Attitudes to morphine in chronic heart failure patients
- 1Department of Palliative Medicine, Kirkwood Hospice, Huddersfield, UK
- 2Department of Health Sciences, Hull York Medical School, University of York, York, UK
- 3Department of Academic Cardiology, University of Hull, Hull, UK
- 4Department of Palliative Medicine, Hull York Medical School, University of Hull, Hull, UK
- Correspondence to Dr Stephen Oxberry, Kirkwood Hospice, 21 Albany Road, Dalton, Huddersfield HD5 9UY, UK;
- Received 12 September 2011
- Accepted 17 November 2011
Objectives Low-dose opioids are used for the palliation of pain, breathlessness and cough in advanced chronic heart failure (CHF) patients. The authors wanted to determine any potential barriers or facilitators to opioid administration in patients with CHF by assessing their knowledge, concerns and attitudes to morphine therapy.
Methods Semistructured interviews were held with a purposive sample of 10 men with symptoms of CHF. Data were analysed using a constant comparative approach until thematic saturation.
Results Four key areas emerged: medication use; symptoms; prior morphine experience; and attitudes, concerns and anxieties regarding morphine use. Despite polypharmacy, participants said that morphine would be acceptable if it was monitored by a trusted healthcare professional. Many patients had experienced morphine before, often in life-threatening situations such as myocardial infarction, when it had helped greatly. Opioids were not strongly associated exclusively with death and dying (in contrast to patient reports in the cancer literature).
Conclusions Although some concerns about morphine were expressed, these did not appear to override a willingness to consider its use if recommended by a trusted clinician. However, some participants perceived that their doctor was concerned about its use, holding it as a last reserve. Morphine appears to be an acceptable breathlessness treatment option to these people with CHF. Prescribers may need education and reassurance if these medicines are to be used to their full potential and views may be different in other communities.
This is a reprint of a paper that first appeared in BMJ Supportive & Palliative Care, 2012, Volume 2, pages 29–35.
Funding This study was supported by a Clinical Fellowship Research Grant through the Hull York Medical School, UK. The funder remained separate to the research process and development of the submission.
Competing interests None.
Ethics approval Hull & East Yorkshire REC (number 08/H1304/B).
Provenance and peer review Not commissioned; externally peer reviewed.