title: "I feel uncomfortable 'calling a patient out'": educational needs of palliative medicine fellows in managing opioid misuse.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. childersjw2@upmc.edu
authors.forename: Julie W
authors.initials: JW
authors.lastname: Childers
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000193:education* / Q000706:statistics & numerical data*; D055030:Drug Users; D004521:Educational Measurement; D017051:Hospice Care; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009293:Opioid-Related Disorders / Q000517:prevention & control*; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology*; D010166:Palliative Care; D010414:Pennsylvania / Q000453:epidemiology; D011361:Professional Competence; D055815:Young Adult