Junior doctors’ attitudes to opioids for refractory breathlessness in patients with advanced chronic obstructive pulmonary disease

Abstract

This is the first study of doctors to demonstrate high awareness, confidence, willingness and experience in prescribing opioids for the off-licence indication of refractory breathlessness in COPD. These findings differ significantly from attitudes reported overseas and are unexpected given the doctors surveyed were recently qualified. The low awareness of possible adverse events and limited insight regarding knowledge gaps is concerning and highlights the significant need for greater education in palliative care.

Approaches to palliative oxygen therapy in chronic obstructive pulmonary disease: a multi‐national survey of specialists

“…We had intended also to survey British respiratory physicians, however, the British Thoracic Society has a policy of not disseminating research surveys to its members. The response rate reflects the current industry standard for online surveys of 33% . Though this may suggest caution in generalising findings, the respondents’ gender and age were similar to the respiratory and palliative medicine workforce demographics in all three countries .…”

Breathlessness and palliative oxygen therapy in advanced chronic obstructive pulmonary disease

“…Similarly, participants may make implicit assumptions regarding clinical management, when responding to case vignette scenarios. However, our findings suggest that Australian junior doctors focus on pharmacological treatments and oxygen for refractory breathlessness, and they have less awareness of the evidence‐based, multidisciplinary, non‐pharmacological interventions, which come first in clinical practice. Further education regarding refractory breathlessness management, and particularly using a comprehensive, stepwise approach, is required to translate evidence into practice.…”

“…We recently reported in the Internal Medicine Journal that junior doctors report high awareness, confidence, willingness and experience prescribing opioids to chronic obstructive pulmonary disease patients with refractory breathlessness . However, opioids are only the final step in a comprehensive management plan, which should first include non‐pharmacological strategies, such as smoking cessation, self‐management education, physical activity, pulmonary rehabilitation, breathing exercises and the use of a handheld fan .…”

Doctors' Attitudes to Palliation and Palliative Care in Patients With Advanced Chronic Obstructive Pulmonary Disease

“…An anonymous survey was designed for all junior doctors who had completed their first year of medical practice after qualification and who were undertaking training (Years 1e4) in internal medicine in the state of Victoria, Australia. As a literature search revealed no appropriate survey instrument, we developed a new questionnaire, 7 which included a case vignette describing an outpatient with severe COPD, receiving maximum disease-modifying therapies and worsening severe refractory breathlessness (Modified Medical Research Council breathlessness score of 4). The case did not have anxiety and was not in the last few days of life.…”