Key concepts in palliative care: The IAHPC list of essential medicines in palliative care

Abstract

Background This paper describes the process of developing a list of essential medicines in palliative care based on a consensus of experts. Method Phase I: guiding principles and identifying the most prevalent symptoms in palliative care. Phase II: identifying the medications used to treat the symptoms, developing an initial list of medicines with a survey of 40 physicians, and implementing a Delphi survey. 112 physicians and pharmacologists were invited to rate the safety and efficacy of each medication. Phase III: representatives of 28 pain and palliative care organisations were invited to a meeting. 26 accepted (93% RR). Participants were split into groups and received the results of the Delphi survey. Groups were instructed to base the discussions on medications for which at least 50% of the respondents rated both safe and effective (score of 7 or above). Results 21 symptoms were identified as the most common in palliative care. 120 medications were recommended to treat these symptoms. 71 participants (63% RR) responded to the Delphi survey. A final list with 33 medications was approved as the International Association for Hospice and Palliative Care (IAHPC) essential medicines list for palliative care. There was no consensus among respondents in recommending medications as safe and effective for bone pain, dry mouth, sweating, fatigue or hiccups. Conclusion Additional research is needed to identify safe and effective medications to treat these symptoms. The IAHPC will soon be implementing a project to update the list of essential medicines in palliative care to reflect these new findings.