title: Prescribing for nausea in palliative care: a cross-sectional national survey of Australian palliative medicine doctors.
abstract: BACKGROUND
  Nausea can be a debilitating symptom for patients with a life-limiting illness. While addressing reversible components, nonpharmacological strategies and antiemetics are the main therapeutic option. The choice of medication, dose, and route of administration remain highly variable.
  
  
  OBJECTIVE
  The aim of this study was to codify the current clinical approaches and quantify any variation found nationally.
  
  
  METHODS
  A cross-sectional study utilizing a survey of palliative medicine clinicians examined prescribing preferences for nausea using a clinical vignette. Respondent characteristics, the use of nonpharmacological interventions, first- and second-line antiemetic choices, commencing and maximal dose, and time to review were collected.
  
  
  RESULTS
  Responding clinicians were predominantly working in palliative medicine across a range of settings with a 49% response rate (105/213). The main nonpharmacological recommendation was "small, frequent snacks." Metoclopramide was the predominant first-line agent (69%), followed by haloperidol (26%), while second-line haloperidol was the predominant agent (47%), with wide variation in other nominated agents. Respondents favoring metoclopramide as first-line tended to use haloperidol second-line (65%), but not vice versa. Maximal doses for an individual antiemetic varied up to tenfold.
  
  
  CONCLUSIONS
  For nausea, a commonly encountered symptom in palliative care, clinicians' favored metoclopramide and haloperidol; however, after these choices, there was large variation in antiemetic selection. While most clinicians recommended modifying meal size and frequency, use of other nonpharmacological therapies was limited.
authors.affiliation: 1 Discipline, Palliative and Supportive Services, Flinders University , Bedford Park, Australia .
authors.forename: Timothy H M
authors.initials: TH
authors.lastname: To
authors.forename: Meera
authors.initials: M
authors.lastname: Agar
authors.forename: Patsy
authors.initials: P
authors.lastname: Yates
authors.forename: David C
authors.initials: DC
authors.lastname: Currow
mesh_terms: D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use*; D001315:Australia; D003430:Cross-Sectional Studies; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use*; D008875:Middle Aged; D009325:Nausea / Q000188:drug therapy*; D010166:Palliative Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D011795:Surveys and Questionnaires
chemical_list: D000932:Antiemetics; D006220:Haloperidol; D008787:Metoclopramide