ASSESSMENT OF KNOWLEDGE ABOUT CANCER PAIN MANAGEMENT BY PHYSICIANS IN-TRAINING

This survey assessed the knowledge of physicians in training about the pharmacology of opioid analgesics and the benefits of palliative radi ation therapy in the management of cancer pain. Eighty-one trainees at the Washington University Medical Center completed a questionnaire th at addressed the palliative care of a hypothetical patient with metast atic non-small cell lung cancer. The questions addressed were 1) opioi d selection, 2) conversion of parenteral to oral morphine, 3) manageme nt of opioid toxicities, 4) opioid addiction, and 5) efficacy of radia tion therapy. The results demonstrated that few physicians in training were familiar with the stepwise progression of analgesic selection ou tline in the World Health Organization (WHO) guideline. When asked to convert a parenteral dose of morphine to an equivalent dose of a contr olled-release preparation, 75% calculated a dose that was less than on e-third the correct dose; only four (5%) calculated the dose correctly . Trainees were familiar with the management of opioid toxicities. The y were unfamiliar with the palliative benefits of radiation therapy. A lthough 41% recognized that complete relief of pain could be achieved in 50%-60% of patients, most (70%) predicted that maximum pain relief would be seen within the first month, and 98% predicted maximum benefi t by 12 weeks. Although cancer pain management has been highlighted in the lay and medical literature, physicians in training still demonstr ate deficiencies in their knowledge about the pharmacology and bioequi valency of the opioid and the benefits of radiation therapy. Published guidelines for the management of cancer pain need to be disseminated to all medical personnel caring for patients with cancer. (C) U.S. Can cer Pain Relief Committee, 1997.