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Clinical decision support for potentially sedating drugs in palliative care: a mixed-methods pilot study
Sabine H Krauss1, Beatrice Odierna2, Stefanie Kolmhuber-Seibold2
1Department of Palliative Medicine, LMU Medizin, LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, D-81377, Germany. Sabine.Krauss@med.uni-muenchen.de.
Background:
Within the framework of the project iSedPall, a Clinical Decision Support Tool (CDST) was developed and piloted to address uncertainties in the use of potentially sedating drugs commonly administered in palliative care. The so-called 'warning list' contains evidence- and expert consensus-based data. This study aimed to test its feasibility of implementation, appropriateness, and acceptability.
Methods:
Mixed-methods pilot study including data from four pilot centres (two inpatient palliative care units, two palliative home care teams): a retrospective cohort study by chart review, an online survey, and focus groups (one focus group per pilot centre and two setting-specific focus groups). Quantitative data was analysed via descriptive statistics and content analysis was used for the focus groups.
Results:
Retrospective cohort study (n = 1,189 patients): The frequency of the use of the warning list depended on the patient group. The list was used most frequently for patients in whom sedation occurred as an adverse drug reaction. Online survey: 13/33 respondents used the list. Eight planned to continue using the warning list after the end of the project. Focus groups (six focus groups with overall n = 22 professionals): Generally, the aim of the warning list was well understood. The benefits were seen primarily in terms of education and background information. Participants also suggested the availability in electronic form. A potential risk is that the warning list could be misinterpreted as dose recommendations for sedation.
Conclusions:
The warning list seems to be appropriate, acceptable, and feasible to be implemented for professionals, according to pilot evidence from four centres. The mixed-methods approach proved valuable in carefully exploring the risks alongside the benefits. Future research should be conducted in more generalisable settings, take a closer look at different professional groups as well as settings, and further explore the various types of potential use of the CDST. Implementation in electronic form should be explored carefully, reflecting positive and negative consequences on daily routines.
Trial Registration:
The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00027241; Date of registration: 10/12/2021; https://drks.de/search/en/trial/DRKS00027241 ).
