Luckett Tim, Newton-John Toby, Phillips Jane, Holliday Simon, Giannitrapani Karleen, Powell-Davies Gawaine, Lovell Melanie, Liauw Winston, Rowett Debra, Pearson Sallie-Anne, Raymond Bronwyn, Heneka Nicole, Lorenz Karl
IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
BMJ Open. 2020 Feb 17;10(2):e034363. doi: 10.1136/bmjopen-2019-034363.
To explore the perspectives of general practitioners (GPs) concerning the risk of opioid misuse in people with cancer and pain and related clinical considerations.
A qualitative approach using semistructured telephone interviews. Analysis used an integrative approach.
Primary care.
Australian GPs with experience of prescribing opioids for people with cancer and pain.
Twenty-two GPs participated, and three themes emerged. Theme 1 () contextualised misuse as a relatively minor concern compared with pain control and toxicity, and highlighted underlying systemic factors, including limitations in continuity of care and doctor expertise. Theme 2 () captured participants' relative comfort in prescribing opioids for pain in cancer versus non-cancer contexts, and acknowledgement that compassion and greater perceived community acceptance were driving factors, in addition to scientific support for mechanisms and clinical efficacy. Participant attitudes towards prescribing for people with cancer versus non-cancer pain differed most when cancer was in the palliative phase, when they were unconcerned by misuse. Participants were equivocal about the risk-benefit ratio of long-term opioid therapy in the chronic phase of cancer, and were reluctant to prescribe for disease-free survivors. Theme 3 () captured participants' acknowledgement that they sometimes prescribed opioids for cancer pain as a default, easier option compared with more holistic pain management.
Findings highlight the role of specific clinical considerations in distinguishing risk of opioid misuse in the cancer versus non-cancer population, rather than diagnosis per se. Further efforts are needed to ensure continuity of care where opioid prescribing is shared. Greater evidence is needed to guide opioid prescribing in disease-free survivors and the chronic phase of cancer, especially in the context of new treatments for metastatic disease.
探讨全科医生（GPs）对癌症患者及疼痛患者阿片类药物滥用风险的看法以及相关临床考量。
采用半结构化电话访谈的定性研究方法。分析采用综合方法。
初级医疗保健机构。
有为癌症患者及疼痛患者开具阿片类药物经验的澳大利亚全科医生。
22名全科医生参与研究，出现了三个主题。主题1（ ）将滥用视为与疼痛控制和毒性相比相对较小的问题，并强调了潜在的系统性因素，包括护理连续性和医生专业知识的局限性。主题2（ ）体现了参与者在为癌症患者与非癌症患者的疼痛开具阿片类药物时相对安心的态度，并承认除了对作用机制和临床疗效的科学支持外，同情心和更高的社区认可度也是驱动因素。当癌症处于姑息阶段时，参与者对为癌症患者与非癌症患者开具阿片类药物的态度差异最大，此时他们对滥用并不担忧。参与者对癌症慢性期长期阿片类药物治疗的风险效益比看法不一，并且不愿意为无病生存者开具此类药物。主题3（ ）体现了参与者承认他们有时将为癌症疼痛开具阿片类药物作为默认选择，这比更全面的疼痛管理更容易。
研究结果突出了特定临床考量在区分癌症患者与非癌症患者阿片类药物滥用风险方面的作用，而非诊断本身。在阿片类药物处方共享的情况下，需要进一步努力确保护理的连续性。需要更多证据来指导为无病生存者和癌症慢性期患者开具阿片类药物，尤其是在转移性疾病新治疗方法的背景下。
