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Opioid underuse in terminal care of long-term care facility residents with pain and/or dyspnoea : a cross-sectional PACE-survey in six European countries

(2020) PALLIATIVE MEDICINE. 34(6). p.784-794
Author
Organization
Abstract
Background/objectives: Opioids relieve symptoms in terminal care. We studied opioid underuse in long-term care facilities, defined as residents without opioid prescription despite pain and/or dyspnoea, 3 days prior to death. Design and setting: In a proportionally stratified randomly selected sample of long-term care facilities in six European Union countries, nurses and long-term care facility management completed structured after-death questionnaires within 3 months of residents' death. Measurements: Nurses assessed pain/dyspnoea with Comfort Assessment in Dying with Dementia scale and checked opioid prescription by chart review. We estimated opioid underuse per country and per symptom and calculated associations of opioid underuse by multilevel, multivariable analysis. Results: Nurses' response rate was 81.6%, 95.7% for managers. Of 901 deceased residents with pain/dyspnoea reported in the last week, 10.6% had dyspnoea, 34.4% had pain and 55.0% had both symptoms. Opioid underuse per country was 19.2% (95% confidence interval: 12.9-27.2) in the Netherlands, 25.2% (18.3-33.6) in Belgium, 29.3% (16.9-45.8) in England, 33.7% (26.2-42.2) in Finland, 64.6% (52.0-75.4) in Italy and 79.1% (71.2-85.3) in Poland (p < 0.001). Opioid underuse was 57.2% (33.0-78.4) for dyspnoea, 41.2% (95% confidence interval: 21.9-63.8) for pain and 37.4% (19.4-59.6) for both symptoms (p = 0.013). Odds of opioid underuse were lower (odds ratio: 0.33; 95% confidence interval: 0.20-0.54) when pain was assessed. Conclusion: Opioid underuse differs between countries. Pain and dyspnoea should be formally assessed at the end-of-life and taken into account in physicians orders.
Keywords
Anesthesiology and Pain Medicine, General Medicine, Opioids, opioid underuse, older adults, nursing home, end-of-life, OF-LIFE CARE, NURSING-HOME RESIDENTS, PALLIATIVE CARE, SYMPTOM RELIEF, OLDER-PEOPLE, MANAGEMENT, DEMENTIA, REGISTER, MEDICATIONS, DEFINITION

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MLA
Tanghe, Marc, et al. “Opioid Underuse in Terminal Care of Long-Term Care Facility Residents with Pain and/or Dyspnoea : A Cross-Sectional PACE-Survey in Six European Countries.” PALLIATIVE MEDICINE, vol. 34, no. 6, 2020, pp. 784–94, doi:10.1177/0269216320910332.
APA
Tanghe, M., Van Den Noortgate, N., Deliens, L., Smets, T., Onwuteaka-Philipsen, B., Szczerbińska, K., … Piers, R. (2020). Opioid underuse in terminal care of long-term care facility residents with pain and/or dyspnoea : a cross-sectional PACE-survey in six European countries. PALLIATIVE MEDICINE, 34(6), 784–794. https://doi.org/10.1177/0269216320910332
Chicago author-date
Tanghe, Marc, Nele Van Den Noortgate, Luc Deliens, Tinne Smets, Bregje Onwuteaka-Philipsen, Katarzyna Szczerbińska, Harriet Finne-Soveri, et al. 2020. “Opioid Underuse in Terminal Care of Long-Term Care Facility Residents with Pain and/or Dyspnoea : A Cross-Sectional PACE-Survey in Six European Countries.” PALLIATIVE MEDICINE 34 (6): 784–94. https://doi.org/10.1177/0269216320910332.
Chicago author-date (all authors)
Tanghe, Marc, Nele Van Den Noortgate, Luc Deliens, Tinne Smets, Bregje Onwuteaka-Philipsen, Katarzyna Szczerbińska, Harriet Finne-Soveri, Sheila Payne, Giovanni Gambassi, Lieve Van den Block, and Ruth Piers. 2020. “Opioid Underuse in Terminal Care of Long-Term Care Facility Residents with Pain and/or Dyspnoea : A Cross-Sectional PACE-Survey in Six European Countries.” PALLIATIVE MEDICINE 34 (6): 784–794. doi:10.1177/0269216320910332.
Vancouver
1.
Tanghe M, Van Den Noortgate N, Deliens L, Smets T, Onwuteaka-Philipsen B, Szczerbińska K, et al. Opioid underuse in terminal care of long-term care facility residents with pain and/or dyspnoea : a cross-sectional PACE-survey in six European countries. PALLIATIVE MEDICINE. 2020;34(6):784–94.
IEEE
[1]
M. Tanghe et al., “Opioid underuse in terminal care of long-term care facility residents with pain and/or dyspnoea : a cross-sectional PACE-survey in six European countries,” PALLIATIVE MEDICINE, vol. 34, no. 6, pp. 784–794, 2020.
@article{8658922,
  abstract     = {{Background/objectives:

Opioids relieve symptoms in terminal care. We studied opioid underuse in long-term care facilities, defined as residents without opioid prescription despite pain and/or dyspnoea, 3 days prior to death.

Design and setting:

In a proportionally stratified randomly selected sample of long-term care facilities in six European Union countries, nurses and long-term care facility management completed structured after-death questionnaires within 3 months of residents' death.

Measurements:

Nurses assessed pain/dyspnoea with Comfort Assessment in Dying with Dementia scale and checked opioid prescription by chart review. We estimated opioid underuse per country and per symptom and calculated associations of opioid underuse by multilevel, multivariable analysis.

Results:

Nurses' response rate was 81.6%, 95.7% for managers. Of 901 deceased residents with pain/dyspnoea reported in the last week, 10.6% had dyspnoea, 34.4% had pain and 55.0% had both symptoms. Opioid underuse per country was 19.2% (95% confidence interval: 12.9-27.2) in the Netherlands, 25.2% (18.3-33.6) in Belgium, 29.3% (16.9-45.8) in England, 33.7% (26.2-42.2) in Finland, 64.6% (52.0-75.4) in Italy and 79.1% (71.2-85.3) in Poland (p < 0.001). Opioid underuse was 57.2% (33.0-78.4) for dyspnoea, 41.2% (95% confidence interval: 21.9-63.8) for pain and 37.4% (19.4-59.6) for both symptoms (p = 0.013). Odds of opioid underuse were lower (odds ratio: 0.33; 95% confidence interval: 0.20-0.54) when pain was assessed.

Conclusion:

Opioid underuse differs between countries. Pain and dyspnoea should be formally assessed at the end-of-life and taken into account in physicians orders.}},
  articleno    = {{026921632091033}},
  author       = {{Tanghe, Marc and Van Den Noortgate, Nele and Deliens, Luc and Smets, Tinne and Onwuteaka-Philipsen, Bregje and Szczerbińska, Katarzyna and Finne-Soveri, Harriet and Payne, Sheila and Gambassi, Giovanni and Van den Block, Lieve and Piers, Ruth}},
  issn         = {{0269-2163}},
  journal      = {{PALLIATIVE MEDICINE}},
  keywords     = {{Anesthesiology and Pain Medicine,General Medicine,Opioids,opioid underuse,older adults,nursing home,end-of-life,OF-LIFE CARE,NURSING-HOME RESIDENTS,PALLIATIVE CARE,SYMPTOM RELIEF,OLDER-PEOPLE,MANAGEMENT,DEMENTIA,REGISTER,MEDICATIONS,DEFINITION}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{026921632091033:784--026921632091033:794}},
  title        = {{Opioid underuse in terminal care of long-term care facility residents with pain and/or dyspnoea : a cross-sectional PACE-survey in six European countries}},
  url          = {{http://doi.org/10.1177/0269216320910332}},
  volume       = {{34}},
  year         = {{2020}},
}

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