The use of opioids at the end of life: the knowledge level of Dutch physicians as a potential barrier to effective pain management

BMC Palliative Care

Research Article

Sander D Borgsteede¹  Astrid GM Keijser²  Bregje D Onwuteaka-Philipsen³  H Roeline W Pasman³  Mette L Rurup³  Christiaan A Rhodius⁴  Manon SA Boddaert⁴ 

[1] Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands;Department of Clinical Pharmacy, Academic Medical Center, Amsterdam, The Netherlands;Department of Public and Occupational Health, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands;Department of Public and Occupational Health, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands;VU University Medical Center, Palliative Care Center of Expertise, Amsterdam, The Netherlands;VU University Medical Center, Palliative Care Center of Expertise, Amsterdam, The Netherlands;Department of Medical Oncology, Palliative Care Consultation team, VU University Medical Center, Amsterdam, The Netherlands;

关键词: General Practitioner;    Palliative Care;    Pain Management;    Clinical Specialist;    Knowledge Statement;   

DOI  :  10.1186/1472-684X-9-23

 received in 2010-04-09, accepted in 2010-11-12,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundPain is still one of the most frequently occurring symptoms at the end of life, although it can be treated satisfactorily in most cases if the physician has adequate knowledge. In the Netherlands, almost 60% of the patients with non-acute illnesses die at home where end of life care is coordinated by the general practitioner (GP); about 30% die in hospitals (cared for by clinical specialists), and about 10% in nursing homes (cared for by elderly care physicians).The research question of this study is: what is the level of knowledge of Dutch physicians concerning pain management and the use of opioids at the end of life?MethodsA written questionnaire was sent to a random sample of physicians of specialties most often involved in end of life care in the Netherlands. The questionnaire was completed by 406 physicians, response rate 41%.ResultsAlmost all physicians were aware of the most basal knowledge about opioids, e.g. that it is important for treatment purposes to distinguish nociceptive from neuropathic pain (97%). Approximately half of the physicians (46%) did not know that decreased renal function raises plasma concentration of morphine(-metabolites) and 34% of the clinical specialists erroneously thought opioids are the favoured drug for palliative sedation.Although 91% knew that opioids titrated against pain do not shorten life, 10% sometimes or often gave higher dosages than needed with the explicit aim to hasten death. About half felt sometimes or often pressured by relatives to hasten death by increasing opioiddosage.The large majority (83%) of physicians was interested in additional education about subjects related to the end of life, the most popular subject was opioid rotation (46%).ConclusionsAlthough the basic knowledge of physicians was adequate, there seemed to be a lack of knowledge in several areas, which can be a barrier for good pain management at the end of life. From this study four areas emerge, in which it seems likely that an improvement can improve the quality of pain management at the end of life for many patients in the Netherlands: 1)palliative sedation; 2)expected effect of opioids on survival; and 3) opioid rotation.

【 授权许可】

Unknown   
© Rurup et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.