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

Table 4 Attitudes and experiences concerning opioid rotation*, tolerance**, addiction and shortening of life by opioids

	General practitioners	Elderly care physicians	Clinical specialists	p-value^†	Total n = 406
	n = 182	n = 110	n = 112		n = 406^†
	%often/sometimes	%often/sometimes	%often/sometimes		%often/sometimes
Opioid rotation*
• I rotate opioids in practice	70	66	47	<0.05	62
• I rotate opioids if pain control is inadequate	77	72	65	≥0.05	72
• I rotate opioids in case of side-effects	67	73	63	≥0.05	67
• I find calculating of opioid dosages when rotating difficult	62	57	57	≥0.05	59
Tolerance and fear of addiction**
• I have noticed that tolerance can develop in the usage of opioids	68	74	85	<0.05	74
• Tolerance hampers the usage of opioids in pain control	15	20	29	<0.05	20
• Patients' fear of addiction hampers the usage of opioids in practice	49	35	51	<0.05	46
Shortening of life by opioids
• It occurs that relatives of a patient or other persons concerned, put pressure on me to increase the opioids in the hope of hastening death	36	75	50	<0.05	50
• When titrating the dosage of opioids upwards against pain, I take into account that this may hasten the death of the patient	38	44	68	<0.05	48
• It occurs that I increase the dosage of opioids to a level above that of what is needed for pain and symptom control with the explicit aim to hasten the death of the patient	11	1	19	<0.05	10

* The following definition of tolerance was given in the questionnaire: "By tolerance for a drug we mean that a patient needs a higher dose to reach the same pain relief while the pain stimulus remains the same. Tolerance has proven to be difficult to measure in practice, we are interested in your personal experience."
^† chi-square test testing differences between the three groups of physicians
^‡including 2 physicians who did not specify their specialty
** The following definition of opioid rotation was given in the questionnaire: "With the term "opioid rotation" we mean the replacing of one opioid by another opioid."

ISSN: 1472-684X