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The prescription of opioid analgesics to terminal cancer patients: Impact of physicians' general attitudes and contextual factors

Published online by Cambridge University Press:  01 December 2003

P. PERETTI-WATEL ,
M.K. BENDIANE ,
Y. OBADIA ,
R. FAVRE ,
J.M. LAPIANA ,
J.P. MOATTI  and
THE SOUTH-EASTERN FRANCE PALLIATIVE CARE GROUP
P. PERETTI-WATEL
Affiliation:
Regional Centre for Disease Control of South-Eastern France, Marseilles, France Health and Medical Research National Institute, Research Unit 379, “Social Sciences Applied to Medical Innovation,” Institut Paoli Calmettes, Marseilles, France
M.K. BENDIANE
Affiliation:
Regional Centre for Disease Control of South-Eastern France, Marseilles, France Health and Medical Research National Institute, Research Unit 379, “Social Sciences Applied to Medical Innovation,” Institut Paoli Calmettes, Marseilles, France
Y. OBADIA
Affiliation:
Regional Centre for Disease Control of South-Eastern France, Marseilles, France Health and Medical Research National Institute, Research Unit 379, “Social Sciences Applied to Medical Innovation,” Institut Paoli Calmettes, Marseilles, France
R. FAVRE
Affiliation:
Assistance Publique Hôpitaux de Marseilles, Service of Medical Oncology, Marseilles, France
J.M. LAPIANA
Affiliation:
Palliative Care Unit “La Maison,” Gardanne, France
J.P. MOATTI
Affiliation:
Health and Medical Research National Institute, Research Unit 379, “Social Sciences Applied to Medical Innovation,” Institut Paoli Calmettes, Marseilles, France Department of Economics, University of Aix-Marseilles II, Marseilles, France
THE SOUTH-EASTERN FRANCE PALLIATIVE CARE GROUP
Affiliation:
Regional Centre for Disease Control of South-Eastern France, Marseilles, France
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Abstract

Objective: This study aimed to examine factors associated with the prescription of opioid analgesics to terminal cancer patients, including physicians' general attitudes toward morphine and contextual factors.

Methods: A survey was conducted among a sample of French general practitioners (GPs) and oncologists. Respondents were asked to describe the last three terminally ill patients they had followed up to death.

Results: Overall, 526 GPs and oncologists (global response rate: 57%) described 1,082 cancer patients, among whom 85.4% received opioid analgesics. Among other significant predictors (patient age, cancer type, family assistance), this prescription was less frequent for female patients followed by male physicians (OR = 0.53), and more frequent for patients followed by physicians trained in palliative care (OR = 2.70). On the other hand, physicians' attitudes toward morphine were not associated with prescription of morphine and other opioid analgesics.

Significance of results: Although nonprescription of opioid analgesics is only a crude proxy measure for undertreatment of cancer pain, our findings suggest the need to develop training in palliative care in order to standardize practices among GPs and specialists. Our results also highlight the necessity to study pain assessment as an interaction between the physician and the patient, and to consider patients' and physicians' respective genders as a key variable within this interaction.

Keywords

Opioid analgesicsCancerEnd-of-lifeAttitudesFrance
Type
Research Article
Information
Palliative & Supportive Care , Volume 1 , Issue 4 , December 2003 , pp. 345 - 352
Copyright
© 2003 Cambridge University Press

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References

REFERENCES

Ahmedzai, S. (1995). Recent clinical trials of pain control: Impact on quality of life. European Journal of Cancer, 31, S2–S7.Google Scholar
Ahmedzai, S. (1997). Pain control in patients with cancer. European Journal of Cancer, 33, S55–S62.Google Scholar
Atkinson, R.L., Atkinson, R.C., Smith, & E.E., et al. (1996). Introduction to Psychology. New York: Harcourt, Brace & Company.
Bonn, D. (2000). Support for euthanasia falls as care of dying patients improves. The Lancet Oncology, 1, 13.Google Scholar
Borkan, J., Reis, S., Hermoni, & D., et al. (1995). Talking about the pain: A patient-centered study on low back pain in primary care. Social Science & Medicine, 40, 977–988.Google Scholar
Breitbart, W., McDonald, M.V., Rosenfeld, & B., et al. (1996). Pain in ambulatory AIDS patients. I. Pain characteristics and medical correlates. Pain, 68, 315–321.Google Scholar
Cleeland, C.S., Gonin, R., Hatfield, & A.K., et al. (1994). Pain and its treatment in outpatients with metastatic cancer. New England Journal of Medicine, 330, 592–596.Google Scholar
Daut, R.L. & Cleeland, C.S. (1982). The prevalence and severity of pain in cancer. Cancer, 50, 1913–1918.Google Scholar
Ferrell, B.R. & Ferrell, B.A. (eds.). (1996). Pain in the Elderly. Seattle: IASP Press.
Fishbein, M. (1967). A consideration of beliefs, and their role in attitude measurement. In Readings in Attitude Theory and Measurement, Fishbein, M. (ed.). New York: John Wiley & Sons.
Fishbein, M. & Ajzen, I. (1972). Attitudes and opinions. Annual Review of Psychology, 23, 487–544.Google Scholar
Greenwald, H.P., Bonica, J.J., & Bergner, M. (1987). The prevalence and severity of pain in cancer. Cancer, 60, 2563–2569.Google Scholar
Hodes, R. (1989). Cancer patients' needs and concerns when using narcotic analgesics. In Advances in Pain Research and Therapy, Hill, C.S. & Fields, W.S. (eds.). New York: Raven Press.
Im, E.O. & Chee, W. (2001). A feminist critique of research on cancer pain. Western Journal of Nursing Research, 23, 726–752.Google Scholar
Larue, F., Colleau, S.M., Brasseur, & L., et al. (1995a). Multicentre study of cancer pain and its treatment in France. British Medical Journal, 310, 1034–1037.Google Scholar
Larue, F., Colleau, S.M., Fontaine, & A., et al. (1995b). Oncologists and primary care physicians' attitudes toward pain control and morphine prescribing in France. Cancer, 76, 2181–2185.Google Scholar
Marquié, L., Raufaste, E., Lauque, & D., et al. (2003). Pain rating by patients and physicians: Evidence of systematic pain miscalibration. Pain, 102, 289–296.Google Scholar
Martin, R. & Lemos, K. (2002). From heart attacks to melanoma: Do common sense models of somatization influence symptom interpretation for female victims? Health Psychology, 21, 25–32.Google Scholar
McCaffrey, M. & Ferrell, B.R. (1997). Influence of professional vs. personal role on pain assessment and use of opioids. Journal of Continuing Education in Nursing, 28, 69–77.Google Scholar
McQuay, H., Moore, A., & Justins, D. (1997). Treating acute pain in hospital. British Medical Journal, 314, 1531–1535.Google Scholar
Mercadante, S., Casuccio, A., Pumo, & S., et al. (2000). Factors influencing the opioid response in advanced cancer patients with pain followed at home: The effects of age and gender. Supportive Care in Cancer, 8, 123–130.Google Scholar
Sela, R.A., Bruera, E., Conner-spady, & B., et al. (2002). Sensory and affective dimensions of advanced cancer pain. Psycho-Oncology, 11, 23–34.Google Scholar
Soliman, H.M., Melot, C., & Vincent, J.L. (2001). Sedative and analgesic practice in the intensive care unit: The results of a European survey. British Journal of Anaesthesia, 87, 186–192.Google Scholar
Twycross, R.G. & Fairfield, S. (1982). Pain in far-advanced cancer. Pain, 313, 84–95.Google Scholar
Vallerand, A.H. & Polomano, R.C. (2000). The relationship of gender to pain. Pain Management Nursing, 1, 8–15.Google Scholar
Vigano, A., Bruera, E., & Suarez-Almazor, M.E. (1998). Age, pain intensity, and opioid dose in patients with advanced cancer. Cancer, 83, 1244–1250.Google Scholar
Von Roenn, J.H., Cleeland, C.S., Gonin, & R., et al. (1993). Physician attitudes and practice in cancer pain management: A survey from the Eastern Cooperative Oncology Group. Annals of Internal Medicine, 119, 121–126.Google Scholar
Wicker, A.W. (1969). Attitudes versus actions: The relationships of verbal and overt behavioral responses to attitude objects. Journal of Social Issues, 25, 41–78.Google Scholar
World Health Organization. (1990). Cancer pain relief and palliative care. WHO Technical Report Series, No. 804.
Zenz, M. & Willweber-Strumpf, A. (1993). Opiophobia and cancer pain in Europe. Lancet, 341, 1075–1076.Google Scholar
Zenz, M., Zenz, T., Tryba, & M., et al. (1995). Severe undertreatment of cancer pain in Germany—A three years' survey. Journal of Pain and Symptom Management, 10, 187–191.Google Scholar