Professionals’, patients’ and families’ views on the use of opioids for chronic breathlessness: A systematic review using the framework method and pillar process

This episode features Florence Reedy (Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK).

Chronic breathlessness is a prevalent symptom amongst patients with advanced medical conditions. In combination with disease-modifying therapies and non-pharmacological interventions, regular low dose opioids may safely reduce moderate to severe chronic breathlessness due to advanced medical conditions. Implementation of opioids for chronic breathlessness in clinical practice varies widely.

Clinicians’ and patients’ fears of opioids causing respiratory depression, addiction and regulatory scrutiny are significant barriers in the use of opioids for breathlessness. Education and information are necessary, but insufficient as a sole strategy, to improve implementation of opioid use for this indication. Clinicians’ interactions with patients and their families strongly influence acceptance of, and adherence to opioid treatment regimens for chronic breathlessness.

An agreed protocol for opioid initiation, titration and monitoring for use by clinicians in conjunction with agreed clinical guidelines may improve both their knowledge and confidence around opioid use for the symptomatic reduction of chronic breathlessness. Additional research on patients’ and carers’ experiences of opioids for chronic breathlessness is necessary to inform better implementation of opioids into clinical practice.