MEDICAL-STUDENT KNOWLEDGE OF MORPHINE FOR THE MANAGEMENT OF CANCER PAIN

Inadequate training of physicians contributes to the undertreatment of cancer pain. To address these concerns, the University of Kentucky ha s introduced a 4-week course for final-year medical students that teac hes the principles of clinical pharmacology and pain management. The p urposes of this study are to assess the knowledge deficits of final-ye ar medical students about the use of morphine for cancer pain and to a ssess the efficacy of a short course on cancer pain management. Eighty -six final-year medical students completed a 22-item questionnaire ass essing their knowledge and attitudes toward the use of morphinefor can cer pain. Students indicated their agreement with each statement on a four-point scale (one, strongly disagree; four, strongly agree). All s tudents then completed a compulsory short course on pain management. T he course content included a 1-hr lecture on chronic nonmalignant pain , a 1-hr lecture on acute pain management, and a 1-hr lecture on cance r pain management. In addition, students completed small-group, proble m-based learning modules on several aspects of pain management. After the course, all students completed the same 22-item survey. The alpha reliability score of the pretest instrument was 0.55, and the posttest reliability was 0.86. Upon course completion, students agreed most st rongly (mean +/- SEM) that morphine should be given on a regular sched ule for cancer pain (3.41 +/- 0.08), that cancer pain management frequ ently requires co-analgesics (3.36 +/- 0.06), and that patients with g ood pain relief function better than those with continuing pain (3.39 +/- 0.08). A comparison of pretest and posttest means on. specific ite ms suggested that the greatest amount of learning took place in the fo llowing content areas: morphine is a good oral analgesic; increases in cancer pain should be treated by increasing the morphine dose; respir atory depression is not a concern for cancer pain patients; and morphi ne can be used over a wide range of doses. The regular use of morphine was recognized as the treatment drug of choice for cancer pain. The s tudents showed improved knowledge scores on ten of the 22 items on the posttest survey. A significant increase in learning occurred on six k nowledge and attitude items. On only one item (nausea as a side effect of morphine) did the knowledge scores decrease on the posttest. A sig nificant minority (40%) of senior medical students had deficits in kno wledge about the use of morphine for cancer pain. The risk of addictio n, respiratory depression, and tolerance were misunderstood by a signi ficant minority (25%) of students. J Pain Symptom Manage 1998;15:359-3 64. (C) Elsevier Science Inc. 1998.