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

Rurup, Mette L; Rhodius, Christiaan A; Borgsteede, Sander D; Boddaert, Manon SA; Keijser, Astrid GM; Pasman, H Roeline W; Onwuteaka-Philipsen, Bregje D

doi:10.1186/1472-684X-9-23

Table 2 Answers to the knowledge statements per specialty*

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

		General practitioners	Elderly care physicians	Clinical specialists	p-value^†	Total
		n = 182	n = 110	n = 112		n = 406
Average number of correct answers		10,4	10,6	9,5		10,2
		%	%	%		%
Pain
1. In the management of pain it is important to differentiate between nociceptive and neuropathic pain	% true % false % don't know	98 1 1	100 0 0	94 0 6	<0.05	97 1 2
2. Administration of opioids early on in the disease hampers good pain control later on in the disease process	% true % false % don't know	3 96 2	8 91 1	10 84 6	<0.05	6 91 3
3. Opioids may cause or worsen pain	% true % false % don't know	26 45 29	34 43 23	35 43 22	≥0.05	30 45 25
Prescribing opioids
4. Once opioids have been started, other analgesics should be discontinued	% true % false % don't know	4 96 1	1 99 0	5 92 3	≥0.05	4 96 1
5. Opioids are only indicated for cancer patients	% true % false % don't know	0 100 0	0 100 0	2 98 0	≥0.05	0 100 0
6. Simultaneous prescription of a weak opioid (e.g. tramadol) and a strong opioid (e.g. morphine) is contra-indicated^‡	% true % false % don't know	49 28 22	57 26 17	57 29 14	≥0.05	54 28 19
7. Decreased renal function raises plasma concentration of morphine(-metabolites)	% true % false % don't know	51 22 27	55 23 22	57 23 19	≥0.05	54 22 23
8. Opioids have a maximum dosage	% true % false % don't know	4 94 2	4 93 3	8 88 4	≥0.05	5 92 3
Side-effects
9. Life-threatening respiratory depression is a real danger when titrating morphine against pain	% true % false % don't know	16 83 2	19 75 6	31 68 1	<0.05	21 77 3
10. Drug management of nausea in treatment with opioids is evidence-based	% true % false % don't know	40 18 42	50 12 38	34 17 50	≥0.05	41 16 43
Opioid rotation*
11. You want to change a daily dosage of 60 mg oxycodon to a fentanyl patch with an equivalent dosage. The strength of the patch is.^**	% 25 μg p/h ^† % 50 μg p/h ^† % false % don't know	28 38 6 28	37 34 12 17	25 24 11 41	<0.05	30 33 9 28
Sedation and shortening of life by opioids
12. Opioids titrated against pain, shorten life	% true % false % don't know	3 96 1	2 95 3	14 81 6	<0.05	6 91 3
13. Opioids are the favoured drugs for palliative sedation	% true % false % don't know	13 86 1	5 95 0	34 57 8	<0.05	17 81 3
14. Opioids are appropriate drugs to perform euthanasia	% true % false % don't know	0 99 1	0 97 3	8 86 6	<0.05	2 95 3

* correct answer is printed in bold
^†chi-square test testing differences between the three groups of physicians
^‡a simultaneous prescription of a weak and a strong opioid is not a contra-indication in the true sense of the word. It is, however, for pharmacodynamic reasons in general not a sensible combination. This is why it is not advocated in the available guidelines for treatment of pain.
** physicians could circle the following options 12/25/50/75/100/125/150 μg per hour or "don't know". With this question 2 answers were considered correct, because different guidelines give different conversions, which leads to two different answers

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ISSN: 1472-684X

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