Pharmacy-Perceived Barriers to Cancer Pain Control: Results of the North Carolina Cancer Pain Initiative Pharmacist Survey

Abstract

Spanish

French

OBJECTIVE:

To assess pharmacists' knowledge, attitudes, and beliefs regarding the use of narcotics in cancer pain management, identify pharmacist counseling activities for cancer pain patients, assess pharmacy-related barriers to cancer pain management, and evaluate the availability of narcotic analgesics.

METHODS:

Mailing of a six-page survey.

SETTING:

Five hundred randomly selected pharmacists registered in North Carolina.

PARTICIPANTS:

Of 500 pharmacists surveyed, 141 surveys were completed and returned for a response rate of 28.2 percent.

RESULTS:

Pharmacists surveyed were knowledgeable regarding the problem of undertreatment of cancer pain. More than 80 percent of respondents replied that most cancer patients experience pain at some time during their illness. Eighty-five percent of respondents agreed that the nurse must believe the patient's report of pain and that the patient is the best judge of the intensity of the pain. Conservative physician prescribing patterns and conservative administration patterns of nurses were identified as perceived barriers to adequate pain management by 51 and 44 percent of respondents, respectively. Less than 30 percent of respondents frequently counseled cancer pain patients and were unable to identify patients who have cancer pain as a major medical illness. Hospital pharmacists recommended adjunctive therapy more often than did community pharmacists (p=0.013). Interventions in pain management regimens were more often conducted by hospital pharmacists than by community pharmacists (p=0.049). Differences in availability of narcotics was noted among practice sites for some more potent narcotics. Of the pharmacists surveyed, only 43 percent had attended a continuing education program on cancer pain management. Ninety-six percent of respondents were interested in attending a continuing education program in the future.

CONCLUSIONS:

Pharmacists in North Carolina are aware that the undertreatment of cancer pain is a serious medical problem. Unfortunately, pharmacists appear to be unable to identify patients with cancer pain as a major medical problem; therefore, counseling activity is limited. Addiction is still perceived as a barrier by some pharmacists. Through organizations such as the North Carolina Pain Initiative, these problems can be addressed.

Get full access to this article

View all access options for this article.

References

Elliot

Foley

. Neurologic pain syndromes in patients with cancer. Crit Care Clin 1990; 6: 398–420.

Koeller

. Understanding cancer pain. Am J Hosp Pharm 1990; 47 (suppl 1):s3–6.

Speigel

Bloom

. Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosom Med 1983; 45: 333–9.

Cleeland

. The impact of pain on patients with cancer. Cancer 1984; 54: 35–41.

Bond

. Psychologic and emotional aspects of cancer pain. In: Bonica

Ventragridda

, eds. Advances in pain research and therapy. Vol. 2. New York: Raven Press; 1979: 81–8.

Strang

Quarner

. Cancer-related pain and its influence on quality of life. Anticancer Res 1990; 10: 109–12.

Curtis

Fernsler

. Quality of life of oncology hospice patients: A comparison of patient and primary caregiver reports. Oncol Nurs Forum 1989; 16: 49–53.

Strang

. Emotional and social aspects of cancer pain. Acta Oncol 1992; 31: 323–6.

National Cancer Institute. Executive summary of the National Cancer Institute workshop on cancer pain. Bethesda, MD, September 14–15, 1990.

10.

Levin

Cleeland

Dar

. Public attitudes toward cancer pain. Cancer 1985; 56: 2337–9.

11.

Bressler

Geraci

Schatz

. Misperceptions and inadequate pain management in cancer patients. DICP Ann Pharmacother 1991; 25: 1225–30.

12.

Cleeland

Gonin

Hatfield

Edmonson

Blum

Stewart

Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 1994; 330: 592–6.

13.

Daut

Cleeland

. The prevalence and severity of pain in cancer. Cancer 1982; 50: 1913–8.

14.

Kanner

Portenoy

. Unavailability of narcotic analgesics for ambulatory cancer patients in New York City. J Pain Sympt Manage 1986; 1: 87–9.

15.

Kanner

Cooper

. Availability of narcotic analgesics for ambulatory patients with pain. Adv Pain Res Ther 1989; 11: 191–5.

16.

Holdsworth

Raisch

. Availability of narcotics and pharmacists' attitudes toward narcotic prescriptions for cancer patients. Ann Pharmacother 1992; 26: 321–6.

17.

Grossman

Scheidler

. Skills of medical students and house officers in prescribing narcotic medications. J Med Educ 1985; 60: 552–7.

18.

Morgan

. American opiophobia: Customary underutilization of opioid analgesics. Adv Alcohol Subst Abuse 1986; 5: 163–73.

19.

Charap

. The knowledge, attitudes and expectations of medical personnel treating pain in the terminally ill. Mt Sinai J Med 1978; 45: 561–80.

20.

Weissman

Gutman

Dahl

. Physician cancer pain education: A report from the Wisconsin Cancer Pain Initiative. J Pain Sympt Manage 1991; 6: 445–8.

21.

Portenoy

Coyle

. Controversies in the long-term management of analgesic therapy in patients with advanced cancer. J Pain Sympt Manage 1990; 5: 307–19.

22.

Elliot

. Physician acquisition of cancer pain management knowledge. J Pain Sympt Manage 1991; 6: 224–9.

23.

Jacox

Carr

Payne

. New clinical-practice guidelines for the management of pain in patients with cancer. N Engl J Med 1994; 330: 651–5.