A clinical audit of opioid prescription and documentation practices for patients with advanced lung cancer found infrequent reporting and patient education regarding the use of opioids.
This study was published in the Internal Medicine Journal.
For this study, investigators from the University of Melbourne conducted a retrospective record audit of outpatients with advanced non-small cell lung cancer treated at a tertiary hospital between 2015 and 2019. Overall, 1,022 patients visited the center during the study period, including 205 who were newly initiated on opioids for cancer-related symptoms during their care. The primary endpoints were risk assessment, safeguarding, and patient education upon prescription of opioids.
Reported opioid-related risk factors included previous recreational drug use (13.6%) and a history of falls (7.9%), but were infrequently documented, according to the study authors. Certain safeguards and adverse effects management practices were “variably instituted,” with 30% of patients receiving written general practitioner correspondence at opioid initiation, 91% attending clinic follow-up, and 26.8% receiving a laxative co-prescription.
Two-thirds of patients received no documented opioid education prior to initiation of treatment with opioids. There was no significant association between patient characteristics and comorbidities and the provision of opioid education. Compared to medical oncologists, palliative care doctors or nurse practitioners were eight times more likely to document opioid education (odds ratio, 8.5; P<0.0001).
In conclusion, the authors wrote, “Guideline?recommended risk assessment, safeguards, and patient education were infrequently documented when opioids were initiated. Clinician training, decision assist prompts in electronic prescribing software, and written education resources for patients may address these gaps in care.”