Development of a Saudi Palliative Care Essential Medication List (EML)

Abstract

Background:In response to the request of the Saudi Health Council, an expert palliative multi-disciplinary central committee was created to develop a model of the essential Saudi palliative medication list (EML), to be updated every 2 years, based on the World Health Organization (WHO) criteria for EML.Objectives: Our aim was to explore the degree of consensus among physicians involved in palliative care (PC) regarding appropriate pharmacological treatment for common symptoms of palliative patients with cancer and to thus develop a national medication list of essential medicines for PC based on expert opinion. This list will serve as a key for future decision making in clinical practice. Methods:We conducted a descriptive cross-sectional study of all consultants from July 2020 to August 2020. A structured questionnaire was used to collect the data, which were analyzed using Statistical Package for the Social Sciences (SPSS) version 25. Results:The top palliative consultant experts in the Kingdom of Saudi Arabia participated in the study, with a high level of consensus among the experts. More than 60 medications were included in the review. The survey influenced the PC medication list following consensus. The preference for a medication was grouped into three categories-mandatory, necessary, and optional-based on administration frequency and the specified categories. The "mandatory" medications such as baclofen tablets, loperamide, ibuprofen tablets, midazolam injections, Tylenol III and fentanyl injections, morphine injections, morphine (IR) syrup, and morphine (SR) tablets were considered. The "necessary" medications such as modafinil tablets, morphine (SR) 60 mg, megestrol, and prednisone were considered. The "optional" medications included the following: fentanyl 500 mcg injections, hydrocortisone cream, and atropine eye drops. Conclusions:The drugs prescribed and reported in this survey can be incorporated with the WHO EML, which in turn can lead to a constructive change in local drug policies and provide a basis for the minimum standard of care for PC institutions.