Medical Student Knowledge of Morphine for the Management of Cancer Pain

Abstract

Inadequate training of physicians contributes to the undertreatment of cancer pain. To address these concerns, the University of Kentucky has introduced a 4-week course for final-year medical students that teaches the principles of clinical pharmacology and pain management. The purposes of this study are to assess the knowledge deficits of final-year medical students about the use of morphine for cancer pain and to assess the efficacy of a short course on cancer pain management. Eighty-six final-year medical students completed a 22-item questionnaire assessing their knowledge and attitudes toward the use of morphine for cancer pain. Students indicated their agreement with each statement on a four-point scale (one, strongly disagree; four, strongly agree). All students then completed a compulsory short course on pain management. The course content included a 1-hr lecture on chronic nonmalignant pain, a 1-hr lecture on acute pain management, and a 1-hr lecture on cancer pain management. In addition, students completed small-group, problem-based learning modules on several aspects of pain management. After the course, all students completed the same 22-item survey. The alpha reliability score of the pretest instrument was 0.55, and the posttest reliability was 0.86. Upon course completion, students agreed most strongly (mean +/- SEM) that morphine should be given on a regular schedule for cancer pain (3.41 +/- 0.08), that cancer pain management frequently requires co-analgesics (3.36 +/- 0.06), and that patients with good pain relief function better than those with continuing pain (3.39 +/- 0.08). A comparison of pretest and posttest means on specific items suggested that the greatest amount of learning took place in the following content areas: morphine is a good oral analgesic; increases in cancer pain should be treated by increasing the morphine dose; respiratory depression is not a concern for cancer pain patients; and morphine can be used over a wide range of doses. The regular use of morphine was recognized as the treatment drug of choice for cancer pain. The students showed improved knowledge scores on ten of the 22 items on the posttest survey. A significant increase in learning occurred on six knowledge and attitude items. On only one item (nausea as a side effect of morphine) did the knowledge scores decrease on the posttest. A significant minority (40%) of senior medical students had deficits in knowledge about the use of morphine for cancer pain. The risk of addiction, respiratory depression, and tolerance were misunderstood by a significant minority (25%) of students.

Degree of Knowledge of Health Care Professionals About Pain Management and Use of Opioids in Pediatrics

“…Even though it is one of the major fears related to the use of opioids in our study, the respondents reported that this situation is seldom experienced (incidence of 0.5%). This result is in consonance with other studies reporting that respiratory depression is a rare adverse effect, particularly when opioids are titrated for pain treatment [33,34].…”

Pain knowledge and attitude: a survey among nurses in 23 health institutions in Western Ethiopia

“…In the present study, pharmacology based items were the domain of weakest performance which is congruent with other international research studies who have also established that nurses illustrated the poorest knowledge and attitudes in the area of pharmacological aspects of pain and its management. High prescription rate of IM and PRN were demonstrated to be a sign of poor quality pain management (22,(28)(29)(30).…”

Knowledge toward Cancer Pain and the Use of Opioid Analgesics among Medical Students in their Integrated Clinical Clerkship

“…28 The question with the 2nd most incorrect answer is the one on "Any patient given opioids for pain relief is at 25% or more risk for addiction," which is similar to the results reported by other investigators. 19,27 As most (86%) of the students either did not know the answer or agreed with the statement, it can be deduced that they continue to be concerned about addiction as an undesirable effect of opioid use. For this reason, it should be emphasized in succeeding lectures on cancer pain and pain management that psychological dependence is a very rare phenomenon in the palliative care population.…”