Prescribing for Malignant Bowel Obstruction in Palliative Care: A Cross-Sectional Australia and New Zealand Survey of Palliative Medicine Practitioners

Purpose: Pharmacological management of malignant bowel obstruction can be complex with a variety of treatment options available, many of which are used off-label for this condition. The current prescribing practices of Palliative Care Clinicians in Australia and New Zealand remain unclear. To capture current prescribing preferences among palliative care clinicians, assess the presence of variability in prescribing practices, and explore the rationale behind their choices as well as any potential barriers to pharmacological management. Methods: A cross-sectional online survey of palliative medicine clinicians in 2024 used a clinical vignette to elicit prescribing preferences for first, second, and third-line agents, including the number of agents used and factors influencing decisions. Results: 117 responses were collected. For initial therapy, clinicians chose to prescribe Dexamethasone (78%) and Haloperidol (69%). For second and third line therapy Cyclizine (42%) and Levomepromazine (42%) were the most common responses. The number of agents prescribed was diverse, with results showing 24% initiating one agent, 33% two agents and 43% initiating three or more agents. Only 28% of respondents agreed or strongly agreed that there was a standard approach to prescribing in Australia and New Zealand. Conclusion: Responses revealed variation in prescribing practices despite a dominant first-line strategy. No clear consensus was found for second and third-line choices. The comparison to the 2021 MASCC guidelines revealed a disconnect between reported prescribing patterns and the level of supporting evidence. These findings highlight the need for further research and the need for localised guidelines to reduce variability.