Impact of a Structured Pathway on Nausea and Vomiting Treatment in Palliative Care: A Before-After Study

Abstract

Background:

Nausea and vomiting are distressing symptoms in palliative care. Due to a heterogeneous population and limited evidence, clinical management remains challenging. Guidelines often recommend an etiology-based treatment approach, but supporting evidence is scarce, particularly for noncancer patients.

Objectives:

Evaluating the impact of a structured, etiology-based treatment pathway on nausea and vomiting burden and treatment quality in palliative care patients.

Setting/Subjects:

Single-center, before-after study in adult patients on a German tertiary palliative care unit, comparing symptom burden and treatment quality before (Phase 1, 15 months) and after (Phase 2, 12 months) implementation of the pathway.

Measurements:

Outcome measures were change in symptom burden score on day 3 (Integrated Palliative Care Outcome Scale ([IPOS]), treatment quality (quality indicator [QI]; burden reduction on IPOS), and duration of symptoms (days). Significance level was set at α < 0.01.

Results:

In Phase 1, 172/330 patients (52.1%) experienced 230 episodes of nausea/vomiting, versus 139/280 patients (49.6%) with 178 episodes in Phase 2. On day 3, symptom burden scores for nausea decreased to a greater extent in Phase 2 (p = 0.007); vomiting showed a nonsignificant reduction (p = 0.021). The QI (nausea) was met in 124/178 (69.7%) versus 129/156 (82.7%) (p = 0.0056), and the QI (vomiting) was met in 66/93 (71.0%) versus 81/95 (85.3%) (p = 0.0176) episodes. Symptom duration decreased from 3 (0–25) to 2 (0–23) days (p < 0.001).

Conclusions:

The systematic etiology-based pathway significantly improved cause identification and treatment quality. While benefits were more pronounced in cancer patients, this structured approach provides a robust framework for enhancing antiemetic management in the palliative care setting. Further studies should investigate antiemetic treatment in noncancer patients.