Nurses' willingness to maximize opioid analgesia for severe cancer pain, and its predictor.
OBJECTIVE
The effectiveness of cancer pain management (CPM) is influenced by nurses' willingness to maximize opioid analgesia for severe cancer pain. The purposes of this study were to identify the willingness of nurses to provide maximum-dose opioids whenever needed for CPM and to determine its associated predictors.


METHODS
This multicenter study was conducted among the entire total of registered nurses in seven large hospitals in Korea. Its overall response rate was 41.6%, and the data from 930 who responded (40.1%) were analyzed. We utilized a three-step, multidimensional, multiple logistic regression to identify the predictors of nurses' willingness.


RESULTS
Only 255 nurses (27.4%) indicated that they recommended the maximum dose of opioids whenever it was needed. The respondents who were more likely to recommend morphine showed the following characteristics: older nurses (odds ratio, OR, 1.57; confidence interval, CI, 1.13-2.19); they knew the effectiveness of opioids for CPM (OR 1.53; CI 1.06-2.20); rarely concerned about a patient's addiction to opioids (OR 2.16; CI 1.48-3.15), or to a family member's addiction (OR 1.81; CI 1.20-2.73); prior experience with pain assessment tools (OR 1.62; CI 1.11-2.37); practical experience caring for cancer patients with pain over 51% (OR 1.55; CI 1.09-2.19).


CONCLUSIONS
Our multicenter study suggested that in order to improve nurses' willingness to recommend opioids liberally in CPM: (1) attitudes about fear of opioid addiction must be changed; (2) the efficiency of opioids in CPM must be taught; and (3) implementation of pain assessment tools must be undertaken.
Chang
Yoon Jung
YJ
Cancer Information Branch, Research Institute, National Cancer Center, Goyang, South Korea.
Yun
Young Ho
YH
Park
Sang Min
SM
Lee
So Woo
SW
Park
Hyeoun-Ae
HA
Ro
You-Ja
YJ
Huh
Bong Yul
BY
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008297:Male; D009020:Morphine / Q000008:administration & dosage; D015999:Multivariate Analysis; D009369:Neoplasms / Q000188:drug therapy*; D009723:Nurse-Patient Relations; D009726:Nurses; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D009020:Morphine