Ingielewicz Anna, Brunka Zuzanna, Szczupak Mateusz, Szymczak Robert K
Department of Emergency Medicine, Faculty of Health Science, Medical University of Gdansk, Gdansk, Poland.
Poland Hospice Foundation, Kopernika Street 6, 80-208, Gdansk, Poland.
Support Care Cancer. 2025 Feb 1;33(2):140. doi: 10.1007/s00520-025-09189-z.
Patients receiving hospice care at the end of life often suffer from a variety of ailments. They may need medication to alleviate symptoms for the rest of their lives. The most common and recommended way to take opioids and steroids is orally. Less frequently, the subcutaneous or intravenous routes are used. The intranasal route is a relatively uncommon but interesting alternative for administering drugs.
The study aims to identify hospice patients who may benefit from changing the standard opioid and steroid administration route to intranasal delivery.
The electronic medical records of all home and inpatient hospice patients (both rural and urban) were analyzed between February and April 2024. The study focused on the magnitude and type of problems associated with taking medications via standard routes and assessed the potential for changing to an intranasal route of administration.
Patients who were prescribed morphine, dexamethasone, or both during co-administration were included in the analysis. Of the 282 patients receiving hospice care over the study period, 95 met the inclusion criteria (33.7%). According to the researcher's original survey 87% of patients experienced issues with taking medications through the standard route. Among the problems related to oral medicines, consciousness disorders were the most significant at 66%. For subcutaneous administration, the main issues were reluctance to inject at 19% and lack of cooperation from caregivers at 20%.
The profile of a hospice patient who may benefit from intranasal administration of symptomatic drugs includes patients with impaired consciousness, aversion to subcutaneous injections, and reluctance to administer injections by caregivers.
临终时接受临终关怀的患者常常患有多种疾病。他们可能需要终生服用药物来缓解症状。服用阿片类药物和类固醇最常见且推荐的方式是口服。较少情况下，会采用皮下或静脉注射途径。鼻内途径是一种相对不常见但有趣的给药替代方式。
本研究旨在确定可能受益于将标准阿片类药物和类固醇给药途径改为鼻内给药的临终关怀患者。
分析了2024年2月至4月期间所有居家和住院临终关怀患者（包括农村和城市患者）的电子病历。该研究重点关注通过标准途径服药相关问题的严重程度和类型，并评估改为鼻内给药途径的可能性。
在联合用药期间开具吗啡、地塞米松或两者的患者被纳入分析。在研究期间接受临终关怀的282名患者中，95名符合纳入标准（33.7%）。根据研究人员最初的调查，87%的患者在通过标准途径服药时遇到问题。在与口服药物相关的问题中，意识障碍最为显著，占66%。对于皮下注射，主要问题是患者不愿注射，占19%，以及护理人员不配合，占20%。
可能受益于鼻内给予对症药物的临终关怀患者特征包括意识受损、厌恶皮下注射以及护理人员不愿注射的患者。
