Physician Attitudes and Practice in Cancer Pain Management. A Survey from the Eastern Cooperative Oncology Group

Northwestern University Medical School, Section of Medical Oncology, Chicago, IL 60611.
Annals of internal medicine (Impact Factor: 17.81). 08/1993; 119(2):121-6.
Source: PubMed


The Eastern Cooperative Oncology Group (ECOG) conducted a groupwide survey to determine the amount of knowledge about cancer pain and its treatment among physicians practicing in ECOG-affiliated institutions and to determine the methods of pain control being used by these physicians.
A questionnaire was sent to all ECOG physicians with patient care responsibilities (medical oncologists, hematologists, surgeons, and radiation therapists), practicing in university institutions, Community Clinical Oncology Program (CCOP) institutions, and Cooperative Group Outreach Programs (CGOP) institutions.
A physician cancer pain questionnaire developed by the Pain Research Group at the University of Wisconsin was used. The questionnaire was designed to assess physicians' estimates of the magnitude of pain as a specific problem for cancer patients, their perceptions of the adequacy of cancer pain management, and their report of how they manage pain in their own practice setting.
The study analyzed responses to 897 of 1800 surveys. In regard to the use of analgesics for cancer pain in the United States, 86% felt that the majority of patients with pain were undermedicated. Only 51% believed pain control in their own practice setting was good or very good; 31% would wait until the patient's prognosis was 6 months or less before they would start maximal analgesia. Adjuvants and prophylactic side-effect management should have been used more frequently in the treatment plan. Concerns about side-effect management and tolerance were reported as limiting analgesic prescribing. Poor pain assessment was rated by 76% of physicians as the single most important barrier to adequate pain management. Other barriers included patient reluctance to report pain and patient reluctance to take analgesics (both by 62%) as well as physician reluctance to prescribe opioids (61%).
Professional education needs to focus on the proper assessment of pain, focus on the management of side effects, and focus on the use of adjuvant medications. A better understanding of the pharmacology of opioid analgesics is also needed. Physicians also need to educate patients to report pain and to effectively use the medications that are prescribed for pain management.

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    • "Breivik et al. [1] reported that in a study of 5,084 cancer patients, 56% had cancer pain of a moderate or worse degree, and only 41% of the patients were using appropriate opioids. In addition, in the reports of Von Roenn et al. [2] and Zenz et al. [3], 40-70% of patients with cancer pain were receiving inappropriate pain treatment. Insufficient treatment for cancer pain arises from several factors that interfere with pain treatment; such factors include fear and aversion of patients and medical staff toward the use of opioids because of the possibility of opioid abuse and addiction, insufficient palliative care programs, lack of experience and inexperienced use of opioids by medical staff, and complications arising from the use of opioids. "
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    ABSTRACT: More than 80% of cancer patients experience cancer pain. Among them, more than 50% experience moderate to severe pain. To control cancer pain, a variety of methods have been used, including medications and nerve blocks. In some patients, however, it is impossible to perform nerve blocks due to caner metastasis into the epidural space, while in other patients, opioid dose escalation is impossible due to opioid side effects; thus, cancer pain management is difficult. Scrambler therapy is a novel approach for pain control that uses EKG-like pads, which are applied above and below the site of pain. Scrambler therapy synthesizes 16 different types of nerve action potentials that provide "non-pain" information via cutaneous nerves. The advantages of this treatment are that it is non-invasive and safe and has no significant side effects. In this case series, we report the treatment results of using scrambler therapy in three cancer patients with intractable pain.
    The Korean journal of pain 01/2013; 26(1):65-71. DOI:10.3344/kjp.2013.26.1.65
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    • "Healthcare providers tend to show a lack of attention to and knowledge about pain management [29,31-33] and consequently do not always treat pain according to specific guidelines [31,32]. This has been regarded as one of the main factors causing inadequate pain relief in cancer patients [29,34,35]. For these patient- and professional-related reasons, inadequate treatment of cancer pain persists, despite decades of efforts to provide clinicians with information on analgesics and pain-relieving techniques [36-42], and despite the availability of evidence-based guidelines on cancer pain [43]. "
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    ABSTRACT: One-half of patients with cancer have pain. In nearly one out of two cancer patients with pain, this was undertreated. Inadequate pain control still remains an important problem in this group of patients. Therefore, in 2008 a national, evidence-based multidisciplinary clinical practice guideline 'pain in patients with cancer' has been developed. Yet, publishing a guideline is not enough. Implementation is needed to improve pain management. An innovative implementation strategy, Short Message Service with Interactive Voice Response (SVS-IVR), has been developed and pilot tested. This study aims to evaluate on effectiveness of this strategy to improve pain reporting, pain measurement and adequate pain therapy. In addition, whether the active role of the patient and involvement of caregivers in pain management may change. A cluster randomised controlled trial with two arms will be performed in six oncology outpatient clinics of hospitals in the Southeastern region of the Netherlands, with three hospitals in the intervention and three in the control condition. Follow-up measurements will be conducted in all hospitals to study the long-term effect of the intervention. The intervention includes training of professionals (medical oncologists, nurses, and general practitioners) and SMS-IVR to report pain in patients with cancer to improve pain reporting by patients, pain management by medical oncologists, nurses, and general practitioners, and decrease pain intensity. This innovative implementation strategy with technical tools and the involvement of patients, may enhance the use of the guideline 'pain in patients with cancer' for pain management. Short Message Service alerts may serve as a tool to support self-management of patients. Therefore, the SMS-IVR intervention may increase the feeling of having control over one's life. TRAIL REGISTRATION: Netherlands Trial Register (NTR): NTR2739.
    Implementation Science 12/2011; 6(1):126. DOI:10.1186/1748-5908-6-126 · 4.12 Impact Factor
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    • "Well-designed surveys can produce meaningful data that provide comprehensive descriptions of knowledge, practice and clinician beliefs (Porter et al., 1997; Von Roenn et al., 1993; White and Brooker, 1997). Survey data can identify compliance with evidence-based practice, practice variation and the need for knowledge generation and knowledge translation (White and Brooker, 1997). "
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    ABSTRACT: Survey research provides information regarding clinician opinion, adherence to evidence-based recommendations and practice variation. Yet, the conduct of large surveys can present numerous challenges. Practical challenges such as establishing a sampling strategy consistent with a population's distribution may be anticipated. Additional unanticipated challenges may emerge during survey implementation that require troubleshooting and result in additional costs. Our objective is to inform nurse clinicians and researchers of our experiences in the conduct of a large, Canadian survey of critical care nurses. Specifically, we describe administrative, financial and logistical considerations and challenges. Administrative challenges included negotiation with each provincial/territorial nursing association to facilitate survey distribution. Financial considerations included anticipated and unanticipated costs such as postage, nursing association fees, translation, printing, shipping and research assistant time. Logistical challenges included systematizing survey mail outs and tracking, and translating survey materials and responses for bilingual provinces. Conduct of this large national survey required considerable financial resources, time, energy and coordination. We anticipate greater understanding of the work and cost associated with planning and implementing such surveys may inform researchers as well as critical care nurses considering responding to future survey invitations.
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