Nasal spray medicine research to help patients who would like to die at home
Carers and relatives could help terminally ill patients better manage pain and agitation at home in new research.
Researchers at University Hospital Southampton (UHS) have been awarded £1.2 million to lead the national study.
Many palliative care patients would prefer to die at home. The INDIGO study aims to support them to make this choice.
It will provide training for carers and relatives to manage a patient’s symptoms. This will mean they can give two treatments themselves via a nasal spray, rather than waiting for a district nurse.
The study has been funded by the National Institute for Health and Care Research (NIHR).
It is being led by Dr Mark Banting, a Consultant in Palliative Medicine at UHS and is being supported by the Southampton Clinical Trials Unit. The research forms part of his UHS Research Leaders Programme award.
Reducing pain and anxiety
Currently, if a palliative care patient is in pain or agitated, their carer or relative needs to call a district nurse to come and give them an injection under the skin to relieve the symptoms.
It can take some time for the district nurse to arrive. The patient therefore has to wait before their pain or agitation can be treated.
“You wait about an hour and a half, on average, for a district nurse to come,” Dr Banting explains.
“If these intranasal treatments work, carers could administer the medication within five to ten minutes. That’s a significant improvement.”
Working with relatives and carers
The INDIGO study will investigate whether carers or relatives can give two medicines, diamorphine and midazolam, to palliative care patients as a spray up the nose.
Diamorphine is a pain killer, whereas midazolam is used to treat agitation. These medicines, or similar ones, are currently given to these patients as injections by a district nurse.
During the first phase of the study, the researchers will work with carers and relatives to create training materials on how to administer the drugs. This will help ensure they are easy for them to understand and follow.
The second phase will see if it is feasible for carers and relatives to give patients these medicines in this way, using the training materials.
Before giving one of the medicines, carers taking part will call the district nurse. If they succeed in giving the drug themselves, they can then cancel the nurse’s visit.
Giving people the choice
This study could enable more palliative care patients to choose to die at home, by giving them more ways to manage their symptoms in a timely manner.
The research is being supported by the Southampton Clinical Trials Unit. The team is working with collaborators from hospices in Southampton, Gloucester and Yorkshire, the University of Edinburgh and the University of Southampton.
Once this study is complete, it could lead to a randomised trial that would ultimately change clinical practice.
If carers are able to give these treatments in this way, the researchers also plan to see if other palliative care medicines could be given as a spray up the nose.
“This is about increasing the options that people have,” Dr Banting explains. “It would give us more ways to manage symptoms, so that people can stay at home if that’s where they want to be.”