Practice patterns of strong opioid recommendations by palliative care consultation services in German hospitals (online survey).

Abstract

Background: Strong opioids are central to effective symptom control in palliative care. In cases of complex symptom burden, primary care teams frequently rely on palliative care consultation services (PCCSs) for expert guidance. This survey explored the recommendations issued by hospital-based PCCS teams regarding the use of strong opioids in patients with advanced disease (e.g. clinical indications, opioid agent).

Methods: A closed online survey was conducted via the SoSci Survey platform. All PCCS teams registered with the German Association for Palliative Medicine were invited to participate in November 2024, with a reminder sent three weeks later.

Results: Thirty-nine PCCS teams participated (21 university hospitals, 18 general hospitals). All respondents agreed on the indication for strong opioids in cancer-related pain and dyspnea. Differences emerged regarding the use of opioids in patients with non-malignant conditions: although most PCCS considered opioids appropriate for dyspnea associated with pulmonary (n = 37) or cardiac disease (n = 33), non-cancer pain was less consistently endorsed (n = 20). Hydromorphone and morphine were the most commonly used opioids (> 30 services reporting frequent use), whereas the use of fentanyl, oxycodone, and buprenorphine varied widely across services.

Conclusions: There is consensus regarding the use of opioids in patients with cancer-related pain and dyspnea. The differing approaches to their use for symptoms caused by non-malignant conditions suggest varying clinical interpretations and underscore the need for further research and clearer guidelines.