Pediatric residents’ perceived barriers to opioid use in sickle cell disease pain management

Abstract

Objective Current guidelines recommend high‐priority treatment of severe sickle cell disease (SCD) pain with opioids; however, patients with SCD have historically been undertreated. We used mixed methods to assess pediatric residents’ perceptions toward opioid use in SCD pain management. Methods We distributed a survey to 88 residents at an urban pediatric medical center in a cross‐sectional study. Participants responded to questions about perceived barriers to acute SCD pain management and attitudes toward patients with SCD. Responses were examined using bivariate analyses. Five pediatric residents were interviewed, to provide more in‐depth understanding of barriers to SCD pain management. Results Fifty‐three residents (60%) completed the survey. Participants were divided into “more experienced” (had seen ≥ 21 patients with SCD; 45.3%) or “less experienced.” Both groups reported potential for tolerance and dependence as major barriers to opioid use in SCD. Less experienced residents reported a greater need for additional training in SCD pain management (P < 0.05), more concern about addiction, and greater empathy for patients with SCD (P < 0.05). Both groups agreed that patients with SCD were “frustrating to care for.” Thematic analysis revealed that increased patient and provider barriers led to distrust, ultimately leading to undertreatment of pain and inadequate care. Conclusion Although more experienced residents reported feeling more comfortable treating acute SCD pain and were less concerned with addiction compared with less experienced residents, certain negative views of patients with SCD were prevalent among all residents. Findings suggest that residency training must address provider attitudes as well as knowledge about SCD.

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

“…Gaps in knowledge related to palliative care and pain management are well documented among adult hematology/oncology trainees as well as in clinicians in a variety of other adult‐based areas of practice. Our pilot data 25 and published literature 17,23 suggest a need for increased education among pediatrics residents. To the best of our knowledge, no prior studies have evaluated levels of knowledge in these areas among PHO trainees.…”

“…Opioids are often the first‐line treatment for persistent moderate to severe pain in patients with cancer 12 and for vaso‐occlusive crises in patients with sickle cell disease 13 . However, there is growing recognition of the lack of adequate training in symptom management, specifically with opioids, among practitioners at all levels and in multiple specialties 14–20 . Furthermore, most state and federal clinical practice guidelines related to opioid prescribing exclude cancer patients 21 .…”

“…Furthermore, most state and federal clinical practice guidelines related to opioid prescribing exclude cancer patients 21 . As a result, many children and adults with cancer and sickle cell disease receive inadequate management of their pain 17,22–24 …”

“…13 However, there is growing recognition of the lack of adequate training in symptom management, specifically with opioids, among practitioners at all levels and in multiple specialties. [14][15][16][17][18][19][20] Furthermore, most state and federal clinical practice guidelines related to opioid prescribing exclude cancer patients. 21 As a result, many children and adults with cancer and sickle cell disease receive inadequate management of their pain.…”

“…21 As a result, many children and adults with cancer and sickle cell disease receive inadequate management of their pain. 17,[22][23][24] In this study, we sought to investigate the level of knowledge related to, and comfort with, opioid use for pain control among current trainees in PHO in the United States (US). Our primary aim was to assess comfort with opioid use for pain control, and compare average knowledge of commonly used pain medications among PHO fellows by training year.…”