Essential medications in palliative care: an updated survey of Australian and New Zealand medical practitioners practising palliative care.

BACKGROUND

Palliative care patients experience complex symptoms requiring varied pharmacological management. Medication choice depends on the underlying aetiology of symptoms, guideline recommendations, clinician preference and medication availability.

AIM: The aim of this study was to canvass the views of practising Australian and New Zealand medical practitioners practising palliative care regarding the medications they perceive to be essential for managing prevalent end-of-life symptoms, in an update to a previous clinician survey conducted in 2000. This study also canvassed respondents' views on whether patients experienced difficulties accessing these medications.

METHODS

A cross-sectional survey was conducted in 2022 among current members of the Australian and New Zealand Society of Palliative Medicine (ANZSPM). The questionnaire explored ideal pharmacological management for 19 different symptoms experienced at the end of life. A descriptive analysis of results was calculated in SPSS version 28.0.

RESULTS

Survey reponses were received from 13.5% of ANZSPM members. For most symptoms (n = 70), a large number of medications were listed as essential. The most concordant first-ranked medications included hyoscine butylbromide for noisy breathing (48.8%), benzodiazepines for breathlessness (nominated by respondents as a class, 41.2%), dexamethasone for cachexia (36.4%) and morphine for cough (35.5%). Respondents most frequently indicated there was no essential medication for oral ulceration, dry mouth, delirium and anorexia. Lidocaine for oral ulceration was ranked the most difficult for patients to access in the community (85.7%).

CONCLUSIONS

There remains various opinions on essential medications for palliative care. This suggests the need for ongoing research to reach an evidence-based consensus for clinical practice.