Oncologists and primary care physicians' attitudes toward pain control and morphine prescribing in france

Abstract

Background. Two representative samples of primary care physicians (N=600) and medical oncologists (N=300) in France were surveyed about their attitudes toward and knowledge about cancer pain management. Methods. The survey was conducted by telephone with a questionnaire based on a model developed by the University of Wisconsin‐Madison Pain Research Group. It was designed to assess physicians' estimates of the prevalence of pain among patients with cancer, their practice in prescribing analgesics, their training in cancer pain management, and the quality of care received by cancer patients in their own practice and in France. Results. Barriers to adequate cancer pain management are prevalent and consistently more common among primary care physicians than among medical oncologists. Although 85% of primary care physicians and 93% of medical oncologists express satisfaction with their own ability to manage cancer pain, 76% of primary care physicians and 50% of medical oncologists report being reluctant to prescribe morphine for cancer pain. Both groups cite fear of side effects as their main reason to hesitate to prescribe morphine. Concerns about the risk of tolerance (odds ratio [OR], 1.15–2.52), perceptions that other effective drugs are available (OR, 1.11–2.41), perceptions that morphine has a poor image in public opinion (OR, 0.96–2.07), and the constraints of prescription forms (OR, 1.12‐2.26) contribute significantly to physicians' infrequent prescription of morphine, as are being female (OR, 1.01‐2.03) and being an older oncologist (OR, 1.09‐2.51). Conclusions. This study (1) confirms the existence among French physicians of attitudinal barriers and knowledge deficits previously reported in other countries that can impede cancer pain management, (2) identifies new barriers to the proper prescription of morphine for cancer pain control, and (3) reveals discrepancies in physicians' attitudes and knowledge about pain control which suggest a need for the systematic evaluation of cancer patients' care. Cancer 1995; 76:2375‐82.

Attitudes of medical oncologists toward palliative care for patients with advanced and incurable cancer

“…A substantial 42% of respondents reported that they had not received adequate training in palliative care during their residency training. This finding is consistent with previously published data regarding the training of medical oncologists in the management of cancer pain, [17][18][19] communication skills, 20,21 and palliative care. 19,22 2) In response to the statement, "most medical oncologists I know are expert in the management of the physical and psychological symptoms of advanced cancer," more respondents disagreed (41.8%) than agreed (37.5%).…”

Primary Care Physicians’ Perspectives of Their Role in Cancer Care: A Systematic Review

“…47 50,63 ; however, about half felt unprepared to manage longterm side-effects 40 or conduct surveillance for recurrence. 60 In general, high levels of confidence were reported for tasks such as pain management, 55 conveying bad news 71 and psychological support. 50,63,64,67 However, lower levels of training or knowledge were reported for areas such as surveillance testing, 60 active treatment or surgery 38,54 and advising on complementary therapies, 61 leading to a reluctance to fulfil such roles.…”

“…It appears that PCP confidence levels fluctuate along the cancer care continuum and according to the type of care needed. High confidence was reported for non-cancer specific tasks such as pain management and psychosocial support, 50,55,63 while confidence was lower for active treatment, surveillance testing and management of long-term effects, 38,40,54,60 suggesting PCPs are willing but feel unprepared to manage certain aspects of cancerspecific care. This may be attributed to PCPs' reports of minimal formal training in survivorship care, the lack of appropriate guidelines, insufficient contact with oncologists and insufficient experience.…”

Cancer-Related Pain Management and the Optimal Use of Opioids

“…Doctors with more prejudice about opioids were women and older oncologists. 49 Varela & Aubry revealed, also in France, that more than 60% of doctors thought that morphine had a ceiling dose. 50 As per 1 082 dying patients, French GP and oncologists prescribe opioids in 85.4% of them.…”

“…48 In France, 76% of 600 GP and 50% of 300 oncologists were reluctant to prescribe morphine. 49 Both groups mentioned fear of side effects as the main reason, as well as concerns about the risk of tolerance, morphine's poor public image and the constraints of prescription forms. Doctors with more prejudice about opioids were women and older oncologists.…”