Analgesic prescribing habits and patterns of Canadian chief urology residents: A national survey

Abstract

Introduction: Prior studies have identified significant knowledge gaps in acute and chronic pain management among graduating urology residents as of five years ago. Since then, there has been increasing awareness of the impact of excessive opioid prescribing on long-term narcotic use and development of adverse narcotic-related events. However, it is unclear whether the attitudes and experience of graduating urology residents have changed. We set out to evaluate the attitudes and experience of graduating urology residents in prescribing opioid/non-opioid analgesia for acute (AP), chronic non-cancer (CnC), and chronic cancer (CC) pain.
 Methods: Graduating urology residents were surveyed at a review course in 2018. The survey consisted of open-ended and close-ended five-point Likert scale questions. Descriptive statistics, Mann-Whitney U-test, and Student’s t-test were performed.
 Results: A total of 32 PGY5 urology residents completed our survey (92% response rate). The vast majority agreed that formal training in managing AP/CnC/CC to be valuable (91/78/81%). Most find their training in CnC/CC management to be inadequate and are unaware of any opioid prescribing guidelines; 66% never counsel patients on how to dispose of excess opioids. In general, 88% are comfortable prescribing opioids, whereas most are very uncomfortable prescribing cannabis or antidepressants (100%/78%). Residents reported the Acute Pain Service as the highest-rated resource for information, and dedicated textbooks the least.
 Conclusions: This survey demonstrated that experience in pain management remains variable among urology residents. Knowledge gaps remain, particularly in the management of chronic cancer/non-cancer pain.

Opioid Disposal Practices of Patients with Life-Limiting Cancers in an Outpatient Palliative Care Clinic: A Cross-Sectional Study

“…The reported prevalence was 11% among patients with cancer surveyed in an emergency department (Silvestre et al, 2017) and 40% among patients with acute and chronic non-cancer pain (Buffington et al, 2019). Similarly, a survey of urology residents found that only 34% had ever counselled their patients about how to dispose of their excess opioids (Dergham et al, 2020). Patients likely received more clinician education in our study because of the increased attention to opioid-related harms generated by the public health crisis (Know More: Opioid Public Awareness, 2020;Opioid Stewardship, n.d.).…”

QUEST at 25: An enduring innovation in Canadian urology

“…With an ongoing opioid epidemic, surveys have looked at the narcotics prescribing habits of graduating residents. 3 When new technology was introduced into practice, such as prostate magnetic resonance imaging, QUEST assessed the experience of trainees into its interpretation. It has also gauged graduates' comfort with performing major oncological procedures independently and their level of exposure to robotic surgery when this surgical approach proliferated in Canadian academic institutions.…”