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Prescribing for nausea in palliative care: A cross-sectional national survey of australian palliative medicine doctors

Journal Article


Abstract


  • Background: Nausea can be a debilitating symptom for patients with a life-limiting illness. While addressing reversible components, nonpharmacological strategies and antiemetics are the main therapeutic option. The choice of medication, dose, and route of administration remain highly variable. Objective: The aim of this study was to codify the current clinical approaches and quantify any variation found nationally. Methods: A cross-sectional study utilizing a survey of palliative medicine clinicians examined prescribing preferences for nausea using a clinical vignette. Respondent characteristics, the use of nonpharmacological interventions, first-and second-line antiemetic choices, commencing and maximal dose, and time to review were collected.Results: Responding clinicians were predominantly working in palliative medicine across a range of settings with a 49% response rate (105/213). The main nonpharmacological recommendation was "small, frequent snacks." Metoclopramide was the predominant first-line agent (69%), followed by haloperidol (26%), while second-line haloperidol was the predominant agent (47%), with wide variation in other nominated agents. Respondents favoring metoclopramide as first-line tended to use haloperidol second-line (65%), but not vice versa. Maximal doses for an individual antiemetic varied up to tenfold.Conclusion: For nausea, a commonly encountered symptom in palliative care, clinicians' favored metoclopramide and haloperidol; however, after these choices, there was large variation in antiemetic selection. While most clinicians recommended modifying meal size and frequency, use of other nonpharmacological therapies was limited.

Publication Date


  • 2014

Citation


  • To, T. H. M., Agar, M., Yates, P., & Currow, D. C. (2014). Prescribing for nausea in palliative care: A cross-sectional national survey of australian palliative medicine doctors. Journal of Palliative Medicine, 17(9), 1032-1036. doi:10.1089/jpm.2013.0610

Scopus Eid


  • 2-s2.0-84907013364

Start Page


  • 1032

End Page


  • 1036

Volume


  • 17

Issue


  • 9

Place Of Publication


Abstract


  • Background: Nausea can be a debilitating symptom for patients with a life-limiting illness. While addressing reversible components, nonpharmacological strategies and antiemetics are the main therapeutic option. The choice of medication, dose, and route of administration remain highly variable. Objective: The aim of this study was to codify the current clinical approaches and quantify any variation found nationally. Methods: A cross-sectional study utilizing a survey of palliative medicine clinicians examined prescribing preferences for nausea using a clinical vignette. Respondent characteristics, the use of nonpharmacological interventions, first-and second-line antiemetic choices, commencing and maximal dose, and time to review were collected.Results: Responding clinicians were predominantly working in palliative medicine across a range of settings with a 49% response rate (105/213). The main nonpharmacological recommendation was "small, frequent snacks." Metoclopramide was the predominant first-line agent (69%), followed by haloperidol (26%), while second-line haloperidol was the predominant agent (47%), with wide variation in other nominated agents. Respondents favoring metoclopramide as first-line tended to use haloperidol second-line (65%), but not vice versa. Maximal doses for an individual antiemetic varied up to tenfold.Conclusion: For nausea, a commonly encountered symptom in palliative care, clinicians' favored metoclopramide and haloperidol; however, after these choices, there was large variation in antiemetic selection. While most clinicians recommended modifying meal size and frequency, use of other nonpharmacological therapies was limited.

Publication Date


  • 2014

Citation


  • To, T. H. M., Agar, M., Yates, P., & Currow, D. C. (2014). Prescribing for nausea in palliative care: A cross-sectional national survey of australian palliative medicine doctors. Journal of Palliative Medicine, 17(9), 1032-1036. doi:10.1089/jpm.2013.0610

Scopus Eid


  • 2-s2.0-84907013364

Start Page


  • 1032

End Page


  • 1036

Volume


  • 17

Issue


  • 9

Place Of Publication