Development of criteria for identifying potentially inappropriate prescribing in older adults with cancer receiving palliative care (PIP-CPC)

Cathal A. Cadogan*, Melanie Murphy, Sarah McLean, Kathleen Bennett, Carmel M. Hughes

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Objectives: 

To develop criteria for identifying potentially inappropriate prescribing of medications for symptomatic relief in older adults (≥65 years) with cancer who are receiving palliative care and have an estimated life expectancy of <1 year.

Materials and methods: 

A two-round Delphi exercise was conducted using web-based questionnaires. A panel of 18 expert stakeholders with expertise in palliative care, oncology and/or geriatric medicine across Ireland and the United Kingdom rated their level of agreement with each statement using a 5-point Likert scale and had the option of adding free-text comments throughout the questionnaire. A priori decision rules were used to accept or reject criteria. 


Results: 

Twenty-eight criteria were presented in Round 1. Group consensus was achieved for 15 criteria which were included in the final set of criteria. Following a review of the panel's ratings and additional comments for the remaining 13 criteria, four criteria were removed from Round 2. Group consensus was achieved for all nine criteria included in Round 2. The final set comprised 24 criteria relating to: anorexia-cachexia (n = 1); anxiety (n = 2); constipation (n = 5); delirium (n = 1); depression (n = 3); diarrhoea (n = 1); dyspnoea/breathlessness (n = 1); fatigue (n = 2); insomnia (n = 2); nausea and vomiting (n = 2); pain (n = 3); duplicate drug classes (n = 1). 

Conclusion: 

A consensus-agreed set of prescribing criteria has been developed for identifying potentially inappropriate prescribing of medications for symptomatic relief in older adults with cancer who are receiving palliative care and have an estimated life expectancy of less than one year. Future studies should examine the application and validity of these criteria.

Original languageEnglish
JournalJournal of Geriatric Oncology
Early online date15 Jun 2021
DOIs
Publication statusEarly online date - 15 Jun 2021

Bibliographical note

Funding Information:
Cathal Cadogan was jointly supported by the Irish Cancer Society and All Ireland Institute of Hospice and Palliative Care [grant number: PAL17CAD ].

Funding Information:
Melanie Murphy was supported by a Clement Archer Scholarship from the School of Pharmacy and Biomolecular Sciences , Royal College of Surgeons in Ireland .

Funding Information:
Kathleen Bennett was supported by a Health Research Board award [grant number: RL-15-1579 ].

Publisher Copyright:
© 2021 The Authors

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

Keywords

  • Aged
  • Cancer
  • Delphi
  • Geriatric oncology
  • Older adults
  • Palliative care
  • Prescribing

ASJC Scopus subject areas

  • Oncology
  • Geriatrics and Gerontology

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