8
132 Journal of Pain and Symptom Management Vol.8No. 3April1993 A Comparative Study of the Attitudes of Physicians and Nurses Toward the Management of Cancer Pain Betsy L. Fife, PhD, Neil Irick, MD, and Julie D. Painter, MSN Walther Cancer Institute,Indiana University Schoolof Nursing, and CommunityHospitals Indiana Regional Cancer Center (B.L.F.), Walther Cancer Institute Pain Resource Center oj Indiana (N.I.), and Community HospitalsIndiana Regional Cancer Center u.D.P), Indianapolis, Indiana Although the effective management ofcancerpain &@ma!s on adequate collaboration and cooperation of the physician and the nurse, little research has been done comparing the attitudes of the twogroups. This study investigated the attitudes ofphysicians and nurses toward cancer pain and its treatment with respect to three domains: (a) the management of cancer pain as a health-care issue; {b) the potential problems of addiction and drug misuse; and (c) the involvement ofpatients in the management of their own pain. A question.naire was mailed to a randomly selecled sample of individuals registered with the Health Professions Bureau of Indiana. It was completed by 500 physicians an.d 4 71 nurses. Speczfx differences that were found are discussed, along with the implications of these dijferences for the management of cancer pain and the education of professionals. J Pain Symptom Manage 1993;8:132-139. Key Words Cancer pain, education, addiction Idroductkm It is estimated that in the United States more than 1,130,OOO new cases of cancer will be diagnosed during 1992,’ and experts have indicated that 30%-40% of all individuals with cancer, and 60%-900/o of those with terminal cancer, experience pain as a result of their illness.2-4 Furthermore, it has been found that Address reprint requeststo: Betsy Fife, PhD, indiana Regional Cancer Center, 1500 North Ritter Avenue, Indianapolis, IN 46219, USA. Acctpedfmpublication: October 7, 1992. attitudes of the general public toward cancer and the pain associated with it involve high levels of fear and anxiety.“,” Cancer pain has been described as a dimension of the illness that disrupts all aspects of the patient’s well- being and affects quality of life for every member of the fami!y.7-!’ Inadequate management of cancer pain is widely recognized!‘*1u and has been cited as a national health problem of first priority.4 A number of factors have been suggested to explain the problem of undertreatment. First, there is a social stigma associated with the use of opioid drugs. As a result, patients often wait until pain becomes severe before taking analge- 0 U.S. Cancer Pain Relief Committee. 1993 Published by Elsevier, New York, New York 088539!?4./93/$6.00

A comparative study of the attitudes of physicians and nurses toward the management of cancer pain

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Page 1: A comparative study of the attitudes of physicians and nurses toward the management of cancer pain

132 Journal of Pain and Symptom Management Vol. 8No. 3April1993

A Comparative Study of the Attitudes of Physicians and Nurses Toward the Management of Cancer Pain Betsy L. Fife, PhD, Neil Irick, MD, and Julie D. Painter, MSN Walther Cancer Institute, Indiana University School of Nursing, and Community Hospitals Indiana Regional Cancer Center (B.L.F.), Walther Cancer Institute Pain Resource Center oj Indiana (N.I.), and Community Hospitals Indiana Regional Cancer Center u.D.P), Indianapolis, Indiana

Although the effective management ofcancerpain &@ma!s on adequate collaboration and cooperation of the physician and the nurse, little research has been done comparing the attitudes of the two groups. This study investigated the attitudes ofphysicians and nurses toward cancer pain and its treatment with respect to three domains: (a) the management of cancer pain as a health-care issue; {b) the potential problems of addiction and drug misuse; and (c) the involvement ofpatients in the management of their own pain. A question.naire was mailed to a randomly selecled sample of individuals registered with the Health Professions Bureau of Indiana. It was completed by 500 physicians an.d 4 71 nurses. Speczfx differences that were found are discussed, along with the implications of these dijferences for the management of cancer pain and the education of professionals. J Pain Symptom Manage

1993;8:132-139.

Key Words Cancer pain, education, addiction

Idroductkm It is estimated that in the United States more

than 1,130,OOO new cases of cancer will be diagnosed during 1992,’ and experts have indicated that 30%-40% of all individuals with cancer, and 60%-900/o of those with terminal cancer, experience pain as a result of their illness.2-4 Furthermore, it has been found that

Address reprint requests to: Betsy Fife, PhD, indiana Regional Cancer Center, 1500 North Ritter Avenue, Indianapolis, IN 46219, USA.

Acctpedfmpublication: October 7, 1992.

attitudes of the general public toward cancer and the pain associated with it involve high levels of fear and anxiety.“,” Cancer pain has been described as a dimension of the illness that disrupts all aspects of the patient’s well- being and affects quality of life for every member of the fami!y.7-!’

Inadequate management of cancer pain is widely recognized!‘*1u and has been cited as a national health problem of first priority.4 A number of factors have been suggested to explain the problem of undertreatment. First, there is a social stigma associated with the use of opioid drugs. As a result, patients often wait until pain becomes severe before taking analge-

0 U.S. Cancer Pain Relief Committee. 1993 Published by Elsevier, New York, New York 088539!?4./93/$6.00

Page 2: A comparative study of the attitudes of physicians and nurses toward the management of cancer pain

Vol. 8 No. 3 April I993 Physicians, Nurses, and Cancer Pain Management - I33

sits; many patients, family members, and health-care professionals fear addiction.” Sec- ond, many cancer patients want to he perceived as “strong,” and to be seen by members of the treatment team as “good patients”; therefore, they hesitate to ask for pain medication.lZslZ+ Third, there is a lack of coordination of care as patients move from one setting to another.“-’ Fourth, the subjective nature of pain makes communication regarding its intenGty difficult, and this increases the possibility that a patient’s pain will be inaccurateI;? perceived by others. Finally, inadequacies in the education of health pr-ofessionals that may increase tile fear of addiction, as well as lower the priority of pain management within the treatment schema, speak to the need for a better understanding of the extent and the nature of cancer pain.‘S,“i

Although it is not discussed frequently in the medical literature. the appropriate assess- ment and treatment of the pain associated with cancer is highly dependent upon collabo- ration between the physician and the nurse, as well as upon open communication with the patient and the family. The physician assesses and provides prescriptions, while the nurse assesses the patient’s status, including pain, and serves as an advocate of the patient by promoting understanding of existing prob- lems among other members of the health-care team. Therefore, optimal management of the patient’s pain is determined by adequate and accurate communication between the physi- cian and the nurse regarding their respective assessments, as well as on follow-through on the approach to treatment.

There have been no previous studies that use the same questionnaire to assess simulta- neously the perceptions of physicians and nurses regarding cancer pain. Consequently, an accurate comparison of the perceptions of the two groups has not been possible and the question of dZerences that could potentially interfere with adequate pain management has not been systematically addressed. The pri- mary purpose of this study was to compare the perspectives of these two groups, determine whether significant discrepancies exist, and, if so, begin KO identify specific problems. A second focus of the study was to provide a basis for the development of educational programs for both physicians and nurses that would address central issues concerning the prob- lems associated with the management of

cancer pain. This inciudes continuing profes- sional education, as well a? suggestions for curriculum changes for the training of both physicians and nurses. If significant discrepan- cies exist between the two groups, educational programs can be planned to minimize the problems in alleviating cancer pain due to these,.differences.

tltolis

A questionnaire was mailed to a randomly selected sample of physicians and nurses li- censed by the Health Professions Bureau of Indiana. There were two mailings to physicians and one mailing to nurses. The second mailing to physicians went to individuals who were not sampled by the first mailing. The mean re- sponse rate for the two mailings to physicians rvas 15%, and the response rate from the single mailing to nurses was 24%. The final sample included 500 physicians and 471 registered nurses.

Participants came from throughout the state, with 43% of the physicians and 63% of the nilrqes located in communities with popula- tions of less than 100,000. All areas of speciali- zation were sampled for both groups, as it was felt that the majority oi physicians and nurses are involved to some extent with the care of individuals and families coping with cancer. Furthermore, both of these groups contribute formally and informally to the development of public policy, as well as to public attitudes that affect the management of cancer pain. Areas of specialization are described in Table 1.

The basic questionnaire used for this re- search (see the Appendix) was developed by Weissman and Dahl” for a survey of first-year medical students. Ten of the original 11 nondemographic items were used in this study.

T&C I heas of Specialization as Represented in the Sample

Physicians (%I Nurses (%)

Family Practice 29.4 Medical/Surgical 22.7

Internal Medicine 11.4 Geriatrics 9.1

Surgery 7.2 Gynecology 8.9

Gynecology 5.4 Psvchiatry 6.2

Psychiatry 4.4 CAtical Care 5.9

Oncology 3.2 Oncology 5.9

Others 39.0 Others 41.3

iV= 500 N= 471

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I34 Fije et al. Ibl. 8 Ml. 3 ,-Q!wiI 1993

Two additional items were added, one that queried respondents’ beliefs about the extent to which the management of cancer..pain is a problem and one that determined the extent to which respondents believe patients should be involved in controlling the treatment they receive for pain.

The questions included in the suwey con- cern three major areas relevant to the problem of cancer pain: (a) attitudes regarding the management of cancer pain as a health-care issue (questions 1, 2, 3, 4, and 10; (see the Appendix); (b) beliefs about the potential fol problems of addiction and drug misuse (ques- tions 5, 6. 8, and 11); and (c) attitudes toward the involvemem of patients in the management of their own pain (questions 7, 9, and 12). Data pertaining to each of these issues were analyzed separately for physicians and nurses, then compared using a likelihood x2 statistic.

Results

Cancer Pain as a Health-(3-e Problem The majority of physician and nurse respon-

dents believe pain management is a problem, that most cancer patients experience pain, and that cancer pain can be relieved with adequate treatment. The distributions of responses for the two groups, however, were significantly different. First, more nurses than physicians view cancer pain as a major problem (84% vs 73%). Second, as shown in Table 2, more nurses believe that most patients suffer pain, whereas more physicians believe that most cancer pain can he effectively relieved with treatment: 76% of physicians and 67% of nurses indicated they believe most patients

Table 2 Perceptions of the Extent of Cancer Pain and the

Effectiveness of Treatment for Cancer Pain

%

% Patienn % Pain relieved suffering pain by trealnient

Physicians Wrrses Physicians Nurses

20 4.5 1.1 1.2 1.9 40 10.0 3.8 3.3 12.7 60 20.8 14.8 15.0 27.5 80 46.4 44.5 53.7 43.5

100 18.3 35.8 26.7 14.4 A’= 491 IV= 466 N= 486 N= 464

Dilkrw~rrs hrtwrw groups. I’S U.OU.

TabL 3 Causes of Cancer Pain

SOUl-CT 5% Physicians :!;J IVllrsr~ - _-

Preesisting condition 1.0 1.7 Cancer itself 91.7 76.0 Cancer treatments 7.2 20.8

N= 484 .V= 462

with cancer arc undermedicated; approsi- matcly 30% of nurse respondents and 25% of physician respondents believe the majority of cancer patients are cithcr aclcquately mcdi- cated or receive more medication than is necessary.

Ninety-two percent of physicians and 76% of nurses believe that cancer pain is due primarily to the disease itself (Table 3). There was a significant difference between the groups on this item (PC 0.00): 21% of nurse respondents indicated they believe that pain is due primarily to the cancer treatments rather thal: to the disease.

Behi$ figarding Addirtion

The concern about addiction and the mis- use of medications by patients with cancer pain is less evident in this sample than in other studies.4*1 I.lT,.i(i.lN Furthermore, the attitudes of the physician and nurse respondents were similar. For example, 73% of physicians and 75% of nurses responded that psychological dependence on analgesics occurs only occa- sionally or rarely, and approximately 25% of respondents in both groups feared addiction. Consistent with this finding. only 10% of physicians and 5% of nurses indicated they believe that increasing requests for analgesics are due to psychological dependence. Approx- imately 90% of both groups indicated they would have little or no concern about addic- tion if a family member used analgesics for the relief of cancer pain. In addition, 97% of both physicians and nurses responded that suicide by an overdose of an opioid drug that was prescribed for cancer pain occurs only occa- sionally or rarely. It is worth noting, however, that the majority of respondents-51% of physicians and 62% of nurses-believe that increasing requests for analgesics are due to drug tolerance rather than to progression of the disease, as experts in cancer pain would contend.‘?

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I-b/. R No. 3 ‘4JuiI 1993 135

Patknt Inuolzmwn t in ill Control

Replies to questions pertaining to the pa- tient’s role in controlling his/her pain rc- vealed relativeiy positive and enlightened attitudes. There was an openness to patient participation and an awareness of the subjec- tive nature of pain: 84% of physicians and 94% of nurses replied that the patient is the most accurate judge of pain intensity, while 64% of physicians and 59% of nurses believed that using maximum doses of analgesics was appro- priate at any time they were needed (Table 4). However, 41% of nurses and 36% of pbysi- cians indicated that the use of analgesics should be restricted according to the indisid- ual’s prognosis. Finally. the vast majority of both nurses and physicians believed that patients should have at least as much control over their pain treatments as health profes- sionals; nurses were significantly more willing to give patients greater control than health professionals (see Table 5).

Chi-square analyses were also used ?o test for differences in responses related to the size of the respondents’ communities, tLe year that the respondents completed their profes- sional training, and for the physician group, the gender of the respondent. This last variable was not included in the analysis for nurses, as there were only 12 male nurse respondents.

Physicians from large urban areas were significantly more likely to believe that the majority of cancer patients are undermedi- cated in the United States-83% from com- munities > 100,000 versus 70% from commu- nities < 100,000 (P < 0.00). The data from nurse respondents were similar in that 76% of nurses from large urban communities indi- cated that the majority of patients are under- medicated, whereas this was true for 64% of nurses from smaller communities (PC 0.03). A greater percentage of physicians (75%) who

Table 4 Appropriate Timing for Use of Maximum Analgesics

Stage 9% Physicians % Kurses

<lrnO 6.2 11.1 <6mo 17.0 19.0 < 1 yr 12.8 10.5 Atiytime 64.0 59.3

N= 483 IV= 458

IMlerencc bctwcc~l groups. P< 0.03.

Table 5 riateness of Patient Involvement

ira Pain Control

Degree of control % Physicians

Ko control 0.4 c Health professionals 12.1 Same as health 61.6

professionals > Health professionals 16.6 Complete contr01 9.8

,V= 498

Dilkrc~~cc hrtwrc~~ groups. I’< 0.01.

% Nurses

0.4 4.1

52.2

21.4 21.8

N= 467

graduated during or after 1980 believed that 80% or more of cancer patients experience pain, whereas this was characteristic of 59% of those who graduated prior to 1980 (P< 0.00). Similarly, of the nurses who completed their education during or after 1980,79% indicated they believe the majority of patients are undermedicated, while only 53% of nurses educated prior to that time indicated that the majority of patients receive inadequate medi- cation to manage their cancer pain (P< 0.00). Sixty-five percent of nurses who completed their education during or after 1980 indicated that maximum doses of pain medication are appropriate at any time, whereas only 44% of nurses who completed their education prior to this time believed that this was appropriate (P I 0.00). There were no statistically signifi- cant differences for the physician group based on gender.

Pearson correlation coefficients were ob tained to examine relationships between per- sonal life experiences and attitudes concern- ing the management of cancer pain. While few of the respondents had cancer themselves (6% of both the physician and nurse groups), 61% of the physician subset and 79% of the nurse subset had a family member or a close friend with cancer at one time or another. There were no significant correlations be- tween this experience and variables pertaining to the treatment of cancer pain. Similarly, although 24% of the physician respondents and 31% of the nurse respondents had experienced pain themselves for longer than 1 mo, this variable was unrelated to beliefs about cancer pain and its treatment.

A question was included at the end of the survey asking if the respondents would con- sider attending an educational program on

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136 FiJe et al. Vo!. 8 No. 3 Afn-il I993

the management of cancer pain, if one was offered: 84% of the pk;qIcian respondents indicated they would, or would consider attending, while this was true for 92% of the nurses responding to the questionnaire.

l?iwussim Because the response rate for both groups

was low, there is a concern about selection bias in interpreting the findings. The relatively enlightened responses of the participants, as compared with findings cited in the litera- ture,4*“20 point to the strong possibility that this sample was biased in favor of the perspec- tives promoted by the American Pain Soci- ety.?’ This assumption was supported by writ- ten comments from a number of physician and nurse respondents, who stated that many of their colleagues are either unaware of the extent of the problem, or are concerned primarily about addiction and legal issues related to the prescription of opioids.

Regardless, some findings would be unaf- fected by selection bias, if any existed. Differ- ences in physicians’ and nurses’ perceptions regarding the extent of the problem of cancer pain and its response to treatment were significant, and may be due to the more prolonged contact nurses have with patients and to the physician’s belief in the treatment s/he is prescribing. For optimal management of cancer pain, it is essential that nurses clearly convey their assessments regarding the pa- tient’s pain to physicians, and that any disa- greements regarding the prescribed doses of analgesics be openly discussed and resolved. The problems resulting from inadequate com- munication were first pointed out in a study done by Marks and Sachar,‘L4 whose findings documented inconsistencies between the amount of opioid ordered and the actual dose administered. In subsequent studies con- ducted 15 and 17 years later, Donovan and colleagues2s and Paice and colleagues,‘4 re- spectively, found tha: inconsistencies between the prescribed dose and that administered continued.

Patients and family members are reluctant to discuss problems of cancer pain with physicians for a variety of reasons.‘” Nurses must provide the support and education for patients and their family members that will enable them to directly

and adequately communicate problems of can- cer pain. The use of a common, widely accepted, valid, and reliable measure for the assessment of pain by both physicians and nurses would be extremely valuable in promoting quality pain relief, and in eliminating problems that are due to inaccurate assessment and inadequate com- munication. Such a measure could serve as a mechanism for consistent communication among the patient, physician, and nurse.

Indiana has many rural communities, as well as large urban centers, and there were two statistically significant differences in percep- tion among individuals who practice in these diverse types of communities. The trend in this study indicated a more liberal attitude reg-ard- ing the use of analgesics in the larger commu- nities for both physicians and nurseb. More liberal attitudes with regard to thk &:w were also characteristic of those individuals who received their education more recently.

Although responses to the questionnaire demonstrated considerable sensitivity to the problems involved in the management of cancer pain, three particular findings indicated that education might promote more effective treatment. First, approximately 25% of the physician respondents and 30% of the nurse respondents do not understand the magnitude of the problem of inadequate pain manage- ment, as they indicated that patients with cancer pain receive either adequate medica- tion or more than is necessary. Second, the majority of nurses and physicians believe it is drug tolerance rather than advancing disease that results in increasing requests for analge- sics. This inaccurate perception might influ- ence the dosage that they are willing to prescribe and/or administer. Third, the find- ing that more than one-third of both physician and nurse respondents assumed that the use of analgesics should be predicated on prognosis rather than on subjectively perceived need will interfere with achieving optimal management of cancer pain for their patients.

It is important to emphasize that respon- dents indicated a high degree of receptiveness to attending an educational program on the management of cancer pain. Joint educational forums would permit discussion of the issues and would have the potential to promote cooperation and help resolve problems of communication suggested hy these findings and those of other investigators.‘“24

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Vol. 8 No. 3 April 1993 Physicians, Nurses, and Canwr Pain Managemmt 137

The lack of association between personal life experiences and attitudes toward prob- lems related to cancer pain is contrary to what would he expected. However, this is consistent with the findings of Weissman and Dahl” in their study of medical students, and it may he partially the result of efforts to separate personal lives from a highly demanding and stressful work situation. A contrary perspective was offered in a number of commenti, in which respondents indicated that it was their experiences with family members who had cancer that sensitized them to the problem of cancer pain.

These findings, as well as those of other investigators,““Y4 indicate the need for further research that compares the attitudes of physi- cians and nurses in varied geographical areas. It will be important to determine whether differences are manifested in actual practice, and how greater communication and coopera- tion between the two groups can be facilitated. As indicated by the findings of this research, such information can be important in resolving the problem of the inadequate management of cancer pain.

This study was a joint effort of members of the Indiana Pain Initiative. We thank the Indiana Division of the American Cancer Society, the Purdue Frederick Company, and the Walther Cancer Institute for their generous support, which made this project possible. We acknowledge Dr. Wayne Evans for his instru- mental role in the initiation of the project. The authors thank two anonymous reviewers and Dr. Phyllis Dexter, Vicki Kennedy, and Laura Hile for their helpful comments on an earlier version of the manuscript.

es

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2. Foley KM Cancer pain syndromes. J Pain Symp tom Manage 1987;2:1%17.

3. Foley IW. The treatment of cancer pain. N Engl J Med 1985;313:84-95.

4. Cleeland CS, Ckeland LM, Dar R, Rineland LC. Factors influencing physician management of can- cer pain. Cancer 1986;56:796800.

5. Dent 0, Goulston Ii Community attitudes toward cancer. J Biosoc Med 1982;16:427-436.

6. Ledn DN, Cleeland CS, Dar R. Public attitudes toward cancer pain. Cancer 1985;56:2337-2339.

7. Ferrell BR, ‘CVisdom C, Schneider C. Quality of life

as an outcome variable in the management of cancer

pain. Cancer 1989;63:2321-2327.

8. Ferrell BR. Rhincr MM, Zichi-Cohen M, Grant M. Pain as a metaphor for illness. I. Impact of cancer pain on family care givers. Oncol Kurs Forum 1991;18:1303-1309.

9. Daut RL, Cleeland CS. The pre\xlence and severity of pain in cancer. Cancer 1982;50:1913- 1918.

10. Brescia FJ. An overview of pain and symptom management in advanced cancer. J Pain Symptom Manage 1987;2:7-11.

11. Melzack R. The tragedy of neediess pain. Sci Am 1990;262:27-33.

12. Fife BL. Coping with the crisis of breast cancer. Unpublished dissertation, 1990.

13. Ward S, Goldberg S, Miller-McCauley V, et al. Patient-related barriers to management of cancer pain. Pain 1993 (in pressj.

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15. Bonicag. Pain research and therapy: past and current studies and future needs. In: Ng I, Bonicag, eds. Pain and discomfort. Amsterdam: Elsevier, 1980.

16. Ferrell BR, ,McCaffery M, Rhiner M. Pain and addiction: an urgent need for change in nursing education. J Pain Symptom Manage 1990;7:117-124.

17. Weissman DE, Dahl JL. Attitudes about cancer pain: a survey of Wisconsin’s first-year medical students. J Pain Symptom Manage 1990;5:345-349.

18. BonicaJJ. Cancer pain: a major national health problem. Cancer Surs 1978:1313-1316.

19. Nachmias D, Kachmias C. Research methods in the social sciences. New York: St Martin’s, 1981.

20. Hill CS, Fields W’s, eds. Drug treatment of cancer pain in a drug-oriented sacieq: advances in pain research and therapy, vol 11. :iewYork: Raven.

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138 Fqe et aL Vol. 8 No. 3 April I993

22. Marks RM, Sachar El. Undertreatment of medi- cal inpatients with narcotic analgesics. Ann Intern Med 1973;78:173-181.

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Aplbendix

Cancer Pain Survey (Demographics Not Included)

Directions: Please check the one response for each question that most clearly represents your thinking on the issue.

6.

1.

2.

3.

4.

5.

What percentage of cancer patients suffer pain? - 20% - 40% - 60% - 80% - 100%

7.

What percentage of pain can be relieved with treatment? - 20% - 40% - 60% - 80% _ 100%

8.

Do you believe the management of pain in the cancer patient is - a major problem _ somewhat of a problem - not a problem

9.

Which of the following is true? - Most patients receive adequate pain

treatment _ Patients receive more pain medica-

tion than necessary _ The majority of patients are under-

medicated

10.

Psychological dependence on narcotics (addiction) as a result of legitimate pre- scription to patients with cancer pain occurs _ very frequently (greater than 1 in 10) - frequently (1:lO to 1:lOO) - occasionally (1:lOO to 1:lOOO) - rarely (less than 1 in 1000)

11.

Suicide with an overdose of narcotics prescribed for cancer pain occurs _ very frequently (greater than 1 in 10) _ frequently (1:lO to 1:lOO) _ occasionally (1: 100 to 1: 1000) _ rarely (less than 1 in 1000)

The bestjudge of cancer pain intensity is _ the treating physician _ the patient’s nurse _ the patient _ the patient’s spouse or family

Your degree of concern about addiction if a member of your family was given mor- phine for cancer pain would be _ no cocccrn ._ mild concern _ moderate concern - extreme concern

At what time is it appropriate for patients to receive maximal dtises of analgesics? - any time - prognosis less than 1 year _ prognosis less than 6 months - prognosis less than 1 month

Cancer pain is most likely due to cancer treatments cancer itself preexisting conditions unrelated to the cancer

Increasing requests for analgesics indicate _ psychological dependence

(addiction) - worsening cancer _ tolerance to the analgesic

Page 8: A comparative study of the attitudes of physicians and nurses toward the management of cancer pain

W. 8 No. 3 April I993 Physicians, Nurses, and Cancer Fain Management 139

12. To what extent do you think the cancer

patient should be involved in his/her

treatment for pain?

14.

S/he should have no control over

treatment for pain S/he should have less control than

health professionals S//he should have as much control as health professionals

S/he should have more control than hea!th professionals

S/he should have complete control over treatment for pain

15.

16.

17. 13. Size of town or city where you practice

_ less than 25,000 _ 26,000-l 00,000 _ greater than iOO,OOO

Have you had cancer? - Yes - No

Has a member of your family or a close friend had cancer? - Yes - No

Have you had pain for any reason longer than 1 month? _ Yes - No

Has a member of your famiiy or a close friend had pain for any reason longer than 1 month? _ Yes

- No