Factors associated with clinician intention to address diverse aspects of pain in seriously ill outpatients.
BACKGROUND
Pain is a common, often undertreated problem among patients with palliative needs.


OBJECTIVE
To evaluate clinician factors associated with intention to address diverse aspects of pain.


METHODS
Clinicians reviewed a clinical vignette describing a frail elderly patient with advanced hormone-refractory metastatic prostate cancer, depression, and pain not on analgesic therapy. Clinicians were surveyed about their intentions for treatment.


METHODS
All 280 primary care and specialist clinicians working in 19 hospital and community-based primary care, oncology, and cardiology clinics at eight geographically dispersed sites in two large VA hospital systems.


METHODS
Endpoints were clinician intention to deliver guideline-concordant care: prescribe opioids/antidepressants, assess existential wellbeing, and offer mental health referral. Demographic and behavioral measures were evaluated in association with endpoints.


RESULTS
Of 208 (74%) responding practitioners, 189 were responsible for prescribing decisions. Of those, 86, 77, 75, and 69 were "very"/"somewhat likely" to prescribe opioids, antidepressants, refer to a mental health specialist, or assess existential wellbeing, respectively. Factors associated with greater intent to prescribe an opioid or antidepressant included female gender, being an attending physician, being a primary care clinician, and greater confidence in pain management skills. Greater trust in the validity of pain ratings was associated with intent to prescribe an antidepressant and assess existential wellbeing. Prescribing opioids was less likely if perceived as an administrative burden. Assessing existential wellbeing was less likely if time constraints were perceived a barrier to evaluating pain. Female gender was the only factor associated with intent to refer to a mental health specialist.


CONCLUSIONS
Our findings suggest useful targets for improving pain management include bolstering clinician confidence in pain management and their trust in pain ratings.
Shugarman
Lisa R
LR
SCAN Foundation, Long Beach, California, USA.
Asch
Steven M
SM
Meredith
Lisa S
LS
Sherbourne
Cathy D
CD
Hagenmeier
Emily
E
Wen
Li
L
Cohen
Angela
A
Rubenstein
Lisa V
LV
Goebel
Joy
J
Lanto
Andy
A
Lorenz
Karl A
KA
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D003625:Data Collection; D003863:Depression / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010146:Pain / Q000188:drug therapy*; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D012720:Severity of Illness Index
D000700:Analgesics; D000701:Analgesics, Opioid; D000928:Antidepressive Agents