Preferences of Caregivers and Patients Regarding Opioid Analgesic Use in Terminal Care

Toyos, Noelia García; Escudero-Carretero, María José; Sanz-Amores, Reyes; Hoyos, Juan-Antonio Guerra-De; Melchor, Juan; Tamayo-Velázquez, María-Isabel

doi:10.1111/pme.12376

Cited by 13 publications

(18 citation statements)

References 36 publications

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“…[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] vealed that the best approach was unknown. 47 Of the remaining 14 studies, 6 (42.9%) identified patient preferences for the purpose of guideline development, [40][41][42]49,50,53 and 10 (71.4%) explored various methods for doing so. 38,39,[43][44][45][46][47][48]51,52…”

Section: Search Resultsmentioning

confidence: 99%

“…49 Two studies identified preferences by focus group, 48,52 and 2 studies employed focus groups plus Delphi consensus process 40 or questionnaire. 41 Two studies identified preferences with interviews, 44,50 and 1 study combined interviews with a questionnaire. 51 One study employed a questionnaire only, 42 and 1 study used only a RAND consensus process.…”

Section: Identifying Patient Preferencesmentioning

confidence: 99%

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How to identify, incorporate and report patient preferences in clinical guidelines: A scoping review

Kim

Armstrong

Berta

et al. 2020

Health Expectations

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Background Clinical guidelines optimize care delivery and outcomes. Guidelines support patient engagement and adherence if they reflect patient preferences for treatment options, risks and benefits. Many guidelines do not address patient preferences. Developers require insight on how to develop such guidelines. Objective To conduct a scoping review on how to identify, incorporate and report patient preferences in guidelines. Search We searched MEDLINE, EMBASE, Scopus, CINAHL, OpenGrey and GreyLit from 2010 to November 2019. Eligibility We included English language studies describing patient preferences and guidelines. Data extraction and synthesis We reported approaches for and determinants and impacts of identifying patient preferences using summary statistics and text, and interpreted findings using a conceptual framework of patient engagement in guideline development. Results Sixteen studies were included: 2 consulted patients and providers about patient engagement approaches, and 14 identified patient preferences (42.9%) or methods for doing so (71.4%). Studies employed single (57.1%) or multiple (42.9%) methods for identifying preferences. Eight (57.1%) incorporated preferences in one aspect of guideline development, while 6 (42.9%) incorporated preferences in multiple ways, most commonly to identify questions, benefits or harms, and generate recommendations. Studies did not address patient engagement in many guideline development steps. Included studies were too few to establish the best approaches for identifying or incorporating preferences. Fewer than half of the studies (7, 43.8%) explored barriers. None examined reporting preferences in guidelines. Conclusions Research is needed to establish the single or multiple approaches that result in incorporating and reporting preferences in all guideline development steps.

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Section: Search Resultsmentioning

confidence: 99%

Section: Identifying Patient Preferencesmentioning

confidence: 99%

How to identify, incorporate and report patient preferences in clinical guidelines: A scoping review

Kim

Armstrong

Berta

et al. 2020

Health Expectations

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“…Despite the availability of the drugs, inadequate pain management has been found among cancer patients [3, 4]. One of the most frequent causes of undertreatment is misconceptions about opioids [5–8]. …”

Section: Introductionmentioning

confidence: 99%

“…A qualitative study revealed that many patients and families believed that opioids should be only used in terminal cases and at the end of life, and that opioid use may be associated with premature death [5]. Another study that attempted to identify the barriers to cancer pain management in Taiwan demonstrated that informed family caregivers of advanced cancer patients had concerns about reporting pain and administering opioids, particularly as they related to disease progression and possible side effects [7].…”

Section: Introductionmentioning

confidence: 99%

The association between different opioid doses and the survival of advanced cancer patients receiving palliative care

2016

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BackgroundConcerns that opioids may hasten death can be a cause of the physicians’ reluctance to prescribe opioids, leading to inadequate symptom palliation. Our aim was to find if there was an association between different opioid doses and the survival of the cancer patients that participated in our palliative care program.MethodsA retrospective study was conducted at Ramathibodi Hospital, Bangkok between January 2013 and December 2015. All of the cancer patients that were referred to palliative care teams by their primary physicians were included in the study. The study data included the patients’ demographics, disease status, comorbidities, functional status, type of services, cancer treatments, date of consultation, and the date of the patient’s death or last follow-up. The information concerning opioid use was collected by reviewing the medical records and this was converted to an oral morphine equivalent (OME), following a standard ratio. The time-varying covariate in the Cox regression analysis was applied in order to determine the association between different doses of opioids and patient survival.ResultsA total of 317 cancer patients were included in the study. The median (IQR) of the OME among our patients was 6.43 mg/day (0.53, 27.36). The univariate Cox regression analysis did not show any association between different opioid doses (OME ≤ 30 mg/day and > 30 mg/day) and the patients’ survival (p = 0.52). The PPS levels (p < 0.01), palliative care clinic visits (HR 0.32, 95%CI 0.24–0.43), home visits (HR 0.75, 95%CI 0.57–0.99), chemotherapy (HR 0.32, 95%CI 0.22–0.46), and radiotherapy (HR 0.53, 95%CI 0.36–0.78) were identified as factors that increased the probability of survival.ConclusionsOur study has demonstrated that different opioid doses in advanced cancer patients are not associated with shortened survival period.

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“…A key factor in uencing this decision, though rarely mentioned by participants, is the role the health care provider serves in informing that decision. Patients often structure their decisions by considering the opinions and suggestions of their healthcare providers 24 . Providers should discuss the trade-offs of pain medication with their patients before the patients decide about whether to take the drug.…”

Section: Main Ndingsmentioning

confidence: 99%

“No Thanks, I Don’t Want to See Snakes Again”: A Qualitative Study of Pain Management Versus Preservation of Cognition in Palliative Care Patients

Wegier¹,

Varenbut²,

Bernstein³

et al. 2020

Preprint

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BackgroundTowards the end of life, use of opioid analgesics becomes more common in patients to control pain and improve quality of life. While pain medication may help manage pain, unwanted cognitive side effects are frequently noted. This balancing act presents a trade-off for patients between pain relief and adverse effects, where the desire to relieve pain must be evaluated against the desire to maintain cognitive clarity and may represent a difficult decision for patients receiving palliative care. Our goal was to understand how patients’ decision making about pain medications balances the pain relief from those medications against the cognitive decline often associated with them.MethodsWe conducted qualitative semi-structured interviews with patients receiving home-based palliative care from a program in Toronto, Canada. Interview recordings were transcribed and analyzed using thematic analysis.ResultsThirty-one interviews were conducted. Some patients preferred cognitive preservation over pain management because of a sense that cognition is central to their identity, the desire to maintain lucidity, a desire to continue participating in work or hobbies, and fear of addiction. Conversely, some patients preferred pain management over cognitive preservation because of a desire to avoid suffering, an inability to sleep without medications, or an acceptance of some cognitive compromise. A few patients attempted to find balance through tapering drugs, limiting their use of breakthrough analgesic doses, or using alternative strategies. ConclusionsDecision making around pain and pain management is a highly preference-sensitive process—with no clear right or wrong decisions, only the preferences of each patient. The findings from this study may influence the design of future patient-facing decision aids around pain management. Future studies should pilot interventions to better assist patients with this decision.

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Preferences of Caregivers and Patients Regarding Opioid Analgesic Use in Terminal Care

Cited by 13 publications

References 36 publications

How to identify, incorporate and report patient preferences in clinical guidelines: A scoping review

How to identify, incorporate and report patient preferences in clinical guidelines: A scoping review

The association between different opioid doses and the survival of advanced cancer patients receiving palliative care

“No Thanks, I Don’t Want to See Snakes Again”: A Qualitative Study of Pain Management Versus Preservation of Cognition in Palliative Care Patients

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