Physician attitudes and practice in cancer pain management. A survey from the Eastern Cooperative Oncology Group.
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.
SourceAvailable from: Seyed Masoud Hashemi[Show abstract] [Hide abstract]
ABSTRACT: Pain has been one of the most debilitating symptoms of cancer. The aim of this study was to evaluate residents' knowledge, attitude, and practice regarding pain control in cancer patients. In a descriptive study, 69 randomly selected third-year various residents practicing in teaching hospitals of Shahid Beheshti School of medicine participated in this study. They have provided their demographic characteristics and completed a questionnaire, based on their "knowledge", "attitude" and "practice" regarding cancer pain and its management. Data analysis has performed using SPSS v.19. A p value of less than 0.05 has considered as significant. Obtained Data from 69 participants including 32 anesthesiology residents has included to our study. The average scores were 35.8±6.1 (ranging from 20 to 49) for the residents' attitude, 25.1±9.1 (ranging from 0 to 53) for their knowledge and 11.2±4.1 (ranging from 0 to 17) for their practice. The overall scores of the questions have related to attitude and knowledge were higher for residents of anesthesiology but the difference was not statistically significant (A: 37.1±4.9 vs. 34.7±6.8, p=0.106, K: 27.2±11.8 vs. 23.3±5.6, p=0.076). The average score for questions on physician' practice was significantly higher in residents of anesthesiology (P: 12.8±3.2 vs. 9.7±4.2, p=0.001). In order to provide patients with adequate pain relief, it has seemed advisable for medical schools to focus on improving the educational curriculum and integrating it into clinical practice.01/2015; 8(1):1-10.
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ABSTRACT: This prospective study was aimed to assess the opinion, awareness and attitude of interns regarding pain assessment, pain management and common barriers in effective pain therapy for patients experiencing pain. A questionnaire including demographic details, knowledge of the tools of pain assessment, choice of drugs used, side effects, lacunae in existing knowledge and barriers in pain management was designed. A total of 160 interns were approached, out of which 149 returned the completed questionnaire. Only a few of them had a chance exposure to cancer pain management but none of them had undergone any formal training, teaching or classes in this field. Most respondents knew that the pain can be measured and the ways to do it. A significant number considered morphine as the preferred drug for managing cancer pain and thought morphine is responsible for addiction and respiratory depression. About 72% interns knew about transdermal preparation of fentanyl and its usage in malignancy but only a few were aware of buprenorphine transdermal patch. Though they were enthusiastic about relieving the cancer patients from suffering, they had limited knowledge of how to achieve this. The common barriers identified by them were lack of adequate knowledge and training and limited availability of opioids. The results of this study emphasize the need of special training programs pain management in order to change the current prevailing situation and improve the quality of analgesia provided to the patients.Indian Journal of Palliative Care 01/2015; 21(1):49-55. DOI:10.4103/0973-1075.150180
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ABSTRACT: Quality of life (QoL) encompasses the physical, psychosocial, social and spiritual dimensions of life lived by a person. Cancer pain is one of the physical component has tremendous impact on the QoL of the patient. Cancer pain is multifaceted and complex to understand and managing cancer pain involves a tool box full of pharmacological and non pharmacological interventions but still there are 50-70% of cancer patients who suffer from uncontrolled pain and they fear pain more than death. Aggressive surgeries, radiotherapy and chemotherapy focus more on prolonging the survival of the patient failing to realize that the QoL lived also matters equally. This paper reviews complementary and alternative therapy approaches for cancer pain and its impact in improving the QoL of cancer patients.Indian Journal of Palliative Care 01/2015; 21(1):105-15. DOI:10.4103/0973-1075.150202