Nasal Fentanyl and Buccal Midazolam for Dying Patients
Status:
Completed
Trial end date:
2018-02-28
Target enrollment:
Participant gender:
Summary
When patients are dying they become unable to take oral medication and if they develop
symptoms (e.g. pain or agitation) they need to be given a subcutaneous injection of
medication. If they are at home this requires that a District Nurse is called and it can take
a long time (sometimes hours) for the Nurse to arrive. This can be a very stressful time for
the patient and family.
There are 2 drug preparations which could potentially be given by family members in the home:
Nasal fentanyl (PecFent) Buccal midazolam (Epistatus) If these preparations helped symptoms
this would give much quicker symptom control for patients and might mean the District Nurse
visit was not needed.
In advance of a community based randomised trial of these modes of administration, it is
important to assess the feasibility of such an approach in terms of carer acceptability and
patient tolerability as well as determine appropriate sample sizes and sampling methods.
There are 2 work packages which would help assess feasibility of a community trial:
1. An open label randomised controlled trial comparing the use of PecFent with or without
Epistatus versus standard subcutaneous breakthrough medication for the management of
breakthrough pain (with or without agitation) in dying hospice patients who either
remain in the hospice or go home.
2. A qualitative interview study to capture the thoughts of relatives of these patients
about the use of these preparations.