In response to this, the National Institute for Health and Clinical Excellence (NICE) have published new guidance to help ensure consistent and adequate prescribing of opioids for patients with terminal or chronic conditions. These are welcome and provide much needed clarity, especially to non-palliative healthcare professionals who work outside of the hospital setting.
It has been reported that doctors are wary of prescribing strong opioids and that non-palliative healthcare professionals need more guidance on the appropriate use of opioids. This second point was highlighted in research which explored Continuous Deep Sedation (CDS) in the UK. Whilst this practice is specifically about relieving agitated or distressed dying patients by sedating them in their last days or hours of life, the study revealed that in 20% of cases the only drug used was morphine (or similar), whereas a mixture of opioids and other drugs is recommended practice. There were no reported cases of opioid-only CDS by palliative professionals (general practice and elderly care were the specialisms reporting the highest incidents), demonstrating a gap in knowledge.
The NICE guidelines recommend better communication to patients and carers around issues such as potential side-effects and patient’s fears that opioid use implies the final stages of life. Up-front information for patients on out-of-hours care, ensuring that patients at home can receive round the clock pain relief, is also regarded as essential. Alongside this, evidence-based information on opioid use for healthcare professionals is provided to ensure consistency across all healthcare settings.
Essentially, these guidelines should help patients to have the best death possible by arming all healthcare professionals with up-to-date guidance on pain relief; and by ensuring that patients have the necessary information to make informed decisions about their care.