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ABSTRACT: A Quebec Survey of Issues in Cancer Pain Management
We report the results of a cancer pain survey mailed to Quebec
hematologist-oncologists and palliative care physicians in 1999.
The survey was designed to sample views on the current status
of pain management and on obstacles to the provision of adequate
pain relief for patients. The survey, formulated by an ethics
network centered at the Clinical Research Institute of Montreal,
was distributed to all members of the Association of Hematologist-Oncologists
of Quebec and to all physician members of the Quebec Palliative
Care Association.
Responses were obtained from 138 Palliative
Care Association members (response rate 61%) and 76 hematologist-oncologists
(response rate 45%). Major obstacles reported included inadequate
assessment of both contributory psychosocial issues and severity
of pain, patient reluctance to take opioids, and inadequate access
to non-drug techniques for pain relief. Access to opioids was
not regarded as a problem.
Both groups felt generally competent
in their ability to manage various aspects of cancer pain therapy.
They gave little credit to their formal medical school or residency
training. Fifty-six percent of the palliative care group and
57% of the hemato-oncologists rated their medical school experience
as only "poor" or "fair" on a 4-point scale. Residency ratings
were modestly better.
We conclude that medical faculties should
assign a high priority to teaching health professionals patient
assessment techniques. Simple symptom assessment scales should
be routinely used in oncology/palliative care practice.
Medical
school training in pain management is not highly regarded and
should be enhanced.
We also note that, based on response to the
scenario of a patient presenting with severe pain, many physicians,
while feeling competent in the use of opioids, may be overly
conservative in their initial use.
01/11/2002; Journal of Pain and Symptom Management
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