I Feel Uncomfortable 'Calling a Patient Out': Educational Needs of Palliative Medicine Fellows in Managing Opioid Misuse

Context. During the past 10 years, advocates of palliative care have sought to be included earlier in the course of patients' illnesses. Palliative care providers may thus be more likely to care for patients who misuse and abuse opioids. Objectives. To assess whether hospice and palliative medicine (HPM) fellows see patients at risk for opioid misuse and how competent they perceive themselves to be to treat pain in these patients. Methods. An electronic survey was distributed to 102 HPM fellows. The survey included questions assessing self-perceived competency in care for patients who misuse opioids. Responses were rated using a Likert scale of one to seven, where one strongly agree and seven strongly disagree; any number greater than two was considered to be nonagreement. Results. Fifty-seven (56%) fellows from 34 programs responded to the survey. In the previous two weeks, 77.2% of respondents had seen at least one patient with a substance use disorder (SUD) and 43.9% had treated a patient whom they were concerned was misusing opioids. Half (47.2%) of respondents stated that they have a working knowledge of addiction, 41.4% agreed their training has prepared them to manage opioid misuse, and 36.8% felt they knew how to differentiate pain from addiction. Only 21.1% were satisfied with how they treat symptoms in this population. Fellowship training in opioid misuse was associated with increased satisfaction. Conclusion. HPM fellows regularly see patients who are at risk for opioid misuse and feel unprepared to treat pain in these patients. There is a need for more education of fellows in this area. J Pain Symptom Manage 2012; 43: 253-260. (C) 2012 U. S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.