The compassionate use of drugs in palliative care for symptom control and ethical justifications for its use: A scoping review

Abstract

Introduction

Compassionate use of drugs is becoming increasingly popular among terminally ill patients who require palliative care and have exhausted all treatment options, with no satisfactory authorized therapies.

Objectives

This scoping review aimed to systematically map the literature on the compassionate use of drugs: (1) for symptom control in palliative care and (2) the ethical justification for its use.

Methods

PubMed, EMBASE and Cochrane databases were searched. Eligibility criteria: any participant with palliative needs, any control, and any study design was accepted. Interventions: any drug used for compassionate reasons. Outcomes: symptom control and ethical-related issues. Filters: articles written in English and published between 2012–2022. Critical appraisal of sources of evidence was made.

Results

Five moderate/high-quality studies were included: one clinical trial, one case series, two case reports/studies, and one expert opinion. Patients were 28, mostly with cancer. Three studies showed symptom control, namely pain. Ethical justifications for compassionate use of drugs were sustained by autonomy, beneficence, and justice. Barriers to compassionate use of drugs were inequitable access, inattentive risk/benefit assessment, and doubtful validity of informed consent.

Conclusions

Although there is some evidence that compassionate use of drugs may help symptom management in palliative care, additional research is necessary to verify its effectiveness.