, Pain Management, and Palliative Care in a Norwegian Nursing Home From 2013 to 2018
Health Services Insights, 2019
In Norway, approximately 50% of older people die in nursing homes (NH). Holistic care and pharmacological management are key factors in quality at the end of life. The purpose of this longitudinal study was to describe the use of opioids in an NH during a 5-year period. We focused on palliative care, symptoms, and suffering during the last 3 days before death. Data were collected from spring 2013 to spring 2018. We used the interRAI assessment instrument annually and when the resident died. We conducted a semi-structured interview with nurses on duty at the deathbed. At the time of death, the residents had an average age of 88.9 years and an average stay of 2.9 years (N = 100). At the first assessment, 19% of the residents used 1 or more type of opioids. On the day of death, 55% had an active prescription for opioids, mainly as subcutaneous injections. The results illustrate the different uses of opioids, including managing pain, dyspnoea, sedation, for comfort, as a prophylaxis, or a combination of reasons. Cancer- and cardiovascular diagnoses were the strongest predictor for using morphine (P < 0.05). Identification of the residents’ needs for opioids is a challenge for palliative care nurses, both ethically and legally.
European Journal of Clinical Pharmacology, 2019
Purpose Opioids reduce cancer-related pain but an association with shorter survival is variably reported. Aim: To investigate the relationship between pain, analgesics, cancer and survival within the European Palliative Care Cancer Symptom (EPCCS) study to help inform clinical decision making. Methods Secondary analysis of the international prospective, longitudinal EPCCS study which included 1739 adults with advanced, incurable cancer receiving palliative care. In this secondary analysis, for all participants with date of death or last follow up, a multilevel Weibull survival analysis examined whether pain, analgesics, and other relevant variables are associated with time to death. Results Date of death or last follow-up was available for 1404 patients (mean age 65.7 [SD:12.3];men 50%). Secondary analysis of this group showed the mean survival from baseline was 46.5 (SD:1.5) weeks (95% CI:43.6–49.3). Pain was reported by 76%; 60% were taking opioids, 51% non-opioid analgesics and 2...
Prescription trends at the end of life in a palliative care unit: observational study
BMC Palliative Care
Background Symptomatic control is essential in palliative care, particularly in end-of-life, in which the pathophysiological changes that characterize this last phase of life strengthen the need to carry out an early therapeutic review. Hence, we aim to evaluate the prescribing pattern at a palliative care unit at two different time points: on admission and the day of the patient’s death. Methods Quantitative, analytic, longitudinal, retrospective and observational study. Participants were adult patients who were admitted and died in a palliative care unit, in Portugal. Sociodemographic, clinical and pharmacological data were collected, including frequencies and routes of administration of schedule prescribed drugs and rescue drugs, from the day of admission until the day of death. Results 115 patients were included with an average age of 70.0 ± 12.9 years old, 53.9 were male, mostly referred by the Hospital Palliative Care Support Teams. The most common pathology was cancer, mainly...
Journal of Pharmacy and Pharmacology 3 (2015) 509-515, 2015
Literature guiding clinicians on appropriate prescribing as death nears is scarce. The aim of this study was to retrospectively evaluate medication changes implemented after palliative care consultations at two VA (veterans affairs) end-of-life care units. Analysis focused on the change in analgesic and chronic disease medication regimens, including administration route. Sixty patients who received an inpatient palliative care consult and subsequently passed away on the either VA end-of-life care unit between June 30, 2010 and June 30, 2011 were included for analysis. Opioid and non-opioid analgesic medications were distinguished in this study. Medication name and route of administration were documented from inpatient electronic medication profiles up to one week prior to the inpatient palliative care consult (T prior), the day after consult (T +1), and the day of death (T death). Opioid analgesic medications prescribed increased from 0.95 per patient prior to consult to 1.87 at death. Investigators observed a shift away from oral opioid analgesic formulations to intravenous and subcutaneous push as the preferred routes of administration at time of death. Chronic medications decreased from 5.15 per patient prior to consult to 1.23 at death. The overall increase in analgesic medications at time of death reflects a focus on symptom management and comfort care in this special population. Trimming of non-essential medications is a patient-specific art and continued efforts should be made to reduce pill burden by removing medications that are not directly related to comfort-care in the palliative patient as death approaches.
Drugs in palliative care: results from a representative survey in Germany
Palliative Medicine, 2004
The development of palliative medicine in inpatient units in Germany has been impressive in the last years. As a first step of quality assurance, a core documentation form was developed in 1996. In 2001, 55 of the 83 palliative inpatient units in Germany and one unit each in Switzerland and Austria participated in the third phase of the evaluation of the core documentation. A total of 1304 patients were documented consecutively in the 57 units for a period of up to three months. This study investigates the frequency of drugs used in palliative care units in Germany. During inpatient treatment, the most common drug classes were strong opioids (68% of the patients), nonopioids (59%), corticosteroids (32%), laxatives (31%), antiemetics (27%), gastric protection agents (24%), neuroleptics (19%), sedatives/anxiolytics (18%), antidepressants (16%) and diuretics (15%). These ten drug classes made up for 72% of all prescriptions in the palliative care units. The substances used most frequently were dipyrone (47% of the patients), morphine (42%), fentanyl (28%), dexamethasone (27%), metoclopramide (21%), sodium picosulfate (15%), haloperidol (13%), pantoprazole (11%), macrogol (11%), amtriptyline (11%), furosemide (10%), omeprazole (9%), lactulose (8%), rofecoxib (8%) and lorazepam (7%). The 15 most commonly used drugs accounted for 54% of the prescriptions in the palliative care units in Germany. Drug treatment was related to sex, age and functional status of the patients. Patients who died in a palliative care unit had received significantly more frequent doses of neuroleptics (P B/0.001), corticosteroids (P B/0.001), sedatives/anxiolytics (PB/0.001) and strong opioids (P B/0.001). This study is the first representative and systematic evaluation of drug treatment in palliative care units in a European country. Many of the 'top 15' drugs were drugs included in the list of essential drugs of the World Health Organisation though availability and cultural differences have an effect on the use of drugs, e.g., the high usage of dipyrone in Germany. Age and sex-related differences in drug therapy were seen, and more research is needed to recognize possible undertreatment of symptoms in subgroups of patients, e.g., treatment of depression in older or male patients. Palliative Medicine 2004; 18: 100 ¡/107
Analgesic Drugs Prescription in Geriatric and Palliative Patients in Slovakia
Clinical social work journal, 2019
Objective: The aim of this study was the evaluation of analgesic drugs prescription as an epidemiological indicator of average annual percentage change (AAPC) in geriatric and palliative patients in the period 2016-2017. Design: Descriptive study. Participants: Geriatric and palliative patients.