Barclay Stephen, Todd Chris, Grande Gunn, Lipscombe Julian
Health Services Research Group, General Practice and Primary Care Research Unit, Institute of Public Health, Cambridge, United Kingdom.
J Pain Symptom Manage. 2002 May;23(5):383-92. doi: 10.1016/s0885-3924(02)00389-5.
During recent years, the national policy of the United Kingdom has increasingly recognized the central place of general practitioners (GPs) in the care of cancer patients, from screening and early diagnosis through to palliative care and bereavement. There are, however, continuing reports of poor control of pain and other symptoms in the community. To investigate general practitioners' prescribing habits and knowledge of some key pain control issues in advanced cancer, a postal questionnaire surveyed a random sample of 450 East Anglian GPs. The response rate was 73.3%. Most respondents were familiar with the modern management of cancer pain, including the World Health Organization approach, the use of oral opioids, and the management of bone pain. There was less awareness of the drug options available for more uncommon situations, especially the dose conversion of oral morphine to subcutaneous diamorphine and drugs that may be used in syringe drivers. GPs in the UK are familiar with the management of the more common pain control problems. However, it is not appropriate to expect GPs to know the details of management of more unusual cancer pain problems. Specialist clinicians need to make themselves readily available to advise their generalist colleagues. The educational implications for GPs are discussed.
近年来，英国的国家政策越来越认识到全科医生（GPs）在癌症患者护理中的核心地位，从筛查和早期诊断到姑息治疗和丧亲之痛的处理。然而，仍不断有报告称社区中疼痛和其他症状控制不佳。为了调查全科医生在晚期癌症中一些关键疼痛控制问题的处方习惯和知识，通过邮寄问卷对450名东安格利亚全科医生进行了随机抽样调查。回复率为73.3%。大多数受访者熟悉癌症疼痛的现代管理方法，包括世界卫生组织的方法、口服阿片类药物的使用以及骨痛的管理。对于更罕见情况的可用药物选择，尤其是口服吗啡向皮下二醋吗啡的剂量转换以及可用于注射泵的药物，了解较少。英国的全科医生熟悉更常见疼痛控制问题的管理。然而，期望全科医生了解更不常见癌症疼痛问题的管理细节是不合适的。专科临床医生需要随时为他们的全科同事提供建议。文中讨论了对全科医生的教育意义。
