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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
  1. * correct answer is printed in bold
  2. chi-square test testing differences between the three groups of physicians
  3. 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.
  4. ** 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