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Primary addiction medicine skills for hospice and palliative medicine physicians : a modified Delphi study
Article
CONTEXT: Hospice and palliative medicine (HPM) physicians frequently care for patients with substance use disorders (SUDs), but there is no consensus on which primary addiction medicine (AM) skills are essential.
OBJECTIVES: Identify key primary AM skills that physicians should acquire during an ACGME-accredited HPM fellowship program.
METHODS: A modified Delphi study consisting of 18 experts on SUD in HPM and medical education. A literature review and expert input identified initial AM skills. In three Delphi rounds, participants rated each skill on a nine-point scale from "not at all important to include" to "crucial to include." We calculated medians (IQRs), analyzed panelists' comments, and grouped skills using the RAND / UCLA appropriateness method.
RESULTS: Among 62 proposed AM skills, 53 skills were rated as appropriate to include (38 of which achieved agreement), and 9 skills were rated as uncertain. AM skills most relevant to HPM included 1) defining chemical coping, median 8.5 (IQR 2); 2) balancing life expectancy with risks of opioid use for patients with SUD, 9 (IQR 0); 3) explaining best practices to dispose unused opioids post-mortem, 8 (IQR 2); 4) managing pain for hospice patients with SUD, 9 (IQR 0.75); and 5) partnering with hospice to manage patients on methadone and buprenorphine, 9 (IQR 2). Experts did not achieve consensus on whether HPM physicians should be encouraged to learn to prescribe buprenorphine for patients with opioid use disorder, 6 (IQR 3).
CONCLUSION: HPM fellowships should consider incorporating the primary AM skills identified in this study in their curricula.
http://dx.doi.org/10.1016/j.jpainsymman.2021.02.035
Voir la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 62»
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