Four Essential Drugs Needed for Quality Care of the Dying: A Delphi-Study Based International Expert Consensus Opinion

Abstract

Based on this consensus opinion and other literature, we suggest four drugs that should be made available in all settings caring for dying patients with cancer, to decrease the gap between knowledge and practice: morphine (i.e., an opioid), midazolam (a benzodiazepine), haloperidol (a neuroleptic), and an antimuscarinic.

Intervention to Improve Care at Life’s End in Inpatient Settings: The BEACON Trial

“…A priori, several processes of care were identified as primary and secondary endpoints to indicate quality of endof-life care 48 (Table 2) The process of writing an opioid order was chosen as the first endpoint because of the importance of pain management at end of life. We selected presence of an order rather than administration as the primary endpoint, because not every patient will need the medication.…”

Therapeutic Actions Promoted To Terminal Patient: Professional Experience At Home Care Service

“…In accordance with the effectiveness of opioid, studies indicate the morphine as the first drug to be administered to the patient in the critical phase of the illness to relieve his pain. [12,[24][25] However, the World Health Organization recommends that the analgesia directed to the patients without prospect of cure must obey clinical criteria, the intensity of the symptoms and the approach of "WHO's analgesic scale". [22] Concerning the analgesic scale, this is a proposal that adapted the use of analgesics according to the intensity of the pain, that must be evaluated by following three steps: the first one is directed to the treatment of mild pain, using non-opioid analgesics and anti-inflammatories; the second one is recommended for patients with moderate pain with the use of weak opioids, combined with non-opioid analgesics and adjuvants; and the third one is reserved for patients with severe pain, in which the weak opioids are replaced by the strong ones, like morphine, methadone, oxycodone and fentanyl, associated with non-opioid analgesics and adjuvants.…”

Letter to the Editor re “Four Essential Drugs Needed for Quality Care of the Dying: A Delphi-Study Based International Expert Consensus Opinion”

“…The recommendation that antimuscarinic agents are required to manage respiratory secretions 1 is not supported by the small number of placebo controlled observations, which suggest, at best, no benefit. Administering compounds that cross the blood-brain barrier places people at risk of adverse effects including agitation and delirium, so if a medication is to be used it should be glycopyrrolate or hyoscine butylbromide.…”