Assessment tools for problematic opioid use in palliative care: A scoping review

Area of Science:

• Palliative Care Research
• Opioid Use Disorder Screening
• Clinical Assessment Tools

Background:

• Problematic opioid use screening is increasingly recommended for patients in palliative care settings.
• Effective tools are needed to identify patients at risk or experiencing problematic opioid use.
• Palliative care patients often manage symptoms with prescription opioids.

Purpose of the Study:

• To conduct a scoping review to identify tools used for assessing problematic opioid use in palliative care.
• To understand the current landscape of opioid use assessment in this specific patient population.

Main Methods:

• A comprehensive scoping review of bibliographic databases, reference lists, and grey literature was performed.
• Studies included adults receiving palliative care for advanced cancer, neurodegenerative, or end-stage organ diseases on prescription opioids.
• Tools for assessing problematic opioid use, including questionnaires and urine drug tests, were identified.

Main Results:

• 42 observational studies (14,431 participants) from 2009-2020 were identified, primarily in US outpatient palliative care.
• Commonly used tools included questionnaires (e.g., CAGE, CAGE-AID, Opioid Risk Tool, SOAPP variants) and urine drug tests.
• Limited studies focused on psychometric validation of tools in palliative care; urine drug test abnormality rates varied widely (8.6%-70%).

Conclusions:

• There is a significant lack of studies validating assessment tools specifically for problematic opioid use in palliative care patients.
• Further research is essential to develop and validate appropriate tools for clinical practice and policy.
• Improved assessment strategies are needed to inform effective management of opioid use in palliative care.