title: Attitudes and beliefs regarding the role of interventional pain management at the end-of-life among caregivers: a 4-year perspective.
abstract: Intrathecal and epidural opioid analgesia represents a major advance in the management of cancer pain, adding a new dimension to opioid therapy by allowing prolonged analgesia through the use of significantly lower doses than those required for systemic administration. However, myths, misconceptions, and apprehension continue to serve as major barriers to effective cancer pain management, and concerns regarding safety, efficacy, and relative ease of utilization still prevail. This, in turn, results in unnecessary suffering, depression, diminished cognitive function, sleep disturbance, functional disability, and compromised quality of life. We conducted a survey to systematically explore medical and paramedical attitudes prior to and 4 years after the introduction an interventional pain program and attempted to qualitatively analyze what appeared as main facilities or difficulties following end-of-life clinical experiences. In general we found that all caregivers were satisfied from using interventional pain relief techniques at the end-of-life; more so among caregivers directly involved in patient care. Although nearly half of the responders initially found "technical manipulations" moderately difficult to difficult, after a simple hands-on instruction all found these techniques to be "helpful, simple and feasible." "When all went well," caregivers found implantable devices as a useful tool to relieve pain, to increase the ability of patients to complete personal endeavors, notably mobilization, but also noted an increased patient anxiety at the end-of-life. "When all went wrong," caregivers evoked the paradoxical attitude of patients to having a "high-tech" treatment at the end-of-life, causing them eventually to have "false hope," as well as the phenomenon of "interdisciplinary hyperactivity," creating what was referred to as therapeutic futility. In summary, this study suggests the importance on insisting to introduce novel techniques into practice despite initial apprehension, however, quality improvement by detecting and overcoming attitudinal barriers remain primordial and requires narrative research.
authors.affiliation: Postoperative and Interventional Pain Unit, Department of Anesthesiology, Geneva University Hospital, Geneva, Switzerland. alex.cahana@hcuge.ch
authors.forename: Alex
authors.initials: A
authors.lastname: Cahana
authors.forename: Flavia
authors.initials: F
authors.lastname: Arigoni
authors.forename: Laurent
authors.initials: L
authors.lastname: Robert
mesh_terms: D017028:Caregivers / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D008297:Male; D010146:Pain / Q000451:nursing* / Q000523:psychology*; D010166:Palliative Care; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013727:Terminal Care