ABSTRACT
Context: There is a lack of consensus about the appropriate moment to assess a potential wish to hasten death (WTHD) in patients with life-threatening illness, despite evidence of its positive appraisal among patients. Objectives: To evaluate the practical potential and acceptability of questions about the WTHD in the first palliative care (PC) clinical encounter. Design: A proof-of-concept single-arm unmasked trial. Subjects: We enrolled 30 advanced cancer patients, 16 inpatients and 14 outpatients in their first PC clinical encounter. Measurements: We assessed the WTHD using a semistructured interview guide, the Assessment of the Frequency and Extent of the Desire to Die (AFEDD) embedded in a multidimensional needs assessment carried out during the first PC encounter. Information about practical potential [patients consider the assessment (a) important and (b) helpful] and acceptability [patients (a) understand and (b) are not bothered by the questions] was obtained. Results: Thirty-two patients were approached and 30 (94%) agreed to participate. The WTHD was present in two outpatients and eight inpatients. The question to assess WTHD were well understood by 94% of patients and was considered not bothersome by 87% and quite or very helpful by 80%, regardless of whether they had WTHD. Conclusions: The results support that clinicians can integrate screening for the WTHD in usual clinical practice within a multidimensional needs assessment. Patient acceptability suggests that this as a part of patient-centered care including in the first PC clinical encounter. Further studies are needed to confirm efficacy and safety in larger and different populations.
Subject(s)
Neoplasms , Palliative Care , Attitude to Death , Humans , Neoplasms/therapy , Proof of Concept Study , Terminally IllABSTRACT
El estreñimiento inducido por opioides (EIO) constituye un problema clínico emergente que empeora la calidad de vida de los pacientes que requieren el uso de opioides para el manejo del dolor. Diferentes fármacos se han comercializado como antagonistas de los receptores opioides Mu periféricos, conocidos con el nombre de Peripheral Acting Mu Opioid Receptor Antagonists o PAMORA (metilnaltrexona, alvimopam y más recientemente naloxegol), que permiten la antagonización de los efectos periféricos de los opioides sin interferir en su efecto analgésico. Tanto metilnaltrexona como naloxegol han sido aprobados para el tratamiento del EIO, mientras que alvimopan está aprobado para la recuperación gastrointestinal después de resección intestinal con anastomosis primaria. Todos ellos han mostrado su eficacia clínica, pero es debatido el papel que han de tener en la estrategia global del manejo del EIO. Se revisa la información disponible sobre los PAMORA y se propone estrategia de uso clínico
The opioid induced constipation (OIC) is an emerging clinical problems that worsen the patients' quality of life requiring opioids for their pain relief. Many drugs have been launched as Peripheral Acting Mu Opioid Receptor Antagonists o PAMORAs (metylnaltrexone, alvimopam and more recently naloxegol), which antagonize the peripheral effects of opioids without affecting the opioids analgesia. Metylnaltrenone and naloxegol have been licensed for the treatment of CIO, meanwhile alvimopam is approved for the recovery of postoperative ileus after major abdominal surgery. All PAMORAs have shown clinical efficacy but is a matter of debate wich should be their role in the manangement of the CIO. The available information about PAMORAs is reviewed and informed strategy on the use of these drugs is proposed
