Risk of opioid misuse in people with cancer and pain and related clinical considerations: a qualitative study of the perspectives of Australian general practitioners.

Luckett, T; Newton-John, T; Phillips, J; Holliday, S; Giannitrapani, K; Powell-Davies, G; Lovell, M; Liauw, W; Rowett, D; Pearson, S-A; Raymond, B; Heneka, N; Lorenz, K

Risk of opioid misuse in people with cancer and pain and related clinical considerations: a qualitative study of the perspectives of Australian general practitioners.

Luckett, T

Newton-John, T

Phillips, J

Holliday, S Giannitrapani, K Powell-Davies, G Lovell, M

Liauw, W Rowett, D Pearson, S-A Raymond, B Heneka, N

Lorenz, K

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Publisher:: BMJ PUBLISHING GROUP
Publication Type:: Journal Article
Citation:: BMJ open, 2020, 10, (2)
Issue Date:: 2020-02-17

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Field	Value	Language
dc.contributor.author	Luckett, T https://orcid.org/0000-0001-6121-5409
dc.contributor.author	Newton-John, T https://orcid.org/0000-0003-4219-4985
dc.contributor.author	Phillips, J https://orcid.org/0000-0002-3691-8230
dc.contributor.author	Holliday, S
dc.contributor.author	Giannitrapani, K
dc.contributor.author	Powell-Davies, G
dc.contributor.author	Lovell, M https://orcid.org/0000-0002-1407-2748
dc.contributor.author	Liauw, W
dc.contributor.author	Rowett, D
dc.contributor.author	Pearson, S-A
dc.contributor.author	Raymond, B
dc.contributor.author	Heneka, N https://orcid.org/0000-0001-8102-1871
dc.contributor.author	Lorenz, K
dc.date.accessioned	2020-12-08T05:47:15Z
dc.date.available	2020-12-08T05:47:15Z
dc.date.issued	2020-02-17
dc.identifier.citation	BMJ open, 2020, 10, (2)
dc.identifier.issn	2044-6055
dc.identifier.issn	2044-6055
dc.identifier.uri	http://hdl.handle.net/10453/144549
dc.description.abstract	OBJECTIVE:To explore the perspectives of general practitioners (GPs) concerning the risk of opioid misuse in people with cancer and pain and related clinical considerations. DESIGN:A qualitative approach using semistructured telephone interviews. Analysis used an integrative approach. SETTING:Primary care. PARTICIPANTS:Australian GPs with experience of prescribing opioids for people with cancer and pain. RESULTS:Twenty-two GPs participated, and three themes emerged. Theme 1 (Misuse is not the main problem) contextualised misuse as a relatively minor concern compared with pain control and toxicity, and highlighted underlying systemic factors, including limitations in continuity of care and doctor expertise. Theme 2 ('A different mindset' for cancer pain) captured participants' relative comfort in prescribing opioids for pain in cancer versus non-cancer contexts, and acknowledgement that compassion and greater perceived community acceptance were driving factors, in addition to scientific support for mechanisms and clinical efficacy. Participant attitudes towards prescribing for people with cancer versus non-cancer pain differed most when cancer was in the palliative phase, when they were unconcerned by misuse. Participants were equivocal about the risk-benefit ratio of long-term opioid therapy in the chronic phase of cancer, and were reluctant to prescribe for disease-free survivors. Theme 3 ('The question is always, 'how lazy have you been?') captured participants' acknowledgement that they sometimes prescribed opioids for cancer pain as a default, easier option compared with more holistic pain management. CONCLUSIONS:Findings highlight the role of specific clinical considerations in distinguishing risk of opioid misuse in the cancer versus non-cancer population, rather than diagnosis per se. Further efforts are needed to ensure continuity of care where opioid prescribing is shared. Greater evidence is needed to guide opioid prescribing in disease-free survivors and the chronic phase of cancer, especially in the context of new treatments for metastatic disease.
dc.format	Electronic
dc.language	eng
dc.publisher	BMJ PUBLISHING GROUP
dc.relation	Cancer Institute NSW
dc.relation.ispartof	BMJ open
dc.relation.isbasedon	10.1136/bmjopen-2019-034363
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1103 Clinical Sciences, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences
dc.title	Risk of opioid misuse in people with cancer and pain and related clinical considerations: a qualitative study of the perspectives of Australian general practitioners.
dc.type	Journal Article
utslib.citation.volume	10
utslib.location.activity	England
utslib.for	1115 Pharmacology and Pharmaceutical Sciences
utslib.for	1112 Oncology and Carcinogenesis
utslib.for	1117 Public Health and Health Services
utslib.for	1103 Clinical Sciences
utslib.for	1117 Public Health and Health Services
utslib.for	1199 Other Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Graduate School of Health/GSH.Clinical Psychology
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Graduate School of Health
utslib.copyright.status	open_access	*
pubs.consider-herdc	false
dc.date.updated	2020-12-08T05:47:13Z
pubs.issue	2
pubs.publication-status	Published
pubs.volume	10
utslib.citation.issue	2

Abstract:

OBJECTIVE:To explore the perspectives of general practitioners (GPs) concerning the risk of opioid misuse in people with cancer and pain and related clinical considerations. DESIGN:A qualitative approach using semistructured telephone interviews. Analysis used an integrative approach. SETTING:Primary care. PARTICIPANTS:Australian GPs with experience of prescribing opioids for people with cancer and pain. RESULTS:Twenty-two GPs participated, and three themes emerged. Theme 1 (Misuse is not the main problem) contextualised misuse as a relatively minor concern compared with pain control and toxicity, and highlighted underlying systemic factors, including limitations in continuity of care and doctor expertise. Theme 2 ('A different mindset' for cancer pain) captured participants' relative comfort in prescribing opioids for pain in cancer versus non-cancer contexts, and acknowledgement that compassion and greater perceived community acceptance were driving factors, in addition to scientific support for mechanisms and clinical efficacy. Participant attitudes towards prescribing for people with cancer versus non-cancer pain differed most when cancer was in the palliative phase, when they were unconcerned by misuse. Participants were equivocal about the risk-benefit ratio of long-term opioid therapy in the chronic phase of cancer, and were reluctant to prescribe for disease-free survivors. Theme 3 ('The question is always, 'how lazy have you been?') captured participants' acknowledgement that they sometimes prescribed opioids for cancer pain as a default, easier option compared with more holistic pain management. CONCLUSIONS:Findings highlight the role of specific clinical considerations in distinguishing risk of opioid misuse in the cancer versus non-cancer population, rather than diagnosis per se. Further efforts are needed to ensure continuity of care where opioid prescribing is shared. Greater evidence is needed to guide opioid prescribing in disease-free survivors and the chronic phase of cancer, especially in the context of new treatments for metastatic disease.

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http://hdl.handle.net/10453/144549