The compassionate use of drugs in palliative care for symptom control and ethical justifications for its use: A scoping review

Q3 Medicine

Ethics, Medicine and Public Health Pub Date : 2023-11-11 DOI:10.1016/j.jemep.2023.100950

I. Aguiar Gouveia , P. Reis-Pina

{"title":"The compassionate use of drugs in palliative care for symptom control and ethical justifications for its use: A scoping review","authors":"I. Aguiar Gouveia , P. Reis-Pina","doi":"10.1016/j.jemep.2023.100950","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Compassionate use of drugs is becoming increasingly popular among terminally ill patients who require palliative care and have exhausted all treatment options, with no satisfactory authorized therapies.</p></div><div><h3>Objectives</h3><p>This scoping review aimed to systematically map the literature on the compassionate use of drugs: (1) for symptom control in palliative care and (2) the ethical justification for its use.</p></div><div><h3>Methods</h3><p>PubMed, EMBASE and Cochrane databases were searched. Eligibility criteria: any participant with palliative needs, any control, and any study design was accepted. Interventions: any drug used for compassionate reasons. Outcomes: symptom control and ethical-related issues. Filters: articles written in English and published between 2012–2022. Critical appraisal of sources of evidence was made.</p></div><div><h3>Results</h3><p>Five moderate/high-quality studies were included: one clinical trial, one case series, two case reports/studies, and one expert opinion. Patients were 28, mostly with cancer. Three studies showed symptom control, namely pain. Ethical justifications for compassionate use of drugs were sustained by autonomy, beneficence, and justice. Barriers to compassionate use of drugs were inequitable access, inattentive risk/benefit assessment, and doubtful validity of informed consent.</p></div><div><h3>Conclusions</h3><p>Although there is some evidence that compassionate use of drugs may help symptom management in palliative care, additional research is necessary to verify its effectiveness.</p></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"31 ","pages":"Article 100950"},"PeriodicalIF":0.0000,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352552523000816/pdfft?md5=7102df58112f0ba19ef62cbcea0e18b3&pid=1-s2.0-S2352552523000816-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ethics, Medicine and Public Health","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352552523000816","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Compassionate use of drugs is becoming increasingly popular among terminally ill patients who require palliative care and have exhausted all treatment options, with no satisfactory authorized therapies.

Objectives

This scoping review aimed to systematically map the literature on the compassionate use of drugs: (1) for symptom control in palliative care and (2) the ethical justification for its use.

Methods

PubMed, EMBASE and Cochrane databases were searched. Eligibility criteria: any participant with palliative needs, any control, and any study design was accepted. Interventions: any drug used for compassionate reasons. Outcomes: symptom control and ethical-related issues. Filters: articles written in English and published between 2012–2022. Critical appraisal of sources of evidence was made.

Results

Five moderate/high-quality studies were included: one clinical trial, one case series, two case reports/studies, and one expert opinion. Patients were 28, mostly with cancer. Three studies showed symptom control, namely pain. Ethical justifications for compassionate use of drugs were sustained by autonomy, beneficence, and justice. Barriers to compassionate use of drugs were inequitable access, inattentive risk/benefit assessment, and doubtful validity of informed consent.

Conclusions

Although there is some evidence that compassionate use of drugs may help symptom management in palliative care, additional research is necessary to verify its effectiveness.

查看原文本刊更多论文

在缓和治疗中同情地使用药物以控制症状及其使用的伦理理由:范围审查

在需要姑息治疗并且已经用尽所有治疗方案，没有令人满意的授权治疗的绝症患者中，富有同情心地使用药物正变得越来越流行。目的:本综述旨在系统地绘制有关药物同情使用的文献:(1)缓和治疗中的症状控制;(2)使用药物的伦理理由。方法检索spubmed、EMBASE和Cochrane数据库。入选标准:任何有姑息治疗需求的参与者，任何对照，任何研究设计均被接受。干预措施:任何出于同情原因使用的药物。结果:症状控制和伦理相关问题。筛选:2012-2022年间发表的英文文章。对证据来源进行了批判性评估。结果共纳入5项中等/高质量研究:1项临床试验、1项病例系列、2项病例报告/研究和1项专家意见。患者为28人，大多数患有癌症。三项研究显示症状控制，即疼痛。出于同情心使用药物的伦理理由是由自主、仁慈和正义来维持的。有同情心地使用药物的障碍是不公平的获取，不注意风险/效益评估，以及知情同意的有效性值得怀疑。结论虽然有一些证据表明同情用药可能有助于姑息治疗的症状管理，但还需要进一步的研究来验证其有效性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Ethics, Medicine and Public Health Medicine-Health Policy

CiteScore

2.20

自引率

0.00%

发文量

107

审稿时长

42 days

期刊介绍： This review aims to compare approaches to medical ethics and bioethics in two forms, Anglo-Saxon (Ethics, Medicine and Public Health) and French (Ethique, Médecine et Politiques Publiques). Thus, in their native languages, the authors will present research on the legitimacy of the practice and appreciation of the consequences of acts towards patients as compared to the limits acceptable by the community, as illustrated by the democratic debate.