Evaluation of knowledge and comfort with opioid prescribing among pediatric hematology/oncology fellows

Abstract

Background Deficits in knowledge and comfort related to pain management have been demonstrated in adult hematology/oncology fellows. No such evaluation has been undertaken in pediatric hematology/oncology (PHO) trainees. Procedure An IRB‐approved survey was administered to PHO fellows throughout the United States (US) to assess comfort with opioid dosing, attitudes related to the use of opioids, and knowledge of basic concepts including weight‐based dosing, incomplete cross‐tolerance, and management of side effects. Results Email addresses were obtained for 132 fellows from 37 programs. Seventy‐eight (59%) fellows participated. No significant difference was demonstrated between training level and comfort with dosing opioids in an opioid‐naive patient, though a smaller proportion of first‐year fellows (65%) reported comfort compared to more senior fellows (85.2% of second‐year fellows, 80.6% of third‐ and fourth‐year fellows). First‐year fellows correctly answered a mean of 5.05 ± 0.43 out of 10 objective knowledge questions; second‐year fellows answered 5.74 ± 0.35 correctly, and third‐ and fourth‐year fellows 5.58 ± 0.30. The majority of respondents chose an appropriate dose of intravenous morphine based on weight (92%), and identified a low‐dose naloxone drip as an appropriate intervention for opioid‐induced pruritis (91%). However, the remainder of the questions had a correct response rate of 15‐68%. Conclusion This study characterizes PHO fellows’ knowledge and comfort with prescribing opioids. Despite high levels of reported comfort, PHO fellows in all levels of training demonstrated knowledge gaps. PHO fellows may benefit from further education in pain management.

Development and Validation of Pediatric Opioid Analgesia Self-Instruction System (PedOASIS): An Opioid Knowledge Tool for Pediatric Clinicians

“…The limitations identified in this study were addressed in the next phase in this project, a randomized, controlled trial testing the finalized tool (PedOASIS II) within a national sample of PHO fellows. 43 The tool was built into a website, allowing investigators to track whether and for how long participants had used the tool. Randomization, provision of the tool, and distribution of the postintervention survey was performed shortly after the baseline survey in an effort to decrease attrition and to introduce the tool earlier in the academic year.…”

“…The limitations identified in this study were addressed in the next phase in this project, a randomized, controlled trial testing the finalized tool (PedOASIS II) within a national sample of PHO fellows 43. The tool was built into a website, allowing investigators to track whether and for how long participants had used the tool.…”

“…50%) 1 0 0 1 0 0 1 0 1 1 0 0 5 (41.7%) 1 1 1 1 0 0 1 1 1 0 0 1 8 (66.7%) 1 0 0 1 0 1 0 1 1 0 0 0 5 (41.7%) 1 0 0 1 0 1 0 0 1 1 0 1 6 (50%) 1 1 0 1 0 0 0 1 1 0 0 1 6 (50%) 0 0 0 0 0 1 0 0 1 0 0 0 2 (16.7%) 1 0 1 1 1 1 0 1 1 0 0 1 8 (66.7%) 0 1 0 1 0 1 0 0 1 0 0 1 5 (41.7%) # Correct responses survey demonstrated a significant increase in knowledge among fellows randomized to receive the knowledge tool compared with controls. 43 The persistence of the coronavirus disease 2019 pandemic has required unprecedented creativity and flexibility in medical education. Virtual and online learning opportunities play a key role in maintaining educational continuity.…”

A randomized controlled trial to examine the effect of the Pediatric Opioid Analgesia Self‐Instruction System (PedOASIS) tool on pediatric hematology/oncology trainee education

“…21 We subsequently modified PedOASIS to focus on PHO-specific scenarios then completed validation and reliability testing, which guided further revisions. 19 The final product contained 10 case-based, single-best-answer multiplechoice questions. Every question included five answer choices, each of which was linked to a detailed explanation; the correct answer was Participants in the intervention group received a link to the website to access the tool (Figure S1).…”

“…Surveys assessed participants' self-reported level of comfort when prescribing opioids for pediatric patients in two clinical scenarios: choosing an opioid and a starting dose for an opioid-naïve patient and converting a patient from one opioid to another by calculating an equivalent starting dose. 22 Comfort in each setting was measured using the following five-point Likert-type scale: 1 = very comfortable; 2 = somewhere between 1 and 3; 3 = somewhat comfortable; 4 = somewhere between 3 and 5; 5 = not comfortable at all. Surveys also evaluated participants' objective knowledge related to dosing in opioid-naïve patients, specifically the use of weight-based dosing, conversion between opioids and routes of administration, and management of common side effects.…”