Cancer pain education among family physicians

Cancer pain education among family physicians

This study used performance-based testing (objective structured clinical evaluation, OSCE) to evaluate the skills of family physicians in assessing and managing the severe pain of a cancer patient, and evaluated a new method of education about the management of cancer pain. Twenty-four primary care...

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Bibliographic Details
Published in:Journal of pain and symptom management Vol. 14; no. 2; pp. 74 - 81
Main Authors: Sloan, Paul A., Donnelly, Michael B., Vanderveer, Barbara, Delomas, Mark, Schwartz, Richard W., Sloan, David A.
Format: Journal Article
Language:English
Published: New York, NY Elsevier Inc 01-08-1997
Elsevier Science
Subjects:
analgesia
Biological and medical sciences
Cancer pain
education
Education, Medical, Graduate
Family Practice - education
Health participants
Humans
Medical sciences
Neoplasms - physiopathology
objective structured clinical examination
Pain
pain assessment
Pain Measurement - methods
Palliative Care - methods
Physicians
Public health. Hygiene
Public health. Hygiene-occupational medicine
standardized patients
pain assessment
Cancer pain
education
objective structured clinical examination
standardized patients
analgesia
Continuing education
Human
Evaluation
General practitioner
Malignant tumor
Pain
Treatment
Palliative care
Perception
Vocational aptitude
Performance
Occupational education
Occupational training
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Summary:This study used performance-based testing (objective structured clinical evaluation, OSCE) to evaluate the skills of family physicians in assessing and managing the severe pain of a cancer patient, and evaluated a new method of education about the management of cancer pain. Twenty-four primary care physicians completed a detailed pain assessment of the same standardized cancer pain patient (Part A). A proctor observed the interviews and rated the physicians on a variety of pre-determined items believed to be important for pain assessment. The physicians were then allowed 5 min to answer management questions about the patient's cancer pain (Part B). After reviewing each physician's performance on Parts A and B, the proctor provided immediate feedback and instruction (Part C) on basic principles of cancer pain assessment and management. On average, the primary care physicians asked 52% (± 4.5%) of the indicated questions of a detailed pain assessment. Performance was poorest in asking about previous pain history, temporal pattern of pain, and pain intensity. Performance on the pain assessment was best for eliciting pain location and pain-relieving factors. Primary care physicians obtained mean scores of 36% (± 3%) on Part B of the OSCE. Although opioid therapy was frequently prescribed, only 42% of prescriptions were for regular administration. Performance on Parts A and B correlated poorly with years in practice, and older physicians tended to perform a less detailed pain assessment than their younger collegues. Most physicians enjoyed participating in this instructional format and believed that the proctor feedback increased the educational value of the module. The results of our study suggest that many family physicians may be inadequate in their clinical assessment and management of cancer pain. Our study supports the need for continuing education in cancer pain management, regardless of years in practice. Further study should evaluate the effects of different educational programs on clinical practice in patient care.
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ISSN:0885-3924
1873-6513
DOI:10.1016/S0885-3924(97)00010-9