Characteristics and clinical challenges in patients with substance use disorder in palliative care-experience from a tertiary center in a high-income country.
Challenges
Palliative care
Substance use disorders
Symptoms
Vulnerable groups
Journal
BMC palliative care
ISSN: 1472-684X
Titre abrégé: BMC Palliat Care
Pays: England
ID NLM: 101088685
Informations de publication
Date de publication:
30 Jan 2024
30 Jan 2024
Historique:
received:
31
10
2023
accepted:
22
01
2024
medline:
30
1
2024
pubmed:
30
1
2024
entrez:
29
1
2024
Statut:
epublish
Résumé
Access to palliative care is often limited for challenging and vulnerable groups, including persons with substance use disorders. However, with optimized healthcare options and liberal substitution policies, this patient group is likely to increase over the upcoming years, and comorbidities will also influence the need for palliative support. Here, we aim at analyzing characteristics and specific challenges associated with substance use disorders (SUD) in palliative care. We retrospectively reviewed all patients diagnosed with substance use disorder that were treated at our Competence Center Palliative Care within the University Hospital Zurich, Switzerland between 2015 and 2021. Patient characteristics, including age, gender, duration of hospitalization, as well as specific metrics like body mass index, distinct palliative care assessment scores, and in-hospital opioid consumption were retrieved from the electronic patient files. Demographics and clinical data were analyzed by descriptive statistics, and compared to those of a control group of palliative care patients without SUD. An opioid calculator was used to standardize opioid intake based on morphine equivalents for meaningful comparisons. The primary characteristics revealed that the majority of individuals were single (56%), had no children (83%), lived alone (39%), and were either unemployed or recipients of a disability pension (in total 50%). Nicotine (89%), opioids (67%), and alcohol (67%) were the most used substances. We identified various comorbidities including psychiatric illnesses alongside SUD (56%), hepatitis A, B, or C (33%), and HIV infection (17%). Patients with SUD were significantly younger (p < 0.5), predominantly male (p < 0.05), and reported a higher prevalence of pain (p < 0.5) compared to the standard cohort of palliative patients. Regarding the challenges most frequently reported by healthcare practitioners, non-compliance, multimorbidity, challenging communication, biographical trauma, lack of social support, and unstable housing situations played a key role. Patients with SUD represent a complex and vulnerable group dealing with multiple comorbidities that profoundly affect both their physical and psychological well-being. Understanding their unique characteristics is pivotal in providing precise and suitable palliative care.
Sections du résumé
BACKGROUND
BACKGROUND
Access to palliative care is often limited for challenging and vulnerable groups, including persons with substance use disorders. However, with optimized healthcare options and liberal substitution policies, this patient group is likely to increase over the upcoming years, and comorbidities will also influence the need for palliative support. Here, we aim at analyzing characteristics and specific challenges associated with substance use disorders (SUD) in palliative care.
METHODS
METHODS
We retrospectively reviewed all patients diagnosed with substance use disorder that were treated at our Competence Center Palliative Care within the University Hospital Zurich, Switzerland between 2015 and 2021. Patient characteristics, including age, gender, duration of hospitalization, as well as specific metrics like body mass index, distinct palliative care assessment scores, and in-hospital opioid consumption were retrieved from the electronic patient files. Demographics and clinical data were analyzed by descriptive statistics, and compared to those of a control group of palliative care patients without SUD. An opioid calculator was used to standardize opioid intake based on morphine equivalents for meaningful comparisons.
RESULTS
RESULTS
The primary characteristics revealed that the majority of individuals were single (56%), had no children (83%), lived alone (39%), and were either unemployed or recipients of a disability pension (in total 50%). Nicotine (89%), opioids (67%), and alcohol (67%) were the most used substances. We identified various comorbidities including psychiatric illnesses alongside SUD (56%), hepatitis A, B, or C (33%), and HIV infection (17%). Patients with SUD were significantly younger (p < 0.5), predominantly male (p < 0.05), and reported a higher prevalence of pain (p < 0.5) compared to the standard cohort of palliative patients. Regarding the challenges most frequently reported by healthcare practitioners, non-compliance, multimorbidity, challenging communication, biographical trauma, lack of social support, and unstable housing situations played a key role.
CONCLUSION
CONCLUSIONS
Patients with SUD represent a complex and vulnerable group dealing with multiple comorbidities that profoundly affect both their physical and psychological well-being. Understanding their unique characteristics is pivotal in providing precise and suitable palliative care.
Identifiants
pubmed: 38287302
doi: 10.1186/s12904-024-01366-x
pii: 10.1186/s12904-024-01366-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
28Subventions
Organisme : Filling the Gap grant for personal protected time to CH
ID : none
Informations de copyright
© 2024. The Author(s).
Références
Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the global burden of Disease Study 2010. Lancet. 2013;382(9904):1575–86.
doi: 10.1016/S0140-6736(13)61611-6
pubmed: 23993280
Nutt DJ, King LA, Phillips LD. Independent Scientific Committee on D. Drug harms in the UK: a multicriteria decision analysis. Lancet. 2010;376(9752):1558–65.
doi: 10.1016/S0140-6736(10)61462-6
pubmed: 21036393
Jones KF, Ho JJ, Sager Z, Childers J, Merlin J. Adapting Palliative Care skills to provide substance use disorder treatment to patients with serious illness. Am J Hosp Palliat Care. 2022;39(1):101–7.
doi: 10.1177/1049909121999783
pubmed: 33685244
Magoon C, Shalev D. Toward holistic care: including substance use in mental health-palliative care integration. Palliat Support Care. 2022;20(4):453–4.
doi: 10.1017/S1478951522000591
pubmed: 35582974
pmcid: 10185337
MacCormac A. Alcohol dependence in Palliative Care: a review of the current literature. J Palliat Care. 2017;32(3–4):108–12.
doi: 10.1177/0825859717738445
pubmed: 29084484
Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649–55.
doi: 10.1097/00000421-198212000-00014
pubmed: 7165009
Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Ad Hoc EWG. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321–36.
doi: 10.1016/S0261-5614(02)00214-5
pubmed: 12765673
Hartrick CT, Kovan JP, Shapiro S. The numeric rating scale for clinical pain measurement: a ratio measure? Pain Pract. 2003;3(4):310–6.
doi: 10.1111/j.1530-7085.2003.03034.x
pubmed: 17166126
Eychmuller S. [SENS is making sense - on the way to an innovative approach to structure Palliative Care problems]. Ther Umsch. 2012;69(2):87–90.
pubmed: 22334197
Knowlton AR, Nguyen TQ, Robinson AC, Harrell PT, Mitchell MM. Pain symptoms Associated with Opioid Use among vulnerable persons with HIV: an exploratory study with implications for palliative care and opioid abuse prevention. J Palliat Care. 2015;31(4):228–33.
doi: 10.1177/082585971503100404
pubmed: 26856123
pmcid: 4778742
Hoffmann-Menzel H, Goldmann J, Kern M, Weckbecker K, Wullenweber L, Radbruch L. [Palliative care of patients receiving opioid substitution therapy]. Schmerz. 2019;33(3):263–80.
doi: 10.1007/s00482-019-0376-0
pubmed: 31098705
Cabanis M, Outadi A, Choi F. Early childhood trauma, substance use and complex concurrent disorders among adolescents. Curr Opin Psychiatry. 2021;34(4):393–9.
doi: 10.1097/YCO.0000000000000718
pubmed: 33993169
Pompili M, Innamorati M, Lester D, Serafini G, Erbuto D, Battuello M, et al. Suicide attempts in acute psychiatric referrals with substance use disorders. Riv Psichiatr. 2012;47(4):313–8.
pubmed: 23023082
Mercadante S, Arcuri E, Santoni A. Opioid-Induced Tolerance and Hyperalgesia. CNS Drugs. 2019;33(10):943–55.
doi: 10.1007/s40263-019-00660-0
pubmed: 31578704
Natoli S. Opioid use in addiction: swinging between pain under-treatment and opioids harms. Minerva Anestesiol. 2019;85(8):819–21.
doi: 10.23736/S0375-9393.19.13767-4
pubmed: 31339027
Schnoll SH, Weaver MF. Addiction and pain. Am J Addict. 2003;12(s2):27–S35.
doi: 10.1080/10550490390210218
Ballantyne JC. Preventing a prescription opioid epidemic in Switzerland. Pain. 2024;165(1):1–2.
doi: 10.1097/j.pain.0000000000003024
pubmed: 37578474
Sullivan MD, Ballantyne JC. The right to Pain Relief: its origins in End-of-life Care and Extension to Chronic Pain Care. Clin J Pain. 2021;38(1):58–63.
doi: 10.1097/AJP.0000000000001000
pubmed: 34699404
Dos Santos Barros V, Bassi-Dibai D, Guedes CLR, Morais DN, Coutinho SM, de Oliveira Simoes G, et al. Barthel Index is a valid and reliable tool to measure the functional independence of cancer patients in palliative care. BMC Palliat Care. 2022;21(1):124.
doi: 10.1186/s12904-022-01017-z
pubmed: 35820921
pmcid: 9277778
Krashin D, Murinova N, Ballantyne J. Management of pain with comorbid substance abuse. Curr Psychiatry Rep. 2012;14(5):462–8.
doi: 10.1007/s11920-012-0298-3
pubmed: 22843539
Ebenau A, Dijkstra B, Ter Huurne C, Hasselaar J, Vissers K, Groot M. Palliative care for patients with substance use disorder and multiple problems: a qualitative study on experiences of healthcare professionals, volunteers and experts-by-experience. BMC Palliat Care. 2020;19(1):8.
doi: 10.1186/s12904-019-0502-x
pubmed: 31937289
pmcid: 6961318
Schwarz T, Anzenberger J, Busch M, Gmel G, Kraus L, Krausz M, et al. Opioid agonist treatment in transition: a cross-country comparison between Austria, Germany and Switzerland. Drug Alcohol Depend. 2024;254:111036.
doi: 10.1016/j.drugalcdep.2023.111036
pubmed: 38091902
Gastberger S, Baumgartner MR, Soyka M, Quednow BB, Hulka LM, Herdener M, et al. Concomitant heroin and Cocaine Use among opioid-dependent patients during Methadone, Buprenorphine or Morphine Opioid Agonist Therapy. Eur Addict Res. 2019;25(4):207–12.
doi: 10.1159/000500542
pubmed: 31067528