Projects per year
Abstract
Background
Opioids are first choice treatment of severe pain, dyspnea and cough at the end of life. The rate and characteristics of opioid use seem to vary between patient groups and care settings, and administration is often restricted for concerns of respiratory depression and hastened death. Though the double effect principle allows physicians to adequately treat symptoms even when life shortening can be expected, terminal pain may remain undertreated. This study reports the rate and characteristics of physicians' use of opioids in patients at the end of life in Flanders, Belgium in 2007.
Methods
We performed a postal questionnaire survey among anonymous physicians certifying a large representative sample of Flemish deaths in 2007 (n=6927). Items on opioid use pertained to dose, route, time of initiation, intention and estimated degree of life shortening, if any. Patient and clinical data (age, sex, cause and place of death) were derived from the death certificates.
Results
Response rate was 58%. Opioids were administered in the last 24 hours in 62% of non-sudden deaths, most often in younger patients, cancer patients and in hospital. In patients experiencing severe pain the rate was 92% and lowest for patients dying at home and non-cancer patients who were also treated for shorter periods than cancer patients, with lower and steadier doses of mostly short-acting IV opioids. A life shortening intention with opioid use was reported in 20% of cases and was associated with a rise in dosage in the last days of life. Physicians estimated an actual life shortening effect of opioids in 55% of cases.
Discussion
This study identified older, non-cancer and out-of-hospital patients as being at higher risk of suboptimal symptom relief at the end of life. Despite evidence to the contrary, life shortening effects of opioids were still expected by physicians, leading to underuse. Palliative care programs should focus on improving knowledge about opioid treatment.
Opioids are first choice treatment of severe pain, dyspnea and cough at the end of life. The rate and characteristics of opioid use seem to vary between patient groups and care settings, and administration is often restricted for concerns of respiratory depression and hastened death. Though the double effect principle allows physicians to adequately treat symptoms even when life shortening can be expected, terminal pain may remain undertreated. This study reports the rate and characteristics of physicians' use of opioids in patients at the end of life in Flanders, Belgium in 2007.
Methods
We performed a postal questionnaire survey among anonymous physicians certifying a large representative sample of Flemish deaths in 2007 (n=6927). Items on opioid use pertained to dose, route, time of initiation, intention and estimated degree of life shortening, if any. Patient and clinical data (age, sex, cause and place of death) were derived from the death certificates.
Results
Response rate was 58%. Opioids were administered in the last 24 hours in 62% of non-sudden deaths, most often in younger patients, cancer patients and in hospital. In patients experiencing severe pain the rate was 92% and lowest for patients dying at home and non-cancer patients who were also treated for shorter periods than cancer patients, with lower and steadier doses of mostly short-acting IV opioids. A life shortening intention with opioid use was reported in 20% of cases and was associated with a rise in dosage in the last days of life. Physicians estimated an actual life shortening effect of opioids in 55% of cases.
Discussion
This study identified older, non-cancer and out-of-hospital patients as being at higher risk of suboptimal symptom relief at the end of life. Despite evidence to the contrary, life shortening effects of opioids were still expected by physicians, leading to underuse. Palliative care programs should focus on improving knowledge about opioid treatment.
| Original language | English |
|---|---|
| Pages (from-to) | 703-703 |
| Number of pages | 1 |
| Journal | Palliative Medicine |
| Volume | 28 |
| Publication status | Published - 1 Jun 2014 |
| Event | 8th world research congress of the European Association for Palliative Care (EAPC) - Lleida, Spain Duration: 5 Jun 2014 → 7 Jun 2014 |
Keywords
- opioids
- end of life
Fingerprint
Dive into the research topics of 'Opioid use in the last 24 hours of life. A large-scale retrospective survey among Belgian physicians'. Together they form a unique fingerprint.Projects
- 1 Finished
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IWT323: Monitoring the quality of end-of-life care in Flanders (MELC-study)
Leemans, K., Deliens, L., Bilsen, J., Cohen, J., Van den Block, L., Meeussen, K., Chambaere, K., Smets, T., Houttekier, D., Pousset, G. & Van Wesemael, Y.
1/09/06 → 31/08/10
Project: Fundamental