Cancer pain: knowledge and attitudes of physicians in Israel

The effectiveness of cancer pain therapy is influenced by the attitudes and knowledge of the treating physicians. As part of a quality improvement project in the management of cancer pain, a survey of 236 medical practitioners was conducted. One hundred seventy-six respondents (74.5%) completed the survey. Fifty-two percent treated patients with cancer pain several times a week or more. Whereas 57.7% of physicians stated that 76-100% of patients could achieve a satisfactory outcome from analgesic therapy, only 17.2% of respondents reported that > 75% actually achieve a satisfactory outcome in their own experience. Unsatisfactory outcome was ascribed to inadequate pain relief (59.7%), or excessive central nervous system (CNS) side effects (43.3%). According to the responding physicians, the major barriers to effective relief include inadequate assessment of the pain and pain relief (65.3%), inadequate knowledge of pain therapy (57.9%), and physician reluctance to prescribe opioids (49.1%). Questions evaluating physician knowledge identified widely prevalent knowledge deficits in pain physiology, risk of addiction, use of adjuvant analgesics, opioid dosing, and treatment of side effects. Specialists in oncology tended to evaluate their knowledge more highly than others (P < 0.05). Despite this, there was no significant knowledge difference between oncologists and noncancer specialists. The data highlight some of the barriers to the successful management of cancer pain in Israel, the prevalence of knowledge deficits, and the common disparity between clinicians' self-assessment of clinical competence and their ability to respond correctly to questions on the management of cancer pain.