Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Pain Symptom Manage. 2012 Feb;43(2):253-60. doi: 10.1016/j.jpainsymman.2011.03.009. Epub 2011 Jun 15.
During the past 10 years, advocates of palliative care have sought to be included earlier in the course of patients' illnesses. Palliative care providers may thus be more likely to care for patients who misuse and abuse opioids.
To assess whether hospice and palliative medicine (HPM) fellows see patients at risk for opioid misuse and how competent they perceive themselves to be to treat pain in these patients.
An electronic survey was distributed to 102 HPM fellows. The survey included questions assessing self-perceived competency in care for patients who misuse opioids. Responses were rated using a Likert scale of one to seven, where one=strongly agree and seven=strongly disagree; any number greater than two was considered to be nonagreement.
Fifty-seven (56%) fellows from 34 programs responded to the survey. In the previous two weeks, 77.2% of respondents had seen at least one patient with a substance use disorder (SUD) and 43.9% had treated a patient whom they were concerned was misusing opioids. Half (47.2%) of respondents stated that they have a working knowledge of addiction, 41.4% agreed their training has prepared them to manage opioid misuse, and 36.8% felt they knew how to differentiate pain from addiction. Only 21.1% were satisfied with how they treat symptoms in this population. Fellowship training in opioid misuse was associated with increased satisfaction.
HPM fellows regularly see patients who are at risk for opioid misuse and feel unprepared to treat pain in these patients. There is a need for more education of fellows in this area.
在过去的 10 年中，姑息治疗的倡导者一直在寻求更早地参与到患者的疾病治疗中。姑息治疗提供者因此更有可能照顾滥用和误用阿片类药物的患者。
评估临终关怀和姑息医学（HPM）研究员是否会看到有阿片类药物滥用风险的患者，以及他们认为自己在治疗这些患者疼痛方面的能力如何。
向 102 名 HPM 研究员发放了电子调查问卷。该调查包括评估自我感知在治疗滥用阿片类药物的患者方面的能力的问题。回答采用 1 到 7 的李克特量表进行评分，其中 1 表示非常同意，7 表示非常不同意；任何大于 2 的数字都被视为不同意。
来自 34 个项目的 57 名（56%）研究员对调查做出了回应。在过去的两周内，77.2%的受访者至少见过一位患有物质使用障碍（SUD）的患者，43.9%的受访者治疗过他们认为正在滥用阿片类药物的患者。有一半（47.2%）的受访者表示他们对成瘾有一定的了解，41.4%的人同意他们的培训使他们能够管理阿片类药物滥用，36.8%的人认为他们知道如何区分疼痛和成瘾。只有 21.1%的人对他们在这一人群中治疗症状的方式感到满意。阿片类药物滥用方面的研究员培训与满意度增加相关。
HPM 研究员经常会看到有阿片类药物滥用风险的患者，并且感到他们没有准备好治疗这些患者的疼痛。需要在这方面为研究员提供更多的教育。
