Abstract
Background: Opioids have an important role in symptom management for people with advanced cancer. Clinical guidelines recommend patient education to ensure the safe use of opioids; however, no Australian studies have explored current education and safeguarding practices when opioids are initiated to advanced cancer patients. Aims: To investigate risk assessment, safeguarding and education practices when opioids are first prescribed to advanced lung cancer patients. Methods: A retrospective medical record audit of outpatients with advanced non-small cell lung cancer seen at a tertiary Australian hospital between 1 January 2015 and 31 December 2019 and prescribed strong opioids for cancer-related symptoms. Results: Of 1022 patients attending the lung cancer clinic, 205 were newly initiated on an opioid. Opioid-related risks including previous recreational drug use (28; 13.6%) and history of falls (16; 7.9%) were infrequently documented. Opioid-related safeguards and adverse effects management were variably instituted: written general practitioner correspondence at opioid initiation (62; 30%), clinic follow up (186; 91%) and laxative co-prescription (55; 26.8%). Most patients (137; 66.8%) received no documented opioid education on drug initiation. There was no association between age (P = 0.653), number of comorbidities (P = 0.569) or chronic alcohol use (P = 0.263) and the provision of education on opioid initiation. Palliative care doctors or nurse practitioners were eight times more likely to document opioid education than medical oncologists (odds ratio = 8.5; confidence interval = 2.9–24.8; P < 0.0001). Conclusion: Guideline-recommended risk assessment, safeguards and patient education were infrequently documented when opioids were initiated. Clinician training, decision-assist prompts in electronic prescribing software and written education resources for patients may address these gaps in care.
Original language | English |
---|---|
Pages (from-to) | 1698-1706 |
Number of pages | 25 |
Journal | Internal Medicine Journal |
Volume | 52 |
Issue number | 10 |
DOIs | |
Publication status | Published - Oct 2022 |
Externally published | Yes |
Keywords
- lung neoplasm
- opioid
- palliative care
- patient education as topic