Cancer pain education among family physicians

Abstract

This study used performance-based testing (objective structured clinical evaluation, OSCE) to evaluate the skills of family physicians in assessing and managing the severe pain of a cancer patient, and evaluated a new method of education about the management of cancer pain. Twenty-four primary care physicians completed a detailed pain assessment of the same standardized cancer pain patient (Part A). A proctor observed the interviews and rated the physicians on a variety of pre-determined items believed to be important for pain assessment. The physicians were then allowed 5 min to answer management questions about the patient's cancer pain (Part B). After reviewing each physician's performance on Parts A and B, the proctor provided immediate feedback and instruction (Part C) on basic principles of cancer pain assessment and management. On average, the primary care physicians asked 52% (+/-4.5%) of the indicated questions of a detailed pain assessment. Performance was poorest in asking about previous pain history, temporal pattern of pain, and pain intensity. Performance on the pain assessment was best for eliciting pain location and pain-relieving factors. Primary care physicians obtained mean scores of 36% (+/-3%) on Part B of the OSCE. Although opioid therapy was frequently prescribed, only 42% of prescriptions were for regular administration. Performance on Parts A and B correlated poorly with years in practice, and older physicians tended to perform a less detailed pain assessment than their younger colleagues. Most physicians enjoyed participating in this instructional formal and believed that the proctor feedback increased the educational value of the module. The results of our study suggest that many family physicians may be inadequate in their clinical assessment and management of cancer pain. Our study supports the need for continuing education in cancer pain management, regardless of years in practice. Further study should evaluate the effects of different educational programs on clinical practice in patient care.

What Doctors Know About Cancer Pain Management

“…16 This finding is similar to the study by Sloan in US where 70% of the physicians were able to assess pain correctly. 6 In the first case scenario on severe pain, the study results reflect a similar rate of morphine use as in the Canadian study 17 compared with other studies conducted in the US and Canada by Cleeland 18 and Macdonald, 19 where only 41% and 48% of the doctors, respectively, would select a strong opioid as the initial management of severe cancer pain. In our study, although a strong opioid was selected by a large proportion of the doctors, co-analgesicwas rarely selected.…”

“…3 Several factors have been identified to explain the undertreatment of cancer pain. Many sur-veys have demonstrated that physicians' knowledge about cancer pain is deficient, 4,5 partly because physicians are inadequately trained in cancer pain management 6 and that they are overly concerned about the addictive effects of analgesics. 4 The lack of expertise has been related to inadequate training both at the undergraduate and post graduate levels.…”

“Pain talk” in hospice and palliative care team meetings: An ethnography

“…The researchers' found that hospice nurses completed items related to pain intensity, pain location and relieving factors very well and did well in relation to analgesic recommendations. They conclude that hospice nurses' performance in both cancer pain assessment and management recommendations exceeded that of resident house staff and family physicians (Sloan et al, 1997). The researchers therefore make the comparison between hospice nurses' skills in pain assessment and management and those of less specialist medical staff.…”

What Doctors Know About Cancer Pain Management

“…1,2 Despite substantial evidence that pain can be managed effectively in as many as 90% of patients, inadequate relief remains a significant problem. Many sur-veys have demonstrated that physicians' knowledge about cancer pain is deficient, 4,5 partly because physicians are inadequately trained in cancer pain management 6 and that they are overly concerned about the addictive effects of analgesics. Many sur-veys have demonstrated that physicians' knowledge about cancer pain is deficient, 4,5 partly because physicians are inadequately trained in cancer pain management 6 and that they are overly concerned about the addictive effects of analgesics.…”