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Opioid underuse in terminal care of long-term care facility residents with pain and/or dyspnoea: A cross-sectional PACE-survey in six European countries.

  • Tanghe, Marc1
  • Van Den Noortgate, Nele2
  • Deliens, Luc3
  • Smets, Tinne3
  • Onwuteaka-Philipsen, Bregje4
  • Szczerbińska, Katarzyna5
  • Finne-Soveri, Harriet6
  • Payne, Sheila7
  • Gambassi, Giovanni8
  • Van den Block, Lieve3
  • Piers, Ruth2
  • 1 End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Ghent, Belgium. , (Belgium)
  • 2 Department of Geriatric Medicine, Ghent University and Ghent University Hospital, Ghent, Belgium. , (Belgium)
  • 3 End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium. , (Belgium)
  • 4 Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. , (Netherlands)
  • 5 Jagiellonian University Medical College, Kraków, Poland. , (Poland)
  • 6 National Institute for Health and Welfare, Helsinki, Finland. , (Finland)
  • 7 International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK.
  • 8 Fondazione Policlinico Universitario A. Gemelli, IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy. , (Italy)
Published Article
Palliative medicine
Publication Date
Jun 01, 2020
DOI: 10.1177/0269216320910332
PMID: 32286149


Opioids relieve symptoms in terminal care. We studied opioid underuse in long-term care facilities, defined as residents without opioid prescription despite pain and/or dyspnoea, 3 days prior to death. In a proportionally stratified randomly selected sample of long-term care facilities in six European Union countries, nurses and long-term care facility management completed structured after-death questionnaires within 3 months of residents' death. Nurses assessed pain/dyspnoea with Comfort Assessment in Dying with Dementia scale and checked opioid prescription by chart review. We estimated opioid underuse per country and per symptom and calculated associations of opioid underuse by multilevel, multivariable analysis. Nurses' response rate was 81.6%, 95.7% for managers. Of 901 deceased residents with pain/dyspnoea reported in the last week, 10.6% had dyspnoea, 34.4% had pain and 55.0% had both symptoms. Opioid underuse per country was 19.2% (95% confidence interval: 12.9-27.2) in the Netherlands, 25.2% (18.3-33.6) in Belgium, 29.3% (16.9-45.8) in England, 33.7% (26.2-42.2) in Finland, 64.6% (52.0-75.4) in Italy and 79.1% (71.2-85.3) in Poland (p < 0.001). Opioid underuse was 57.2% (33.0-78.4) for dyspnoea, 41.2% (95% confidence interval: 21.9-63.8) for pain and 37.4% (19.4-59.6) for both symptoms (p = 0.013). Odds of opioid underuse were lower (odds ratio: 0.33; 95% confidence interval: 0.20-0.54) when pain was assessed. Opioid underuse differs between countries. Pain and dyspnoea should be formally assessed at the end-of-life and taken into account in physicians orders.

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