A Pilot Study To Define Chemical Coping in Cancer Patients Using the Delphi Method.
BACKGROUND
"Chemical coping" is a commonly used term in the pain and palliative care literature, but is heterogeneously defined. We conducted a Delphi survey among palliative care and pain specialists internationally to identify a consensus definition for "chemical coping with opioids" and warning signs for chemical coping.


METHODS
This Delphi survey consisted of two rounds on the following: (1) concepts and definition related to chemical coping, (2) warning signs for chemical coping, and (3) demographics. Consensus in this study was defined as agreement by a minimum of 70% of the experts.


RESULTS
Participating in the first round were 14/19 (74%) physicians; 12/14 (86%) participated in the second round. The international experts reached the following consensus definition for chemical coping with opioids (92% agreement): "The use of opioids to cope with emotional distress, characterized by inappropriate and/or excessive opioid use." They also identified depression (consensus 93%); psychiatric disease (86%); a history of substance abuse (86%); a positive score for the Cut-down, Annoyed, Guilty, and Eye-opener (CAGE) alcoholism screening test (79%); a history of alcoholism (79%); and a history of smoking (71%) as important warning signs for chemical coping.


CONCLUSIONS
Our expert panel reached a consensus definition for chemical coping and related warning signs, which may help clinicians and researchers to identify patients at risk of opioid misuse.
1 Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center , Houston, Texas.|2 Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University , Seoul, Republic of Korea.
Jung Hye
JH
Kwon
1 Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center , Houston, Texas.
David
D
Hui
1 Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center , Houston, Texas.
Eduardo
E
Bruera
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009293:Opioid-Related Disorders / Q000517:prevention & control*; D059408:Pain Management / Q000379:methods*; D010166:Palliative Care; D010865:Pilot Projects; D012307:Risk Factors; D013315:Stress, Psychological / Q000188:drug therapy
D000701:Analgesics, Opioid