F. Larue et al., ONCOLOGISTS AND PRIMARY-CARE PHYSICIANS ATTITUDES TOWARD PAIN CONTROLAND MORPHINE PRESCRIBING IN FRANCE, Cancer, 76(11), 1995, pp. 2375-2382
Background. Two representative samples of primary care physicians (N =
600) and medical oncologists (N = 300) in France were surveyed about
their attitudes toward and knowledge about cancer pain management. Met
hods. The survey was conducted by telephone with a questionnaire based
on a model developed by the University of Wisconsin-Madison Pain Rese
arch Group. It was designed to assess physicians' estimates of the pre
valence of pain among patients with cancer, their practice in prescrib
ing analgesics, their training in cancer pain management, and the qual
ity of care received by cancer patients in their own practice and in F
rance. Results. Barriers to adequate cancer pain management are preval
ent and consistently more common among primary dare physicians than am
ong medical oncologists. Although 85% of primary care physicians and 9
3% of medical oncologists express satisfaction with their own ability
to manage cancer pain, 76% of primary care physicians and 50% of medic
al oncologists report being reluctant to prescribe morphine for cancer
pain. Both groups cite fear of side effects as their main reason to h
esitate to prescribe morphine, Concerns about the risk of tolerance (o
dds ratio [OR], 1.15-2.52), perceptions that other effective drugs are
available (OR, 1.11-2.41), perceptions that morphine has a poor image
in public opinion (OR, 0.96-2.07), and the constraints of prescriptio
n forms (OR, 1.12-2.26) contribute significantly to physicians' infreq
uent prescription of morphine, as are being female (OR, 1.01-2.03) and
being an older oncologist (OR, 1.09-2.51). Conclusions. This study (1
) confirms the existence among French physicians of attitudinal barrie
rs and knowledge deficits previously reported in other countries that
can impede cancer pain management, (2) identifies new barriers to the
proper prescription of morphine for cancer pain control, and (3) revea
ls discrepancies in physicians' attitudes and knowledge about pain con
trol which suggest a need for the systematic evaluation of cancer pati
ents' care.