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The prescription of opioid analgesics to terminal cancer patients: Impact of physicians' general attitudes and contextual factors

Published online by Cambridge University Press:  01 December 2003

P. PERETTI-WATEL ,
M.K. BENDIANE ,
Y. OBADIA ,
R. FAVRE ,
J.M. LAPIANA ,
J.P. MOATTI  and
THE SOUTH-EASTERN FRANCE PALLIATIVE CARE GROUP
P. PERETTI-WATEL
Affiliation:
Regional Centre for Disease Control of South-Eastern France, Marseilles, France Health and Medical Research National Institute, Research Unit 379, “Social Sciences Applied to Medical Innovation,” Institut Paoli Calmettes, Marseilles, France
M.K. BENDIANE
Affiliation:
Regional Centre for Disease Control of South-Eastern France, Marseilles, France Health and Medical Research National Institute, Research Unit 379, “Social Sciences Applied to Medical Innovation,” Institut Paoli Calmettes, Marseilles, France
Y. OBADIA
Affiliation:
Regional Centre for Disease Control of South-Eastern France, Marseilles, France Health and Medical Research National Institute, Research Unit 379, “Social Sciences Applied to Medical Innovation,” Institut Paoli Calmettes, Marseilles, France
R. FAVRE
Affiliation:
Assistance Publique Hôpitaux de Marseilles, Service of Medical Oncology, Marseilles, France
J.M. LAPIANA
Affiliation:
Palliative Care Unit “La Maison,” Gardanne, France
J.P. MOATTI
Affiliation:
Health and Medical Research National Institute, Research Unit 379, “Social Sciences Applied to Medical Innovation,” Institut Paoli Calmettes, Marseilles, France Department of Economics, University of Aix-Marseilles II, Marseilles, France
THE SOUTH-EASTERN FRANCE PALLIATIVE CARE GROUP
Affiliation:
Regional Centre for Disease Control of South-Eastern France, Marseilles, France
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Abstract

Objective: This study aimed to examine factors associated with the prescription of opioid analgesics to terminal cancer patients, including physicians' general attitudes toward morphine and contextual factors.

Methods: A survey was conducted among a sample of French general practitioners (GPs) and oncologists. Respondents were asked to describe the last three terminally ill patients they had followed up to death.

Results: Overall, 526 GPs and oncologists (global response rate: 57%) described 1,082 cancer patients, among whom 85.4% received opioid analgesics. Among other significant predictors (patient age, cancer type, family assistance), this prescription was less frequent for female patients followed by male physicians (OR = 0.53), and more frequent for patients followed by physicians trained in palliative care (OR = 2.70). On the other hand, physicians' attitudes toward morphine were not associated with prescription of morphine and other opioid analgesics.

Significance of results: Although nonprescription of opioid analgesics is only a crude proxy measure for undertreatment of cancer pain, our findings suggest the need to develop training in palliative care in order to standardize practices among GPs and specialists. Our results also highlight the necessity to study pain assessment as an interaction between the physician and the patient, and to consider patients' and physicians' respective genders as a key variable within this interaction.

Keywords

Opioid analgesicsCancerEnd-of-lifeAttitudesFrance
Type
Research Article
Information
Palliative & Supportive Care , Volume 1 , Issue 4 , December 2003 , pp. 345 - 352
Copyright
© 2003 Cambridge University Press

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