Cancer pain: Knowledge and attitudes of physicians in Israel

The effectiveness of cancer pain therapy is influenced by the attitudes and knowledge of the treating physicians. As part of a quality improvement pro ject in the management of cancer pain, a survey of 236 medical practitioner s was conducted. One hundred seventy-six respondents (74.5 %) completed the survey. Fifty-two percent treated patients with cancer pain several times a week or more. Whereas 57.7 % of physicians stated that 76-100 % of patien ts could achieve a satisfactory outcome from analgesic therapy, only 17.2 % of respondents reported that > 75 % actually achieve a satisfactory outcom e in their own experience. Unsatisfactory outcome was ascribed to inadequat e pain relief (59.7 %), or excessive central nervous system (CNS) side effe cts (43.3 %). According to the responding physicians, the major barriers to effective relief include inadequate assessment of the pain and pain relief (65.3 %), inadequate knowledge of pain therapy (57.9 %), and physician rel uctance to prescribe opioids (49.1 %). Questions evaluating physician knowl edge identified widely prevalent knowledge deficits in pain physiology, ris k of addiction, use of adjuvant analgesics, opioid dosing, and treatment of side effects. Specialists in oncology tended to evaluate their knowledge m ore highly than others (P < 0.05). Despite this, there was no significant k nowledge difference between oncologists and noncancer specialists. The data highlight some oft he barriers to the successful management of cancer pain in Israel, the prevalence of knowledge deficits, and the common disparity between clinicians' self-assessment of clinical competence and their abilit y to respond correctly to questions on the management of cancer pain. (C) U .S. Cancer Pain Relief Committee, 1999.