Impact of a Structured Pathway on Nausea and Vomiting Treatment in Palliative Care: A Before-After Study

Nausea and vomiting are distressing symptoms in palliative care. Due to a heterogeneous population and limited evidence, clinical management remains challenging. Guidelines often recommend an etiology-based treatment approach, but supporting evidence is scarce, particularly for noncancer patients.

Evaluating the impact of a structured, etiology-based treatment pathway on nausea and vomiting burden and treatment quality in palliative care patients.

Single-center, before-after study in adult patients on a German tertiary palliative care unit, comparing symptom burden and treatment quality before (Phase 1, 15 months) and after (Phase 2, 12 months) implementation of the pathway.

Outcome measures were change in symptom burden score on day 3 (Integrated Palliative Care Outcome Scale ([IPOS]), treatment quality (quality indicator [QI]; burden reduction on IPOS), and duration of symptoms (days). Significance level was set at α < 0.01.

In Phase 1, 172/330 patients (52.1%) experienced 230 episodes of nausea/vomiting, versus 139/280 patients (49.6%) with 178 episodes in Phase 2. On day 3, symptom burden scores for nausea decreased to a greater extent in Phase 2 (p = 0.007); vomiting showed a nonsignificant reduction (p = 0.021). The QI (nausea) was met in 124/178 (69.7%) versus 129/156 (82.7%) (p = 0.0056), and the QI (vomiting) was met in 66/93 (71.0%) versus 81/95 (85.3%) (p = 0.0176) episodes. Symptom duration decreased from 3 (0-25) to 2 (0-23) days (p < 0.001).

The systematic etiology-based pathway significantly improved cause identification and treatment quality. While benefits were more pronounced in cancer patients, this structured approach provides a robust framework for enhancing antiemetic management in the palliative care setting. Further studies should investigate antiemetic treatment in noncancer patients.