Evidence map›Paper›PMID 33845654›Full record

Trial reportPalliative medicine2021

Healthcare professionals' views of the use of oral morphine and transmucosal diamorphine in the management of paediatric breakthrough pain and the feasibility of a randomised controlled trial: A focus group study (DIPPER).

Liz Jamieson, Emily Harrop, Margaret Johnson, Christina Liossi, Christine Mott, Kate Oulton, Simon S Skene, Ian Ck Wong, Richard F Howard

Open access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Palliative medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
2.0field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 10 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Article
  5. Observational
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 6 institutions in 3 countries.

Liz JamiesonResearch Department of Practice and Policy, University College London School of Pharmacy, London, UK.ORCID 0000-0002-3667-0423
Emily HarropHelen & Douglas House Hospice, Oxford, UK.
Margaret JohnsonPatient & Public Representative c/o Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Christina LiossiSchool of Psychology, University of Southampton, Southampton, UK.ORCID 0000-0003-0627-6377
Christine MottHummingbird House Hospice, Brisbane, Queensland, Australia.ORCID 0000-0002-2538-2530
Kate OultonGreat Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Simon S SkeneSurrey Clinical Trials Unit, University of Surrey, Surrey, UK.ORCID 0000-0002-7828-3122
Ian Ck WongResearch Department of Practice and Policy, University College London School of Pharmacy, London, UK.
Richard F HowardGreat Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Great Ormond Street Hospital for Children NHS Foundation Trust · GBUniversity College London · GBChildren’s Health Queensland Hospital and Health Service · AUOxford University Hospitals NHS Trust · GBUniversity of Cambridge · GBUniversity of Surrey · GB

Funding

Department of Health PB-PG-0317-20036
6 · The paper itself

Abstract

backgroundOral morphine is frequently used for breakthrough pain but the oral route is not always available and absorption is slow. Transmucosal diamorphine is administered by buccal, sublingual or intranasal routes, and rapidly absorbed.

aimTo explore the perspectives of healthcare professionals in the UK caring for children with life-limiting conditions concerning the assessment and management of breakthrough pain; prescribing and administration of transmucosal diamorphine compared with oral morphine; and the feasibility of a comparative clinical trial. DESIGN/

participantsThree focus groups, analysed using a Framework approach. Doctors, nurses and pharmacists (

resultsOral morphine is frequently used for breakthrough pain across all settings; with transmucosal diamorphine largely limited to use in hospices or given by community nurses, predominantly buccally. Perceived advantages of oral morphine included confidence in its use with no requirement for specific training; disadvantages included tolerability issues, slow onset, unpredictable response and unsuitability for patients with gastrointestinal failure. Perceived advantages of transmucosal diamorphine were quick onset and easy administration; barriers included lack of licensed preparations and prescribing guidance with fears over accountability of prescribers, and potential issues with availability, preparation and palatability. Factors potentially affecting recruitment to a trial were patient suitability and onerousness for families, trial design and logistics, staff time and clinician engagement.

conclusionsThere were perceived advantages to transmucosal diamorphine, but there is a need for access to a safe preparation. A clinical trial would be feasible provided barriers were overcome.

Indexed as

Breakthrough PainNeoplasmsAnalgesics, OpioidChildDelivery of Health CareFeasibility StudiesFentanylFocus GroupsHeroinHumansMorphineAnalgesics, OpioidFentanylHeroinMorphinebreakthrough paindiamorphinefocus groupsopioidsPaediatricspain managementpalliative careterminal care

Identifiers

PMID33845654
PMCPMC8188993
OpenAlexW3155657619

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.