Danish pain specialists' rationales behind the choice of fentanyl transdermal patches and oral transmucosal systems--a delphi study.
OBJECTIVE
The aim of this study was to describe the rationale behind the choice of fentanyl administration forms among Danish pain specialists.


METHODS
Sixty Danish physicians specializing in pain management were contacted via an Internet survey system to perform a two-phase Delphi survey. Response rates were 45% in the brainstorming and 88% in the rating phases, respectively. Statistical analysis with SPSS for Windows 15.00 included descriptive statistics and factor analysis.


RESULTS
The most important rationale to choose fentanyl patches was that patients' clinical condition did not allow them to take analgesia orally, while the main explanations for not choosing a fentanyl patch was a specific chronic pain condition such as nonmalignant or neuropathic pain origin, and price. The foremost rationale behind the choice of oral transmucosal fentanyl citrate (OTFC) were cancer patients' need for the alternative to oral, intravenous or subcutaneous rescue medication, followed by patients' wish and ability to administer pain medication independently. The main reasons for not choosing OTFC were price and the argument that OTFC administration requires much energy and healthy patients' mouth and therefore is inapplicable for terminal pain patients.


CONCLUSIONS
The study had shown that the rationales behind the choice of administration form with fentanyl reported by a panel of Danish pain specialists partly differed from those overviewed in the literature and those thought to be important while developing fentanyl patches and OTFC.
University of Copenhagen, Faculty of Pharmaceutical Sciences, Department of Pharmacology and Pharmacotherapy, Copenhagen, Denmark. raj@farma.ku.dk
Ramune
R
Jacobsen
Claus
C
Møldrup
Lona
L
Christrup
D000279:Administration, Cutaneous; D000284:Administration, Oral; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D003625:Data Collection; D003661:Decision Support Techniques; D003718:Denmark; D004333:Drug Administration Routes; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D006801:Humans; D020407:Internet; D008297:Male; D009061:Mouth Mucosa / Q000187:drug effects; D009369:Neoplasms / Q000150:complications; D018710:Pain Clinics / Q000706:statistics & numerical data / Q000639:trends; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D010349:Patient Compliance; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D055502:Secondary Prevention; D013038:Specialization / Q000706:statistics & numerical data / Q000639:trends; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D005283:Fentanyl