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Tranung M, Solheim TS, Løhre ET, Marsaa K, Faksvåg Haugen D, Laird B, Thronæs M, Due Larsen M. Midazolam Indications and Dosing in Palliative Medicine: Results from a Multinational Survey. Curr Oncol 2024; 31:4093-4104. [PMID: 39057177 PMCID: PMC11276578 DOI: 10.3390/curroncol31070305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/10/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Despite sparse evidence and limited guidance on indications, use, and dosing, midazolam is widely used in palliative care. We aimed to describe and compare the use of midazolam in three different countries to improve clinical practice in palliative care. We performed an online survey among palliative care physicians in Norway, Denmark, and the United Kingdom (UK). The focus was indications, dosing, administration, and concomitant drugs. A web-based questionnaire was distributed to members of the respective national palliative medicine associations. The total response rate was 9.4%. Practices in the UK, Norway, and Denmark were overall similar regarding the indications of midazolam for anxiety, dyspnoea, and pain treatment in combination with opioids. However, physicians in the UK used a higher starting dose for anxiety, dyspnoea, and pain treatment compared to Norway and Denmark, as well as a higher maximum dose. Danish physicians preferred, to a higher degree, on-demand midazolam administration. Despite practice similarities in the UK, Norway, and Denmark, differences exist for midazolam dosing and administration in palliative medicine. We demonstrated a lack of consensus on how midazolam should be used in palliative care, setting the stage for future studies on the topic.
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Affiliation(s)
- Morten Tranung
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7034 Trondheim, Norway; (T.S.S.); (E.T.L.); (M.T.); (M.D.L.)
- Department of Clinical Pharmacy, Trondheim Hospital Pharmacy, 7030 Trondheim, Norway
| | - Tora Skeidsvoll Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7034 Trondheim, Norway; (T.S.S.); (E.T.L.); (M.T.); (M.D.L.)
- Cancer Clinic, Trondheim University Hospital, St. Olavs Hospital, 7030 Trondheim, Norway
| | - Erik Torbjørn Løhre
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7034 Trondheim, Norway; (T.S.S.); (E.T.L.); (M.T.); (M.D.L.)
- Cancer Clinic, Trondheim University Hospital, St. Olavs Hospital, 7030 Trondheim, Norway
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, 5006 Bergen, Norway
| | - Kristoffer Marsaa
- Department of Multidisease, Copenhagen University Hospital—North Zealand, 3400 Hilleroed, Denmark;
| | - Dagny Faksvåg Haugen
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, 5009 Bergen, Norway;
- Department of Clinical Medicine K1, University of Bergen, 5007 Bergen, Norway
| | - Barry Laird
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH8 9YL, UK;
| | - Morten Thronæs
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7034 Trondheim, Norway; (T.S.S.); (E.T.L.); (M.T.); (M.D.L.)
- Cancer Clinic, Trondheim University Hospital, St. Olavs Hospital, 7030 Trondheim, Norway
| | - Michael Due Larsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7034 Trondheim, Norway; (T.S.S.); (E.T.L.); (M.T.); (M.D.L.)
- Centre for Clinical Epidemiology, Odense University Hospital, 5000 Odense, Denmark
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Adsersen M, Hansen MB, Neergaard MA, Sjøgren P, Guldin MB, Groenvold M. The first decade of the Danish Palliative Care Database: improvements and ongoing challenges in the quality and use of specialised palliative care. Acta Oncol 2024; 63:259-266. [PMID: 38698699 PMCID: PMC11332489 DOI: 10.2340/1651-226x.2024.28515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/05/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Danish Palliative Care Database comprises five quality indicators: (1) Contact with specialised palliative care (SPC) among referred patients, (2) Waiting time of less than 10 days, (3) Proportion of patients who died from (A) cancer or (B) non-cancer diseases, and had contact with SPC, (4) Proportion of patients completing the patient-reported outcome measure at baseline (EORTC QLQ-C15-PAL), and (5) Proportion of patients discussed at a multidisciplinary conference. PURPOSE To investigate changes in the quality indicators from 2010 until 2020 in cancer and non-cancer patients. Patients/material: Patients aged 18+ years who died from 2010 until 2020. METHOD Register-based study with the Danish Palliative Care Database as the main data source. Indicator changes were reported as percentage fulfilment. RESULTS From 2010 until 2020, the proportion of patients with non-cancer diseases in SPC increased slightly (2.5-7.2%). In 2019, fulfilment of the five indicators for cancer and non-cancer were: (1) 81% vs. 73%; (2) 73% vs. 68%; (3A) 50%; (3B) 2%; (4) 73% vs. 66%; (5) 73% vs. 65%. Whereas all other indicators improved, the proportion of patients waiting less than 10 days from referral to contact decreased. Differences between type of unit were found, mainly lower for hospice. INTERPRETATION Most patients in SPC had cancer. All indicators except waiting time improved during the 10-year period. The establishment of the Danish Palliative Care Database may have contributed to the positive development; however, SPC in Denmark needs to be improved, especially regarding a reduction in waiting time and enhanced contact for non-cancer patients.
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Affiliation(s)
- Mathilde Adsersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Maiken Bang Hansen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mette Asbjoern Neergaard
- Palliative Care Unit, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Per Sjøgren
- Section of Palliative Medicine, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, Aarhus and Institute for Public Health, Aarhus University, Denmark
| | - Mogens Groenvold
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Sørensen DM, Dalton SO, Egholm CL, Bidstrup P, Brodersen JB, Rosted E. Barriers and facilitators to national guideline implementation for palliative cancer care in a Danish cross-sectoral healthcare setting: A qualitative study of healthcare professionals' experiences. Psychooncology 2024; 33:e6267. [PMID: 38078707 DOI: 10.1002/pon.6267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Patients with incurable cancer should receive general palliative care according to their needs, as provided through collaboration between hospital departments, municipalities, and general practices and as outlined in national guidelines. However, the implementation of general palliative care in Denmark has been inadequate. This study aimed to investigate the healthcare professionals' (HCPs') perceptions on barriers to and facilitators of the implementation of the Danish National Guideline (NG) for general palliative care. METHODS This descriptive, qualitative study was guided by the Consolidated Framework for Implementation Research (CFIR). Qualitative focus group and individual interviews were conducted with 23 HCPs. The interview guide, coding, analysis, and reporting of findings were developed within the CFIR framework. RESULTS The main barriers to implementing NG were as follows: lack of knowledge about the NG, lack of an implementation plan, and insufficient communication and collaboration across sectors. Important facilitators were as follows: HCP motivation to meet palliative care needs, HCPs with special functions taking responsibility for incorporating NG into local guidelines, and the role of district nurses specialised in palliative care as opinion leaders providing security and continuity for the HCPs working in palliative care. CONCLUSIONS To address the needs of patients with incurable cancer, greater efforts are required on implementing general palliative care. Although HCPs in our setting were motivated to improve NG implementation, financial resources and strategies are necessary to ensure sufficient knowledge uptake and accommodate identified barriers in order to translate the NG into practice.
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Affiliation(s)
- Dina Melanie Sørensen
- Danish Research Center for Equality in Cancer (COMPAS), Zealand University Hospital, Naestved, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Susanne Oksbjerg Dalton
- Danish Research Center for Equality in Cancer (COMPAS), Zealand University Hospital, Naestved, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health, Copenhagen University, Copenhagen, Denmark
| | - Cecilie Lindström Egholm
- REHPA, Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Pernille Bidstrup
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - John Brandt Brodersen
- The Centre of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
- Research Unit for General Practice, Region Zealand, Denmark
- Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT Arctic University of Norway, Tromsø, Norway
| | - Elizabeth Rosted
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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