Objectives Despite the escalating public health emergency related to opioid-related deaths in Canada and the USA, opioids are essential for palliative care (PC) symptom management.
Opioid safety is the prevention, identification and management of opioid-related harms. The Delphi technique was used to develop expert consensus recommendations about how to promote opioid safety in adults receiving PC in Canada and the USA.
Methods Through a Delphi process comprised of two rounds, USA and Canadian panellists in PC, addiction and pain medicine developed expert consensus recommendations. Elected Canadian Society of Palliative Care Physicians (CSPCP) board members then rated how important it is for PC physicians to be aware of each consensus recommendation.
They also identified high-priority research areas from the topics that did not achieve consensus in Round 2.
Results The panellists (Round 1, n=23; Round 2, n=22) developed a total of 130 recommendations from the two rounds about the following six opioid-safety related domains: (1) General principles; (2) Measures for healthcare institution and PC training and clinical programmes; (3) Patient and caregiver assessments; (4) Prescribing practices; (5) Monitoring; and (6) Patients and caregiver education. Fifty-nine topics did not achieve consensus and were deemed potential areas of research. From these results, CSPCP identified 43 high-priority recommendations and 8 high-priority research areas.
Conclusions Urgent guidance about opioid safety is needed to address the opioid crisis. These consensus recommendations can promote safer opioid use, while recognising the importance of these medications for PC symptom management.
- chronic conditions
- clinical decisions
- education and training
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information
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Contributors All authors contributed to the conception or design of the work. JL and PM drafted the work, and all authors revised it critically for important intellectual content. All authors approved the final version and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding This research was funded by the Global Institute of Psychosocial Palliative and End-of-life Care (GIPPEC) Research Collaboration Grant and Temmy Latner Centre for Palliative Care.
Competing interests AF developed the Opioid Manager app that is available for sale on iTunes. This app is owned by University Health Network. AF does not receive any profits from the sales of this app.
Provenance and peer review Not commissioned; externally peer reviewed.
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