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

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 = 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
  1. * 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."
  2. chi-square test testing differences between the three groups of physicians
  3. including 2 physicians who did not specify their specialty
  4. ** 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."