Opioids in advanced lung malignancy: a clinical audit of opioid prescription, patient education and safeguarding

Anil, N; Smallwood, N; Dunn, S

Author(s): Anil, N; Smallwood, N; Dunn, S;
Details: Publication Year 2022-10,Volume 52,Issue #10,Page 1698-1706
Journal Title: Internal Medicine Journal
Publication Type: Research article
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.
Keywords: Humans; Analgesics, Opioid/adverse effects; Retrospective Studies; Laxatives; *Carcinoma, Non-Small-Cell Lung/drug therapy; *Lung Neoplasms/drug therapy; Patient Education as Topic; Prescriptions; Clinical Audit; Practice Patterns, Physicians'; lung neoplasm; opioid; palliative care
Department(s): Palliative Care
PubMed ID: 33974353
Publisher's Version: https://doi.org/10.1111/imj.15354
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-09-26 05:45:08

Last Modified: 2024-09-26 05:48:04