MacDonald N, Findlay H P, Bruera E, Dudgeon D, Kramer J
Cancer Ethics Programme, Clinical Research Institute of Montreal, Quebec, Canada.
J Pain Symptom Manage. 1997 Dec;14(6):332-42. doi: 10.1016/s0885-3924(97)00259-5.
We report the analysis of a cancer management survey mailed to a representative group of health professionals in 1994. The goals of the study were to gather information on cancer pain treatment practices, and to obtain health professional views on obstacles to ideal pain management. The survey, designed by a working party of pharmacists, nurses and physicians, was distributed to 14,628 physicians. A total of 2,686 physicians responded to the survey, including 39% of medical or radiation oncologists, and 18.19% of physicians who listed their primary interest as Family Medicine. Reflecting the modest emphasis placed on palliative care and cancer pain management in the current Canadian milieu, 67% of physicians rated their past teaching experience as only "fair" or "poor." Lack of exposure to pain education was reflected in the response to a series of hypothetical case scenarios exploring physician choices in managing severe cancer pain. For example, in the initial management of a cancer patient with severe pain, 50% of physicians would not use a strong opioid in the absence of other contraindications to opioid use. A wide variety of analgesics and non-pharmacologic techniques is available to Canadian physicians to assist patients with pain. Few physicians identified the unavailability of analgesics or analgesic techniques as limiting factors in pain management. We conclude that greater emphasis should be placed on pain education in our training programmes. We suggest that further surveys of this type, sponsored by our provincial colleges and medical organizations, can provide feedback which will enhance the adherence by Canadian physicians to published guidelines for pain management.
我们报告了1994年邮寄给一组具有代表性的卫生专业人员的癌症管理调查分析。该研究的目的是收集有关癌症疼痛治疗实践的信息，并获取卫生专业人员对理想疼痛管理障碍的看法。该调查由药剂师、护士和医生工作小组设计，分发给了14628名医生。共有2686名医生回复了调查，其中包括39%的医学或放射肿瘤学家，以及18.19%将其主要兴趣列为家庭医学的医生。反映出当前加拿大环境中对姑息治疗和癌症疼痛管理的重视程度不高，67%的医生将他们过去的教学经历评为“一般”或“差”。在一系列探索医生在管理严重癌症疼痛方面选择的假设病例情景的回复中，体现了缺乏疼痛教育的情况。例如，在对一名患有严重疼痛的癌症患者进行初始管理时，50%的医生在没有其他阿片类药物使用禁忌症的情况下不会使用强效阿片类药物。加拿大医生可以使用各种各样的镇痛药和非药物技术来帮助患者缓解疼痛。很少有医生认为镇痛药或镇痛技术的不可用是疼痛管理的限制因素。我们得出结论，在我们的培训项目中应更加重视疼痛教育。我们建议由我们的省级学院和医学组织发起的此类进一步调查可以提供反馈，这将提高加拿大医生对已发布的疼痛管理指南的遵守情况。
