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Blinded patient preference for morphine compared to placebo in the setting of chronic refractory breathlessness – an exploratory study

Ferreira, Diana H.; Silva, José P.; Quinn, Stephen; Abernethy, Amy P.; Johnson, Miriam J.; Oxberry, Stephen G.; Currow, David C.

Authors

Diana H. Ferreira

José P. Silva

Stephen Quinn

Amy P. Abernethy

Stephen G. Oxberry

David C. Currow

Abstract

Context Patients’ preference for morphine therapy has received little attention in the setting of chronic refractory breathlessness. However, this is one important factor in considering longer term therapy. Objectives The aim of this secondary analysis is to explore blinded patient preference of morphine compared to placebo for this indication and to define any predictors of preference. Methods Data were pooled from three randomized, double-blind, crossover, placebo-controlled studies of morphine (four days each) in chronic refractory breathlessness. Blinded patient preferences were chosen at the end of each study. A multivariable regression model was used to establish patient predictors of preference. Results Sixty-five participants provided sufficient data (60 males; median age 74 years; heart failure 55%, chronic obstructive pulmonary disease 45%; median Eastern Cooperative Oncology Group performance status 2). Forty-three percent of participants preferred morphine (32% placebo and 25% no preference). Morphine preference and younger age were strongly associated: odds ratio = 0.85, 95% confidence interval 0.78, 0.93; P<0.001). There was also an inverse association between morphine preference and sedation (odds ratio = 0.77, 95% confidence interval 0.60, 0.99; P<0.05). An inverse association was also seen between nausea and morphine preference in the univariate model only (P<0.05). No association was seen between morphine preference and breathlessness intensity, either at baseline or change from baseline. Conclusion Participants preferred morphine over placebo for the relief of chronic refractory breathlessness. Morphine offers clinically important improvement but net benefit can be easily outweighed by side effects, reducing net benefits. Side effects require aggressive management to allow more patients to realize benefits.

Journal Article Type Article
Publication Date 2016-02
Journal Journal of pain and symptom management
Print ISSN 0885-3924
Electronic ISSN 1873-6513
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 51
Issue 2
Pages 247-254
Institution Citation Ferreira, D. H., Silva, J. P., Quinn, S., Abernethy, A. P., Johnson, M. J., Oxberry, S. G., & Currow, D. C. (2016). Blinded patient preference for morphine compared to placebo in the setting of chronic refractory breathlessness – an exploratory study. Journal of pain and symptom management, 51(2), 247-254. https://doi.org/10.1016/j.jpainsymman.2015.10.005
DOI https://doi.org/10.1016/j.jpainsymman.2015.10.005
Keywords Patient preference, Palliative care, Breathlessness, COPD, Morphine, Randomized controlled trial
Publisher URL http://www.sciencedirect.com/science/article/pii/S0885392415005655
Additional Information Authors' accepted manuscript of article published in: Journal of pain and symptom management, 2016, v.51, issue 2.

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Copyright Statement
© 2016, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/



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