What Happens to Unused Symptom Response Kits in the Community: A Narrative Review

It is a common practice in Ontario to prescribe patients with advanced life-limiting illness a Symptom Response Kit (SRK), an emergency medication and medical supply kit, to manage distressing symptoms in the community toward the end of life (EOL). These are hugely beneficial to patients; however, the medications included have high risk profiles, and there is no uniform procedure in place for the return or disposal of SRKs. This narrative review aims to identify what happens to unused SRKs when no longer needed. The literature search was conducted on Medline Ovid, Embase, and CINAHL databases in early 2022 and re-conducted from 2022 to September 15, 2023. Ontario Health at Home (OHAH) websites were also searched in early 2022 and again in January 2024. We included conference abstracts, systematic reviews, scoping reviews, and clinical trials published in the English language that discussed the use of SRK (or equivalent) in community palliative care. Twenty-six studies were included, 12 (46.2%) of which originated from the United States and 3 (11.5%) from Canada. Few studies (34.6%) discussed safety. One study provided instructions given to patients and families regarding return or disposal of unused kits. There was no consistent terminology for SRKs in studies or throughout OHAH organization websites. Three OHAH organizations' websites had instructions available on procedures for disposal or return of unused kits. There is a paucity of research on the use of SRK, although the practice is common. There is no consensus on SRK terminology and no studies evaluating the return or safe disposal of SRKs in the community when no longer needed. Future work should establish safety regulations, disposal monitoring, supervision of use, and terminology standardization. OHAH organizations provincially are conducting innovative work in this area.