Attitudes, Knowledge About Cancer Pain Don't Always Jibe

DULUTH, Minn--Community physicians, at least in Minnesota, appearto have the right attitude toward relieving pain in cancer patientsbut may be deficient in specific areas of knowledge about cancerpain management, say Thomas E. Elliott, MD, and his colleagueswith the Minnesota Cancer Pain Project (MCPP), a randomized communitytrial testing innovative strategies to improve cancer pain management.

The researchers, from the University of Minnesota-Duluth, surveyedphysicians from six Minnesota cities to explore whether knowledgedeficits and inappropriate attitudes present barriers to optimalcancer pain management, and also to provide a database for theMCPP.

Fourteen basic concepts of cancer pain management were used toformulate 15 knowledge items and 9 attitude items for the survey.Of 145 physicians who responded to the survey (an 87% responserate), the majority were primary care specialists (73%), withsurgeons representing 22%, and other subspecialists 5%.

Although the physicians' overall knowledge scores were fairlyhigh, with the mean falling within the best quartile of the possiblerange, an analysis of specific survey items showed specific knowledgedeficits (that is, less than 50% of the physicians gave the desiredresponse, with a range of 12% to 48%) (J Pain Symptom Manage 10:494-504,1995).

The survey found that more than 50% of physicians disagreed withthe following true statements:

1. Analgesic tolerance to opioids is not a problem.

2. Addiction risk is low in cancer pain patients.

3. Tolerance develops to sedation and confusion.

4. Cancer pain is not inevitable.

5. Rising doses of opioids to control pain do not indicate thatthe opioid is ineffective.

6. Opioids are indicated by pain intensity not prognosis.

7. Physical dependency to opioids is expected.

8. Parenteral opioids are not necessary to control severe pain.

9. Antidepressants added to opioids can improve analgesia.

In contrast, only two attitudinal items had mean scores deviatingby more than 3 points from the desired response: The physicianssurveyed showed excessive concern regarding the adverse effectsof opioids and indicated little favor toward the effectivenessof complementary pain treatments.

The only demographic variable strongly associated with knowledgeand attitudes was medical specialty, with primary care physiciansshowing more favorable mean scores than surgeons in seven knowledgeitems and two attitude items. The physician's personal experiencewith a friend or family member with cancer had a modest influenceon total attitude mean score but not total knowledge mean score.

"Some results of this study appear incongruous on first glance,"Dr. Elliott notes. For example, physicians showed knowledge deficitsabout the negligible risk of opioid addiction in cancer pain patientsbut expressed the attitude of having almost no concern about opioidaddiction in cancer patients.

Dr. Elliott believes that education addressing specific knowledgeand attitudinal issues, and directed both at the clinical communityand at individual physicians, may bring about improvements incancer pain management in the community.