Ebtesam Ahmed, Maha Saad

Evaluating Patient Education Material of Medications Commonly Used in Palliative Care

Ebtesam Ahmed,  Maha Saad, College of Pharmacy and Health Sciences, Department of Clinical Pharmacy Practice; Students: Magon George, Feroze Karanjia, Jasmine Thomas

Abstract
Introduction: Palliative care is a specialized medical care for patients with serious illnesses; it focuses on providing patients with relief from symptoms such as pain, dyspnea, agitation, secretions, anxiety, and nausea. A number of medications are commonly used to treat the above listed symptoms. Often times, these medications are prescribed based on a non Food and Drug Administration (FDA) approved indication. Patient information material is a major source of knowledge for patients and their families. The aim of this study is to evaluate patient information material of medications use in palliative care and its availability in different languages; specifically focusing on drugs prescribed under off-label indication.

Methods: A list of medications was compiled from the International Association of Hospice and Palliative Care (IAHPC) as well as drugs commonly used in palliative care clinical practice. The medications’ patient information material was then evaluated for inclusion of palliative indications and its availability in multiple languages. Four drug information databases and resources were consulted for that purpose: Lexi-Comp, Micromedex, Drug Facts and Comparison, and Medline Plus. In addition, a total of 10 palliative care specific websites were also checked for availability of patient drug information material. 

Results: A total of 40 medications were identified as commonly used in palliative care, 17 are prescribed based on FDA approved indication, 7 medications are prescribed based on both FDA and non-FDA approved indication, and 16 medications are strictly prescribed based on a non-FDA approved indication. Upon consulting the different resources, comprehensive patient education material was available only for medications used based on their FDA approved indication. The material was available in English and at least one other language. As far as drugs used based on non-FDA approved indication, the patient education material did not clearly address such an indication. The indication was at best extrapolated from the FDA approved indication as it is the case with gabapentin used for neuropathy or mentioned under the side effects profile as it is the case with scopolamine for dry mouth. Palliative care specific websites provided a wealth of information regarding symptom management. However, drugs commonly used in palliative care were only mentioned in the context of symptom management. Medication education material was not available.

Conclusion: There is a clear need for developing drug information material reflecting the palliative care non-FDA approved indication. This will provide patients with an integrated, coherent information about their prescription drugs, increase medication adherence and improve patient care.