Professionals’, patients’ and families’ views on the use of opioids for chronic breathlessness: A systematic review using the framework method and pillar process

Abstract

Background: In combination with non-pharmacological interventions, opioids may safely reduce chronic breathlessness in patients with severe illness. However, implementation in clinical practice varies. Aim: To synthesise the published literature regarding health professionals’, patients’ and families’ views on the use of opioids for chronic breathlessness, identifying issues which influence implementation in clinical practice. Design: Systematic review and synthesis using the five-stage framework synthesis method. Data sources: Three electronic databases (MEDLINE, Embase via OVID, ASSIA via Proquest) were searched (March 2020) using a predefined search strategy. Studies were also citation chained from key papers. Papers were screened against a priori eligibility criteria. Data were extracted from included studies using the framework synthesis method. Qualitative and quantitative data were synthesised using the pillar process. Included studies were critically appraised using the Mixed-Methods Appraisal Tool. Results: After de-duplication, 843 papers were identified. Following screening, 22 studies were included. Five themes were developed: (i) clinician/patient characteristics, (ii) education/knowledge/experience, (iii) relationship between clinician/family, (iv) clinician/patient fear of opioids and (v) regulatory issues. Conclusions: There are significant barriers and enablers to the use of opioids for the symptomatic reduction of chronic breathlessness based on the knowledge, views and attitudes of clinicians, patients and families. Clinicians’ interactions with patients and their families strongly influences adherence with opioid treatment regimens for chronic breathlessness. Clinicians’, patients’ and families’ knowledge about the delicate balance between benefits and risks is generally poor. Education for all, but particularly clinicians, is likely to be a necessary (but insufficient) factor for improving implementation in practice.

Patients’ and their caregivers’ experiences with regular, low-dose, sustained-release morphine for chronic breathlessness associated with COPD: a qualitative study

“…Additionally, for people who do express concerns, information about the low doses used for chronic breathlessness may be sufficient to reassure them. In any case, support from treating clinicians seems to be critical before initiating the study medication 42 43. However, after experiencing net benefit, some participants may want to continue taking morphine even when they face clinicians’ resistance.…”

Palliative home care for older patients with respiratory disease in Japan: Practices and opinions of physicians

“…While opioid abuse has become a social problem in the United States, opioids are still underused in Japan 23 . The obstacle to education on effective opioid prescriptions seems to be a strong belief that opioids are taboo for respiratory disease patients because of their suppression of respiratory function 24 . Academic societies related to palliative and home care must inform patients that there are patients who benefit from opioid prescriptions and promote the proper use of opioids.…”

“…23 The obstacle to education on effective opioid prescriptions seems to be a strong belief that opioids are taboo for respiratory disease patients because of their suppression of respiratory function. 24 Academic societies related to palliative and home care must inform patients that there are patients who benefit from opioid prescriptions and promote the proper use of opioids. The Japanese Association for Home Care Medicine should establish an educational program on respiratory palliative care for end-of-life home care for patients with non-malignant diseases.…”

Implementation and Knowledge of the Clinical Practice Guide for Palliative Care in the Ecuadorian Primary Care Level

“…In the literature that was consulted, the importance of this personnel possessing adequate knowledge to improve quality of life and reduce anguish has been highlighted [ 19 ]. Few of them treat agony, dyspnea, and delirium, being necessary to know correct management of the opioids that help alleviate suffering [ 24 , 25 ]; for them, training should be addressed that removes the myths and erroneous concepts around the use of these substances, such as those related to addiction to morphine derived from its use [ 26 ]. During the 67th World Health Assembly, the WHO urged the countries to ensure funding and allocate resources that include availability of essential medications for symptom relief [ 10 ].…”