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: 16.1). 08/1993; 119(2):121-6.
Source: PubMed

ABSTRACT 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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    • "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.
    Intensive & critical care nursing: the official journal of the British Association of Critical Care Nurses 06/2011; 27(4):173-9. DOI:10.1016/j.iccn.2011.04.004
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    • "Pain and depression in oncological patients: epidemiology and phenomenology Pain prevalence ranges from 14 to 100% in cancer patients [2], with higher percentages found in advanced stages of the disease [3]. Cancer pain is often severe enough to impair a patient's ability to function [4] [5], and its significant impact on the overall quality of life has been described [6]. Particularly, sub-optimally controlled pain remains a common cause of diminished quality of life [7]. "
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    ABSTRACT: Patients with cancer are burdened with pain, ranging in prevalence from 14 to 100% in this population, and with comorbid behavioural symptoms such as depression and cognitive decline. However, the complex relationships between cancer pain, depression and cognitive decline, as well as their causes, still need to be clarified. Here, the existing literature on pain and its relationships with depression and cognitive decline in adult patients with cancer is reviewed, in order to understand the impact of pain on these interrelated symptoms, and the importance of its correct assessment and management. From the literature, it emerges that pain in cancer patients has a multidimensional phenomenology, which is the final product of a complex process involving emotional, cognitive, and sensory components. There is a substantial agreement that cancer patients with pain are at higher risk of having depression and cognitive decline. However, it is still controversial if these symptoms may fit into the same cluster, due to the paucity of studies exploring the simultaneous impact of pain on the psychological and cognitive well-being of patients with cancer, which would be consequential on their treatment and management. Finally, recent advances in immunology/oncology have provided novel insights into the pathophysiologic mechanisms supposedly underlying pain-related symptoms. Particularly, immune dysfunction may represent a common pathogenic ground of pain, depression and cognitive decline in cancer patients. In clinical practice, an appropriate assessment of pain should take into account the relationships with depression and cognitive decline, in order to develop more personalised and effective therapies for its management.
    Surgical Oncology 12/2009; 19(3):160-6. DOI:10.1016/j.suronc.2009.11.006 · 2.37 Impact Factor
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    • "A standardized questionnaire was tailored for study purposes, based on questionnaires of previous studies (Von Roenn JH, 1993; Sloan PA, 1998; Sapir R, 1999; Ger LP, 2000; MacDonald N, 2002; Green CR, 2003). The questionnaire consists of two parts (6 pages). "
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