The use of opioids at the end of life the knowledge level of Dutch physicians as a potential barrier to effective pain management 英文参考文献.docVIP

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The use of opioids at the end of life the knowledge level of Dutch physicians as a potential barrier to effective pain management 英文参考文献.doc

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The use of opioids at the end of life the knowledge level of Dutch physicians as a potential barrier to effective pain management 英文参考文献

Rurupetal.BMCPalliativeCare2010,9:23 /1472-684X/9/23 RESEARCH ARTICLE OpenAccess Theuseofopioidsattheendoflife: theknowledgelevelofDutchphysiciansasa potentialbarriertoeffectivepainmanagement MetteLRurup1,2,ChristiaanARhodius2,3,SanderDBorgsteede4,5,ManonSABoddaert2,3,AstridGMKeijser1, HRoelineWPasman1,2,BregjeDOnwuteaka-Philipsen1,2* Abstract Background:Painisstilloneofthemostfrequentlyoccurringsymptomsattheendoflife,althoughitcanbe treatedsatisfactorilyinmostcasesifthephysicianhasadequateknowledge.IntheNetherlands,almost60%ofthe patientswithnon-acuteillnessesdieathomewhereendoflifecareiscoordinatedbythegeneralpractitioner (GP);about30%dieinhospitals(caredforbyclinicalspecialists),andabout10%innursinghomes(caredforby elderlycarephysicians). Theresearchquestionofthisstudyis:whatisthelevelofknowledgeofDutchphysiciansconcerningpain managementandtheuseofopioidsattheendoflife? Methods:Awrittenquestionnairewassenttoarandomsampleofphysiciansofspecialtiesmostofteninvolvedin endoflifecareintheNetherlands.Thequestionnairewascompletedby406physicians,responserate41%. Results:Almostallphysicianswereawareofthemostbasalknowledgeaboutopioids,e.g.thatitisimportantfor treatmentpurposestodistinguishnociceptivefromneuropathicpain(97%).Approximatelyhalfofthephysicians (46%)didnotknowthatdecreasedrenalfunctionraisesplasmaconcentrationofmorphine(-metabolites)and34% oftheclinicalspecialistserroneouslythoughtopioidsarethefavoureddrugforpalliativesedation. Although91%knewthatopioidstitratedagainstpaindonotshortenlife,10%sometimesoroftengavehigher dosagesthanneededwiththeexplicitaimtohastendeath.Abouthalffeltsometimesoroftenpressuredby relativestohastendeathbyincreasingopioiddosage. Thelargemajority(83%)ofphysicianswasinterestedinadditionaleducationaboutsubjectsrelatedtotheendof life,themostpopularsubjectwasopioidrotation(46%). Conclusions:Althoughthebasicknowledgeofphysicianswasadequate,thereseemedtobealackofknowledge inseveralareas,whichcanbeabarrierforgoodpainmanagementattheendoflife.F