Healthcare professionals’ views of the use of oral morphine and transmucosal diamorphine in the management of paediatric breakthrough pain and the feasibility of a randomised controlled trial: a focus group study (DIPPER)
Healthcare professionals’ views of the use of oral morphine and transmucosal diamorphine in the management of paediatric breakthrough pain and the feasibility of a randomised controlled trial: a focus group study (DIPPER)
Background: oral morphine is frequently used for breakthrough pain but the oral route is not always available and absorption is slow. Transmucosal diamorphine is administered by buccal, sublingual or intranasal routes, and rapidly absorbed.
Aim: to explore the perspectives of healthcare professionals in the UK caring for children with life-limiting conditions concerning the assessment and management of breakthrough pain; prescribing and administration of transmucosal diamorphine compared with oral morphine; and the feasibility of a comparative clinical trial.
Design/ participants: three focus groups, analysed using a Framework approach. Doctors, nurses and pharmacists (n = 28), caring for children with life-limiting illnesses receiving palliative care, participated.
Results: oral morphine is frequently used for breakthrough pain across all settings; with transmucosal diamorphine largely limited to use in hospices or given by community nurses, predominantly buccally. Perceived advantages of oral morphine included confidence in its use with no requirement for specific training; disadvantages included tolerability issues, slow onset, unpredictable response and unsuitability for patients with gastrointestinal failure. Perceived advantages of transmucosal diamorphine were quick onset and easy administration; barriers included lack of licensed preparations and prescribing guidance with fears over accountability of prescribers, and potential issues with availability, preparation and palatability. Factors potentially affecting recruitment to a trial were patient suitability and onerousness for families, trial design and logistics, staff time and clinician engagement.
Conclusions: there were perceived advantages to transmucosal diamorphine, but there is a need for access to a safe preparation. A clinical trial would be feasible provided barriers were overcome.
breakthrough pain, diamorphine, focus groups, opioids, Paediatrics, pain management, palliative care, terminal care
1118-1125
Jamieson, Liz
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Harrop, Emily
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Johnson, Margaret
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Liossi, Christina
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Mott, Christine
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Oulton, Kate
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Skene, Simon S.
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Wong, Ian C.K.
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Howard, Richard F.
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Jamieson, Liz
b57748f6-7e0a-4d3b-b292-fc00c27ee661
Harrop, Emily
cb65a901-089f-40ce-8848-1b1486ea79d9
Johnson, Margaret
722ce22b-1571-4753-bec0-9829e8ce7e92
Liossi, Christina
fd401ad6-581a-4a31-a60b-f8671ffd3558
Mott, Christine
6d242373-b932-4ddc-9478-15107de4209a
Oulton, Kate
6725a8ee-03cc-4349-8320-94103bc5850e
Skene, Simon S.
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Wong, Ian C.K.
4212b691-9e14-497f-aac4-e558e205e372
Howard, Richard F.
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Jamieson, Liz, Harrop, Emily, Johnson, Margaret, Liossi, Christina, Mott, Christine, Oulton, Kate, Skene, Simon S., Wong, Ian C.K. and Howard, Richard F.
(2021)
Healthcare professionals’ views of the use of oral morphine and transmucosal diamorphine in the management of paediatric breakthrough pain and the feasibility of a randomised controlled trial: a focus group study (DIPPER).
Palliative Medicine, 35 (6), .
(doi:10.1177/02692163211008737).
Abstract
Background: oral morphine is frequently used for breakthrough pain but the oral route is not always available and absorption is slow. Transmucosal diamorphine is administered by buccal, sublingual or intranasal routes, and rapidly absorbed.
Aim: to explore the perspectives of healthcare professionals in the UK caring for children with life-limiting conditions concerning the assessment and management of breakthrough pain; prescribing and administration of transmucosal diamorphine compared with oral morphine; and the feasibility of a comparative clinical trial.
Design/ participants: three focus groups, analysed using a Framework approach. Doctors, nurses and pharmacists (n = 28), caring for children with life-limiting illnesses receiving palliative care, participated.
Results: oral morphine is frequently used for breakthrough pain across all settings; with transmucosal diamorphine largely limited to use in hospices or given by community nurses, predominantly buccally. Perceived advantages of oral morphine included confidence in its use with no requirement for specific training; disadvantages included tolerability issues, slow onset, unpredictable response and unsuitability for patients with gastrointestinal failure. Perceived advantages of transmucosal diamorphine were quick onset and easy administration; barriers included lack of licensed preparations and prescribing guidance with fears over accountability of prescribers, and potential issues with availability, preparation and palatability. Factors potentially affecting recruitment to a trial were patient suitability and onerousness for families, trial design and logistics, staff time and clinician engagement.
Conclusions: there were perceived advantages to transmucosal diamorphine, but there is a need for access to a safe preparation. A clinical trial would be feasible provided barriers were overcome.
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02692163211008737
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e-pub ahead of print date: 13 April 2021
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Acknowledgements
The authors would like to thank all the participants who took part in the focus groups. Kate Oulton is a National Institute for Health Research (NIHR) Senior Nurse and Midwife Research Leader. The views expressed in this article are those of the author(s) and not necessarily those of the NIHR, or the Department of Health and Social Care.
Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0317-20036 ). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Publisher Copyright:
© The Author(s) 2021.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
Keywords:
breakthrough pain, diamorphine, focus groups, opioids, Paediatrics, pain management, palliative care, terminal care
Identifiers
Local EPrints ID: 450693
URI: http://eprints.soton.ac.uk/id/eprint/450693
ISSN: 0269-2163
PURE UUID: b3c0e17f-4424-4cbd-bed6-c40a7524f386
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Date deposited: 06 Aug 2021 16:31
Last modified: 18 Mar 2024 03:03
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Author:
Liz Jamieson
Author:
Emily Harrop
Author:
Margaret Johnson
Author:
Christine Mott
Author:
Kate Oulton
Author:
Simon S. Skene
Author:
Ian C.K. Wong
Author:
Richard F. Howard
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