Subcutaneous patient-controlled analgesia in palliative care

Patient-Controlled Analgesia for Managing Pain in Adults Receiving Palliative Care: A Scoping Review

BACKGROUND

Pain remains a significant concern in palliative care settings. Patient-controlled analgesia (PCA) is an opioid delivery system that allows patients to decide when to receive a personally titrated opioid dose. This method of opioid administration effectively and safely manages pain and allows autonomy over one's care.

OBJECTIVE

To understand the extent of evidence regarding PCA for pain management among adults in palliative care settings.

METHODS

Systematic searches of PubMed, CINAHL, Embase, and MEDLINE identified 421 articles published in English between 2009 and 2024. The following data was extracted from eligible articles: source, author, study purpose, location (country and care setting), sample, design and methodology, participant characteristics, and relevant results.

RESULTS

Five studies met inclusion criteria. Findings include information on the PCA devices, rationale for administration, efficacy, and safety, adverse events, and author-identified next steps. Overall, PCA use was found to be safe and effective, sometimes even preferable to other opioid administration regimens.

CONCLUSION

This review provides insights into optimizing pain management for cancer patients, especially in advanced stages of illness. Findings highlight the minimal literature available regarding PCA use in palliative care settings, particularly the complete absence across noncancer diagnoses.

Subcutaneous Patient-Controlled Analgesia in Home-Based Palliative Care: "It's as Straightforward as Pushing a Button, Right at my Fingertips"

Subcutaneous patient-controlled analgesia (SCPCA) in home-based palliative care is a potentially valuable option for providing effective pain relief to some patients, particularly when conventional analgesic approaches prove ineffective or are refused. Our case report illustrates the use of SPCA for the management of breakthrough pain in a patient receiving palliative care at home with no improvement after multiple previous treatments. SCPCA was found to be safe and successful. Future research is essential to explore its precise role, appropriate indications, prescription guidelines, and safety considerations across various palliative care contexts.

Continuous Ambulatory Delivery Device Use for Patients Managed by an Inpatient Palliative Care Team

BACKGROUND

The use of Patient Controlled Analgesia (PCA) via a Continuous Ambulatory Delivery Device (CADD) is a common and effective means of pain and symptom management for hospitalized patients with a malignancy. Studies exploring the indications for starting such a device for hospitalized inpatients referred to inpatient palliative care teams are limited.

AIM

This retrospective chart review aims to explore indications, timing of initiation, and barriers to the use of a CADD.

METHODS

Over a six month period, during daily inpatient palliative care consult team rounds, patients who required a CADD were enrolled in this study. Sixty-one adult patients were identified who required a pump for symptom control. The team's database sheets were used to capture patient demographics.

RESULTS

The main reasons for initiating a Continuous Ambulatory Delivery Device in the above setting included: lack of efficacy of oral opioids and to increase patient autonomy of their pain management. Approximately 20% of patients required transfer to another unit that could accommodate the CADD. The median length of stay for these patients was 13 days, with a median length of half a day for a pump to be started.

CONCLUSIONS

This initial study provides the Palliative Care Consult Team with information on the indications for the use of a CADD. The lack of universal access to a CADD in various areas of our hospital due to differences in departmental protocols may compromise good symptom management and patient safety. These results strengthen the argument that the existing hospital policy requires revamping to improve CADD access. A CADD has been shown to provide hospitalized patients, with a malignancy, with timely access to effective symptom management, and in turn, reducing their length of stay in hospital. These findings will help inform this organization's CADD policy and support the need to broaden access to this device.

Improvement in Nurses' Knowledge of Subcutaneous Catheter Use for Pain Management

BACKGROUND

Nurses often have insufficient knowledge of subcutaneous catheter use for pain management. This quality improvement project evaluated implementation of an evidence-based subcutaneous catheter nursing policy with education to improve pain management for hospitalized patients.

METHOD

A convenience sample of nurses (N = 515) completed a posttest after online training on effective subcutaneous pain management. Patient pain ratings were assessed to evaluate whether they changed after nurses' training.

RESULTS

Posttest scores showed the online learning module effectively contributed to nurses' knowledge of subcutaneous catheter pain management. A statistically significant reduction occurred in patient pain ratings (p < .001) postintervention. The number of patients experiencing moderate or severe pain decreased by 58%, for a significant reduction in pain.

CONCLUSION

An online learning module was successful in educating nurses on pain medication administration through an indwelling subcutaneous catheter. [J Contin Educ Nurs. 2024;55(1):13-20.].