Many US oncologists say they are good at managing their patients’ pain, yet they consider their pain management training to be poor, according to a study published in the Journal of Clinical Oncology.
An anonymous questionnaire following up on a 1990 survey that found a lack of good pain management among US oncologists was mailed to a geographically representative sample of 2000 cancer doctors. The sample included doctors at comprehensive cancer centers, community and teaching hospitals, and those with outpatient offices. The overall survey response rate was 32%; some 610 oncologists participated.
On average, doctors ranked their own ability to manage pain at 7 (on a 0 to 10 scale), but rated other oncologists at 3, or more conservative in their treatment. Doctors rated their pain management education in medical school and residency at 3 and 5, respectively.
According to the survey results, oncologists felt the barriers to pain management include:
- Patients’ opposition to taking opioids
- Patients’ reluctance to report pain
- Poor pain assessment
- Physicians’ reluctance to prescribe opioids
- The perception of excessive medication regulation
Study authors also included 2 invented scenarios in the survey involving a patient who is in pain despite taking a high dose of strong painkillers, such as morphine. Participating oncologists were asked if they would address the situation by increasing the dose, switching to a different medication, or adding a new drug on top of the original one.
Most doctors chose answers that pain specialists would consider to be unacceptable and therefore missed the correct answers; 60% on 1 scenario and 87% on the other. Furthermore, when addressing the same 2 scenarios, only 14% and 16% of oncologists suggested frequent referrals to pain or palliative care specialists, respectively.