A Regional Survey of Attitudes and Experiences in Determining When to Prescribe Intranasal Naloxone for Patients Seen in Palliative Care Clinics in the United States of America

TL;DR

This study explores how palliative care clinicians in the US decide whether to prescribe intranasal naloxone to patients receiving opioids, highlighting their attitudes and the factors they consider.

Contribution

The study provides new insights into the attitudes of palliative care clinicians toward prescribing intranasal naloxone in the absence of clear guidelines.

Findings

Most clinicians did not believe IN prescriptions should be limited to patients with a full code status.

Bystander safety was a key reason for prescribing IN, even for patients with comfort-focused care goals.

Clinician counseling and patient consent were seen as essential before prescribing IN.

Abstract

Published guidelines that help clinicians identify patients who would benefit from the co-prescription of intranasal naloxone (IN) exclude “palliative care patients.” In the absence of clear care standards, palliative care (PC) clinicians may experience uncertainty in how to approach IN co-prescriptions.

Explore the attitudes of PC clinicians in the United States of America who work at regional health care institutions regarding IN prescriptions for patients they prescribe opioids for.

An 18-question electronic survey was distributed to PC clinicians that practice at institutions in Wisconsin or Minnesota with at least 10 other PC clinicians between February and May 2023. The survey explored clinical scenarios in which respondents would and would not prescribe IN.

Fifty-six PC clinicians responded to the survey—response rate 41%. Most respondents (90.9%) did not feel IN prescriptions should be reserved for patients with a full code status; 67.9% of respondents felt that IN prescriptions are reasonable for certain patients with a terminal illness and comfort goals of care. Neither prognosis, duration of opioid therapy, nor dose of opioid therapy were significant factors in determining whether most respondents prescribed IN for their patients. Most respondents (81.8%) felt clinician counseling and patient consent were essential before prescribing IN.

Most PC clinicians in our survey felt that IN prescriptions can be appropriate for patients they prescribe opioids for. Bystander safety was an emerging rationale for why respondents chose to prescribe IN for their patients. Despite public health efforts to make IN more freely available, most respondents felt clinician counseling was essential before prescribing IN for their patients.

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