Four Essential Drugs Needed for Quality Care of the Dying: A Delphi-Study Based International Expert Consensus Opinion
Publication: Journal of Palliative Medicine
Volume 16, Issue Number 1
Abstract
Purpose: The majority of dying patients do not have access to necessary drugs to alleviate their most common symptoms, despite evidence of drug efficacy. Our aim was to explore the degree of consensus about appropriate pharmacological treatment for common symptoms in the last days of life for patients with cancer, among physicians working in specialist palliative care.
Material and methods: Within OPCARE9, a European Union seventh framework project aiming to optimize end-of-life cancer care, we conducted a Delphi survey among 135 palliative care clinicians in nine countries. Physicians were initially asked about first and second choice of drugs to alleviate anxiety, dyspnea, nausea and vomiting, pain, respiratory tract secretions (RTS), as well as terminal restlessness.
Results: Based on a list of 35 drugs mentioned at least twice in the first round (n=93), a second Delphi round was performed to determine ≤5 essential drugs for symptom alleviation in the last 48 hours of life that should be available even outside specialist palliative care. There was ≥80% consensus among the participants (n=90) regarding morphine, midazolam, and haloperidol as essential drugs. For RTS, there was consensus about use of an antimuscarinic drug, with 9%–27% of the physicians each choosing one of four different drugs.
Conclusion: Based on this consensus opinion and other literature, we suggest four drugs that should be made available in all settings caring for dying patients with cancer, to decrease the gap between knowledge and practice: morphine (i.e., an opioid), midazolam (a benzodiazepine), haloperidol (a neuroleptic), and an antimuscarinic.
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Information & Authors
Information
Published In
Journal of Palliative Medicine
Volume 16 • Issue Number 1 • January 2013
Pages: 38 - 43
PubMed: 23234300
Copyright
Copyright 2013, Mary Ann Liebert, Inc.
History
Published online: 14 January 2013
Published in print: January 2013
Published ahead of print: 12 December 2012
Accepted: 17 August 2012
Topics
Authors
Author Disclosure Statement
OPCARE9 is a coordination and support action project funded by Framework Programme 7, European Union. No conflicting financial interests exist.
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