Assessment and knowledge in palliative care in second year family medicine residents

Abstract

Inadequate physician knowledge, particularly in areas of pain assessment and use of analgesics, has been identified as a major factor contributing to poor pain management in cancer patients. In most medical schools, teaching in Palliative Care at both the undergraduate and postgraduate levels is limited or nonexistent. Baseline knowledge and changes in knowledge in areas relevant to Palliative Care were assessed by the use of 2 16-question examinations (Exams A and B) in 78 second-year Family Medicine Residents from the University of Alberta Family Medicine Residency Program. The residents participated in a two-week rotation on the Acute Palliative Care Unit at the Edmonton General Hospital or Grey Nuns Community Health Centre between September 1991 and February 1996. The residents were randomly assigned on their first day (Time 1) to complete either Exam A or B and were subsequently crossed over on their final day of the rotation to complete the alternate Exam (Time 2). Six domains were represented in the Exams as follows: pain assessment, opioid use, adjuvant medications, delirium, urinary catheterization, and hydration. Improvements were noted in the mean percentage results in Time 2 compared with Time 1 for Exams A, B, and A and B combined. Mean global percentage results were 53 +/- 15 versus 73 +/- 13 (p < 0.001) at Times 1 and 2, respectively. There were significant improvements for domains in Time 2 compared to Time 1 (p < or = 0.05) for combined A and B Exam except for urinary catheterization. Despite these documented improvements in scores, serious deficiencies were identified particularly in the areas of pain assessment and opioid use, namely opioid sude effects and issues involving dependence, addiction, and tolerance. Examinations, such as the two used in this study, can be a useful aid in assessing physician knowledge in addition to structuring teaching in Palliative Care. Examination content will require updating as knowledge in Palliative Care evolves.

Effectiveness of a teaching programme in pain and symptom management for junior house officers

“…The low baseline scores in our first questionnaire confirm the findings of other studies, suggesting that there continues to be significant deficiencies in the level of knowledge of pain and symptom management amongst junior doctors [11,13]. A majority of the questions in our questionnaire focused on the use of opioid analgesics.…”

“…Despite the widespread availability and increased use of opiates, the poor responses to these questions in our study are worrying. Previous studies have highlighted deficits in knowledge relating to the use of opioids as being of particular concern [6,13]. Compounding this worry is the fact that junior doctors often do not perceive they have a problem in relation to symptom management.…”

“…Oneschuk et al [13] demonstrated an improvement in knowledge following a 2-week rotation on an acute Palliative Care Unit for family medicine residents. Though such a rotation might arguably represent the ideal for all doctors in training, the reality is that the majority will never have such an opportunity.…”

Attitudes of radiation oncologists toward palliative and supportive care in the United States: Report on National Membership Survey by the American Society for Radiation Oncology (ASTRO).

“…Surveys on PSC have been done for smaller groups of practicing physicians and medical residents/fellows in training, but surveys have never addressed a large group of physicians at a national level. [11][12][13][14][15][16][17][18] The great majority (91%) of radiation oncologists surveyed believe PSC is an important competency for radiation oncologists. Most radiation oncologists reported that they are moderately confident in their ability to assess and manage pain and gastrointestinal symptoms but less confident in their ability to switch a patient's opioid to another formulation to improve analgesic therapy, anorexia, anxiety, and depression.…”

Problems and barriers of pain management in the emergency department: Are we ever going to get better?

“…The treatment of acute pain, especially in the ED, is almost never given a topic for formal teaching. 32 A study by Weinstein and colleagues surveyed medical students at the beginning of their fi rst year and again while in their senior year with questions about pain management and treatment, attitudes toward pain as a presenting complaint and the use of opioid analgesics. They found that prejudice toward the use of narcotics had increased during their fourth year of medical school training.…”