Background Palliative care patients frequently require the use of medications to suppress gastric acid production in conditions such as malignant bowel obstruction, gastrointestinal bleeding and dyspepsia.¹ The subcutaneous (SC) route is often used in palliative care patients for a variety of reasons including swallowing difficulties and poor oral absorption. SC ranitidine was previously utilised for this purpose, but is no longer manufactured, hence the need to find a suitable alternative. Proton pump inhibitors (PPIs) are commonly administered orally for these indications, but less is known about their SC use; a literature review performed in March 2023 found a paucity of published evidence. Accordingly, we sought to collect data from clinical practice to inform the production of a guideline.

Methods A 15-question bespoke survey instrument was designed and distributed to palliative care professionals working in the West Midlands. We investigated the use of SC PPIs, including familiarity with their use, indications for their use, choice of drug, adverse events, and any challenges encountered. Data was exported into Microsoft Excel for subsequent analysis.

Results Of the 73 survey respondents, 47 had never used SC PPIs before. 76% of these were either unaware of the practice or felt there was a need for a guideline. Overall, 95% of respondents desired a guideline for the use of SC PPIs and 74% of them said they would be more likely to prescribe them if a guideline was available.

Conclusions Our survey results and concomitant literature review prompted the production of a regional guideline for SC PPIs in palliative care patients. The guideline has been ratified and published by SPAGG (Specialist Palliative Care Audit and Guidelines Group) in the West Midlands. We aim to audit the use of this guideline within the next year once it has been more widely incorporated into clinical practice.

Reference

1. Wilcock A, Howard P, Charlesworth S. Palliative Care Formulary. 8th ed. Pharmaceutical Press; 2023.