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Subcutaneous administration of drugs and hydration in acute palliative care units: Physician attitudes and beliefs in the United States and Canada

Published online by Cambridge University Press:  21 December 2023

Michael Tang Open the ORCID record for Michael Tang [Opens in a new window] ,
Rida Khan ,
Alejandra Ruiz Buenrostro ,
Clark R. Andersen ,
Jenny Lau Open the ORCID record for Jenny Lau [Opens in a new window] ,
David Hui ,
Camilla Zimmermann  and
Eduardo Bruera
Michael Tang*
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Rida Khan
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Alejandra Ruiz Buenrostro
Affiliation:
Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
Clark R. Andersen
Affiliation:
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Jenny Lau
Affiliation:
Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
David Hui
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Camilla Zimmermann
Affiliation:
Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
Eduardo Bruera
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
*
Corresponding author: Michael Tang; Email: MJTang@mdanderson.org
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Abstract

Objectives

The objective of this study was to compare the attitudes and beliefs of PCU physicians leaders in the United States versus Canada regarding the subcutaneous method in the administration of medications and hydration in order to gain a better understanding as to why variations in practice exist.

Methods

This survey trial took place from November 2022 to May 2023. The MD Anderson Cancer Center institutional review board in Houston, Texas, approved this study. The participants were the physician leaders of the acute palliative care units (PCUs) in the United States and Canada. The survey comprised questions formulated by the study investigators regarding the perceived comfort, efficiency, and preference of using the subcutaneous versus the intravenous method. The consent form and survey links were emailed to the participants.

Results

Sixteen PCUs were identified in the United States and 15 PCUs in Canada. Nine US and 8 Canadian physicians completed the survey. Physicians in Canada were more likely to use the subcutaneous route for administering opioids, antiemetics, neuroleptics, and hydration. They preferred subcutaneous over intravenous or intramuscular routes (p = 0.017). Canadian physicians felt their nursing staff was more comfortable with subcutaneous administration (p = 0.022) and that it was easier to administer (p = 0.02). US physicians felt the intravenous route was more efficient (p = 0.013).

Significance of results

The study results suggest that exposure to the subcutaneous route influences a physician’s perception. Further research is needed to explore ways to incorporate its use to a greater degree in the US healthcare system.

Keywords

Subcutaneous administrationpalliative care unitspalliative caresymptom managementtransition of care
Type
Original Article
Information
Palliative & Supportive Care , First View , pp. 1 - 4
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Copyright
© The Author(s), 2023. Published by Cambridge University Press.

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