Introduction Serotonin syndrome (SS) is an iatrogenic, potentially life-threatening, condition associated with a number of non-specific symptoms for which there is no objective diagnostic test. The use of serotonergic medications in Palliative Care is common and therefore the risk of SS is potentially higher in this patient population, however the incidence of SS is unknown, and it may be under-recognised. Our aim was to explore the experiences of Palliative Care clinicians in diagnosing and managing SS.

Methods Recruitment was conducted through convenience sampling of specialist Palliative Care clinicians who were members of a regional professional network (the Eastern Region Palliative Medicine Development Group). Three focus groups were conducted concurrently in November 2022 (two in-person and one virtually) with a total of 16 participants, using a topic guide relating to: their clinical experiences of SS, the challenges of recognising SS, and suggestions for improving clinical practice with regards to SS. The audio recordings of these discussions were transcribed verbatim and analysed using reflexive thematic analysis in an inductive latent approach.

Results Of the 16 participants, 94% were Palliative Care Consultants and 6% were Specialty Doctors in Palliative Care, with specialist clinical experience in Palliative Care ranging from 5 to 30 years (mean 17.1 years). Analysis generated four initial themes: (1) ‘SS is unfamiliar’, (2) ‘Diagnosis of SS is easy to miss’, (3) ‘Diagnosis of SS is prompted by triggers’, and (4) ‘The importance of SS diagnosis lacks clarity’.

Conclusion The diagnosis and management of SS in Palliative Care are characterised by ambiguity. This qualitative research suggests that recognition of SS is challenging and requires purposeful consideration. As a result, it may be being overlooked, particularly in less severe cases. Suggestions to improve this include promoting a higher index of suspicion of SS, and encouraging pharmacovigilance.