Schulte Erika, Petzke Frank, Spies Claudia, Denke Claudia, Schäfer Michael, Donner-Banzhoff Norbert, Hertwig Ralph, Wegwarth Odette
Department of Palliative Medicine, Universitätsmedizin Göttingen, 37075 Göttingen, Germany.
Pain Clinic, Department of Anesthesiology, Universitätsmedizin Göttingen, 37075 Göttingen, Germany.
J Clin Med. 2022 Apr 29;11(9):2506. doi: 10.3390/jcm11092506.
Background: The pressure on physicians when a patient seeks pain relief and their own desire to be self-effective may lead to the prescription of strong opioids for chronic noncancer pain (CNCP). This study, via physician self-reporting, aims to identify and measure (i) physician adherence to national opioid prescribing guidelines and (ii) physician emotions when a patient seeks a dosage increase of the opioid. Methods: Within a cross-sectional survey—conducted as part of a randomized controlled online intervention trial (ERONA)—600 German physicians were queried on their opioid prescribing behavior (choice and formulation of opioid, indications) for CNCP patients and their emotions to a case vignette describing a patient seeking an opioid dosage increase without signs of objective deterioration. Results: The prescription of strong opioids in this study was not always in accordance with current guidelines. When presented with a scenario in which a patient sought to have their opioid dose increased, some physicians reported negative feelings, such as either pressure (25%), helplessness (25%), anger (23%) or a combination. The risk of non-guideline-compliant prescribing behavior using the example of ultrafast-acting fentanyl for CNCP was increased when negative emotions were present (OR: 1.7; 95%-CI: 1.2−2.6; p = 0.007) or when sublingual buprenorphine was prescribed (OR: 15.4; 95%-CI: 10.1−23.3; p < 0.001). Conclusions: Physicians’ emotional self-awareness represents the first step to identify such direct reactions to patient requests and to ensure a responsible, guideline-based opioid prescription approach for the long-term well-being of the patient.
当患者寻求疼痛缓解时医生所面临的压力以及他们自身想要产生有效治疗效果的愿望，可能会导致为慢性非癌性疼痛（CNCP）患者开具强效阿片类药物。本研究通过医生自我报告，旨在识别并衡量：（i）医生对国家阿片类药物处方指南的遵守情况；（ii）当患者寻求增加阿片类药物剂量时医生的情绪。方法：在一项横断面调查中（作为随机对照在线干预试验（ERONA）的一部分进行），对600名德国医生就其针对CNCP患者的阿片类药物处方行为（阿片类药物的选择和剂型、适应症）以及他们对一个病例 vignette 的情绪进行了询问，该 vignette 描述了一名患者在没有客观病情恶化迹象的情况下寻求增加阿片类药物剂量。结果：本研究中强效阿片类药物的处方并不总是符合当前指南。当面对患者寻求增加阿片类药物剂量的情景时，一些医生报告了负面情绪，如压力（25%）、无助（25%）、愤怒（23%）或多种情绪的组合。当出现负面情绪时（比值比：1.7；95%置信区间：1.2 - 2.6；p = 0.007），或者当开具舌下含服丁丙诺啡时（比值比：15.4；95%置信区间：10.1 - 23.3；p < 0.001），以超快效芬太尼用于CNCP为例的不符合指南的处方行为风险会增加。结论：医生的情绪自我认知是识别此类对患者请求的直接反应，并确保为患者的长期健康采用基于指南的、负责任的阿片类药物处方方法的第一步。
