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Clinical rationale for administering fentanyl to cancer pain patients: Two Delphi surveys of pain management experts in Denmark

Ramune Jacobsen, MS, MPH, Claus Møldrup, PhD, Lona Christrup, PhD


Objective: To describe the rationale behind the choice of fentanyl administration forms as reported by Danish nurses and physicians specializing in pain management.
Methods: Sixty nurses and 60 physicians specializing in pain management in Denmark were contacted via an Internet survey system to perform two Delphi surveys. In the brainstorming phase, the main reasons for administering and not administering fentanyl patches and oral transmucosal fentanyl citrate (OTFC) were identified. In the second phase, the nursing and medical experts rated the importance of these reasons on an 11-point Numerical Rating Scale.
Results: Responses from 10 pain nurses and 14 pain doctors were used for the final analysis. Impossible or difficult oral intake of analgesia was the most important reason to administer fenantyl patches, whereas patients’ dermatological problems and neuropathic pain origin were the most important reasons for not administering fenantyl patches in both panels. OTFC was presented as an alternative or second choice administration form for breakthrough cancer pain by both nurses and doctors. A damaged mouth, the high cost, and energy required for administration of this medication were reported as the main reasons why OTFC was only rarely prescribed to cancer pain patients in Denmark.
Conclusions: The reasons for administering fentanyl in different administration forms reported by Danish pain nurses and pain specialists partly differed from those derived from the literature. Studies of pain management traditions could improve the understanding of the reasons for analgesic administration.


fentanyl, administration forms, nurses, pain specialists, rationale, Delphi survey, Denmark

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Zacny JP, Lichtor JL, Zaragoza JG, et al.: Subjective and behavioral responses to intravenous fentanyl in healthy volunteers. Psychopharmacology (Berl). 1992; 107(2/3): 319-326.

Jeal W, Benfield P: Transdermal fentanyl. A review of its pharmacological properties and therapeutic efficacy in pain control. Drugs. 1997; 53(1): 109-138.

Fine PG, Streisand JB: A review of oral transmucosal fentanyl citrate: Potent, rapid and noninvasive opioid analgesia. J Palliat Med. 1998; 1(1): 55-63.

Danish Medicine Agency (Laegemiddelstyrelsen): The list of approved medicines. Available at Accessed December 19, 2007.

US Food and Drug Administration: Duragesic label. Available at Accessed December 19, 2007.

US Food and Drug Administration: Medication guide actiq. Available at Accessed December 20, 2007.

Mosser KH: Transdermal fentanyl in cancer pain. Am Fam Physician. 1992; 45(5): 2289-2294.

Southam MA: Transdermal fentanyl therapy: System design, pharmacokinetics and efficacy. Anticancer Drugs. 1995; 6(Suppl 3): 29-34.

Mystakidou K, Katsouda E, Tsilika E, et al.: Transdermal therapeutic fentanyl-system (TTS-F). In Vivo. 2004; 18(5): 633-642.

Gourlay GK: Treatment of cancer pain with transdermal fentanyl. Lancet Oncol. 2001; 2(3): 165-172.

Kornick CA, Santiago-Palma J, Moryl N, et al.: Benefit-risk assessment of transdermal fentanyl for the treatment of chronic pain. Drug Saf. 2003; 26(13): 951-973.

Mercadante S, Fulfaro F: Alternatives to oral opioids for cancer pain. Oncology (Williston Park). 1999; 13(2): 215-225.

Radovanovic D, Pjevic M, Malbasa Z, et al.: The use of transdermal fentanyl in the treatment of cancer pain. Arch Oncol. 2002; 10(4): 263-266.

Simmonds MA, Richenbacher J: Transdermal fentanyl: Longterm analgesic studies. J Pain Symptom Manage. 1992; 7(3 Suppl): S36-S39.

Gordon DB: Oral transmucosal fentanyl citrate for cancer breakthrough pain: a review. Oncol Nurs Forum. 2006; 33(2): 257-264.

Mystakidou K, Katsouda E, Parpa E, et al.: Oral transmucosal fentanyl citrate for the treatment of breakthrough pain in cancer patients: An overview of its pharmacological and clinical characteristics. J Opioid Manag. 2005; 1(1): 36-40.

Mystakidou K, Katsouda E, Parpa E, et al.: Oral transmucosal fentanyl citrate: overview of pharmacological and clinical characteristics. Drug Deliv. 2006; 13(4): 269-276.

Rees E: The role of oral transmucosal fetanyl citrate in the management of breakthrough cancer pain. Int J Palliat Nurs. 2002; 8(6): 304-308.

Zeppetella G, Ribeiro MD: Opioids for the management of breakthrough (episodic) pain in cancer patients. Cochrane Database Syst Rev. 2006; 25(1): CD004311.

Reddy SK, Nguyen P: Breakthrough pain in cancer patients: New therapeutic approaches to an old challenge. Curr Rev Pain. 2000; 4(3): 242-247.

Efstathiou N, Ameen J, Coll AM: Healthcare providers’ priorities for cancer care: A Delphi study in Greece. Eur J Oncol Nurs. 2007; 11(2): 141-150.

Møldrup C, Morgall JM: Risks of Future Drugs: A Danish Expert Delphi. Technol Forec Soc Change. 2001; 67(1): 273- 289.

Stevens B, McGrath P, Yamada J, et al.: Identification of pain indicators for infants at risk for neurological impairment: A Delphi consensus study. BMC Pediatr. 2006; 61.

Akins RB, Tolson H, Cole BR: Stability of response characteristics of a Delphi panel: Application of bootstrap data expansion. BMC Med Res Methodol. 2005; 537.

Nevo D, Chan YE: A Delphi study of knowledge management systems: Scope and requirements. Inf Manage. 2007; 44: 538-597.

Bland JM, Altman DG: Cronbach’s alpha. Br Med J. 1997; 314(7080): 572.

Fayers PM, Machin D: Quality of Life. Assessment, Analysis and Interpretation. Chichester, England: Wiley, 2007.

Kilner T: Educating the ambulance technician, paramedic, and clinical supervisor: Using factor analysis to inform the curriculum. Emerg Med J. 2004; 21(3): 379-385.

Altman DG: Practical Statistics for Medical Research. London: Chapman & Hall/CRC, 1991.

John Bell & Associates: Statistics for practical people. Available at Accessed January 28, 2008.

Christrup LL, Foster D, Popper LD, et al.: Pharmacokinetics, efficacy, and tolerability of fentanyl following intranasal versus intravenous administration in adults undergoing third-molar extraction: A randomized, double-blind, double-dummy, twoway, crossover study. Clin Ther. 2008; 30(3): 469-481.

Dale O, Hjortkjaer R, Kharasch ED: Nasal administration of opioids for pain management in adults. Acta Anaesthesiol Scand. 2002; 46(7): 759-770.

Lennernas B, Hedner T, Holmberg M, et al.: Pharmacokinetics and tolerability of different doses of fentanyl following sublingual administration of a rapidly dissolving tablet to cancer patients: A new approach to treatment of incident pain. Br J Clin Pharmacol. 2005; 59(2): 249-253.

Portenoy RK, Taylor D, Messina J, et al.: A randomized, placebo-controlled study of fentanyl buccal tablet for breakthrough pain in opioid-treated patients with cancer. Clin J Pain. 2006; 22(9): 805-811.

Slatkin NE, Xie F, Messina J, et al.: Fentanyl buccal tablet for relief of breakthrough pain in opioid-tolerant patients with cancer-related chronic pain. J Support Oncol. 2007; 5(7): 327-334.

Zeppetella G: An assessment of the safety, efficacy, and acceptability of intranasal fentanyl citrate in the management of cancer-related breakthrough pain: A pilot study. J Pain Symptom Manage. 2000; 20(4): 253-258.

Prosser H, Walley T: New drug prescribing by hospital doctors: The nature and meaning of knowledge. Soc Sci Med. 2006; 62(7): 1565-1578.

Ljungberg C, Lindblad AK, Tully MP: Hospital doctors’ views of factors influencing their prescribing. J Eval Clin Pract. 2007; 13(5): 765-771.

Powell C: The Delphi technique: Myths and realities. J Adv Nurs. 2003; 41(4): 376-382.

Delbecq AL, Van de Ven AH, Gustafson Dh: Group Techniques for Program Planning. A Guide to Nominal Group and Delphi Processes. Glenview, IL: Scot, Foresman and Company, 1975.

Sackman H: Delphi Critique. Expert Opinion, Forecasting, and Group Process. Lexington: Lexington Books, 1975.

Cook C, Brismee JM, Sizer PS: Factors associated with physiotherapists’ confidence during assessment of clinical cervical and lumbar spine instability. Physiother Res Int. 2005; 10(2): 59-71.

Misener TR, Alexander JW, Blaha AJ, et al.: National Delphi study to determine competencies for nursing leadership in public health. Image J Nurs Sch. 1997; 29(1): 47-51.



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