CANCER PAIN EDUCATION AMONG FAMILY PHYSICIANS

This study used performance-based testing (objective structured clinic al evaluation, OSCE) to evaluate the skills of family physicians in as sessing and managing the severe pain of a cancer patient, and evaluate d a new method of education about the management of cancer pain. Twent y-four primary care physicians completed a detailed pain assessment of the same standardized cancer pain patient (Part A). A proctor observe d the interviews and rated the physicians on a variety of pre-determin ed items believed to be important for pain assessment. The physicians were then allowed 5 min to answer management questions about the patie nt's cancer pain (Part B). After reviewing each physician's performanc e on Parts A and B, the proctor provided immediate feedback and instru ction (Part C) on basic principles of cancer pain assessment and manag ement. On average, the primary care Physicians asked 52% (+/- 4.5%) of the indicated questions of a detailed pain assessment. Performance wa s poorest in asking about previous pain history, temporal pattern of p ain, and pain intensity. Performance on the pain assessment was best f or eliciting pain location and pain-relieving factors. Primary care ph ysicians obtained mean scores of 36% (+/- 3%) on Part B of the OSCE. A lthough opioid therapy was frequently prescribed, only 42% of prescrip tions were for regular administration. Performance on Parts A and B co rrelated poorly with years in practice, and older physicians tended to perform a less derailed pain assessment than their younger colleagues . Most physicians enjoyed participating in this instructional format a nd believed that the proctor feedback Increased the educational value of the module. The results of our study suggest that many family physi cians may be inadequate in their clinical assessment and management of cancer pain. Our study supports the need for continuing education in cancer pain management, regardless of years in practice. Further study should evaluate the effects of different educational programs on clin ical practice in patient care. (C) U.S. Cancer Pain Relief Committee, 1997.