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Call for research on nurse role in palliative care prescribing

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Experts have called for research into whether increased use of specialist nurses can help improve drug adherence rates among palliative care patients taking strong opioids.

The National Institute for Health and Clinical Excellence last week published draft guidance on strong opioid prescribing in palliative care. It highlighted that many patients were concerned about side effects, becoming addicted to the drugs or that they implied “the final stages of life” – all of which affected adherence.

The guidance promotes good communication between clinicians and patients as “essential”. It said clinicians should ask patients about their concerns and offer access to frequent pain control reviews and information on who to contact out of hours, particularly during initiation of treatment.

Patients should also be advised that nausea or drowsiness may occur when starting opioids or at dose increase, but is “likely to be transient”.

But the document also said research was needed to “determine how to address the main concerns of patients, the level of information they require and the best time and methods to deliver this”. This should examine “the benefits of greater involvement in this process by specialist nurses”, it said.

Dr Fergus Macbeth, director of the NICE centre for clinical practice, said: “The new draft guideline puts a strong emphasis on good communication between patient and healthcare professionals.

“This is key to ensuring that any doubts or uncertainties are addressed, thereby enabling the patient to feel content in following what has been prescribed and therefore potentially improving their pain control and reducing any associated side effects.”

The guideline will be available for public consultation until 6 January: http://guidance.nice.org.uk/CG/Wave24/4

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