• J Pain Symptom Manage · Oct 2024

    Use of Essential Medicines for Pain Relief and Palliative Care: a global consensus process.

    • Tania Pastrana, Liliana De Lima, Deborah Dudgeon, Anna Voeuk, Ebtesam Ahmed, and Lukas Radbruch.
    • Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany; International Association for Hospice and Palliative Care, Houston, USA. Electronic address: tpastrana@ukaachen.de.
    • J Pain Symptom Manage. 2024 Oct 30.

    BackgroundThe WHO Model List of Essential Medicines includes 24 medications under the section Medicines for Pain and Palliative Care (EML). The Lancet Commission on Pain and Palliative Care developed the Lancet Essential Package (LEP), including 35 medications designed to alleviate serious health-related suffering worldwide.AimThis study aims to provide recommendations on the appropriate use of essential of medicines in palliative care.MethodsThe global palliative care community was invited to submit guidelines, of which 19/22 were selected. Data was extracted on initial dose, frequency, and maximum daily dose for medications in the LEP and in the WHO EML. For medications where guidance was not available or information differed, a 2-round Delphi process was conducted with 70 experts across regions and income levels. Consensus was set to ≥70% agreement.ResultsConsensus in the guidelines was identified for 24 medications on three parameters. Open questions (mostly on maximum daily dose) were included in the Delphi. 63 experts from 49 countries responded (RR=90%). No consensus was achieved for the maximum daily dose for nine medications. Significant disparities in medication availability were noted between high-income and low/middle-income countries.ConclusionWe were able to partly achieve our goal, with limited evidence and a wide range of clinical practice described by the experts. This highlights an important gap in critical information which affects mostly the provision of palliative care at the primary care. Both limited availability and lack of training on the adequate use of essential medications may affect how clinicians manage symptoms, possibly relying on personal experience or trial and error, rather than evidence-based information.Copyright © 2024. Published by Elsevier Inc.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…