title: Attitudes to morphine in chronic heart failure patients.
abstract: OBJECTIVE
  Low-dose opioids are used for the palliation of pain, breathlessness and cough in advanced chronic heart failure (CHF) patients. The authors wanted to determine any potential barriers or facilitators to opioid administration in patients with CHF by assessing their knowledge, concerns and attitudes to morphine therapy.
  
  
  METHODS
  Semistructured interviews were held with a purposive sample of 10 men with symptoms of CHF. Data were analysed using a constant comparative approach until thematic saturation.
  
  
  RESULTS
  Four key areas emerged: medication use; symptoms; prior morphine experience; and attitudes, concerns and anxieties regarding morphine use. Despite polypharmacy, participants said that morphine would be acceptable if it was monitored by a trusted healthcare professional. Many patients had experienced morphine before, often in life-threatening situations such as myocardial infarction, when it had helped greatly. Opioids were not strongly associated exclusively with death and dying (in contrast to patient reports in the cancer literature).
  
  
  CONCLUSIONS
  Although some concerns about morphine were expressed, these did not appear to override a willingness to consider its use if recommended by a trusted clinician. However, some participants perceived that their doctor was concerned about its use, holding it as a last reserve. Morphine appears to be an acceptable breathlessness treatment option to these people with CHF. Prescribers may need education and reassurance if these medicines are to be used to their full potential and views may be different in other communities.
authors.affiliation: Department of Palliative Medicine, Kirkwood Hospice, Huddersfield, UK.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Oxberry
authors.forename: Lesley
authors.initials: L
authors.lastname: Jones
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
authors.forename: Miriam J
authors.initials: MJ
authors.lastname: Johnson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002908:Chronic Disease; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D004739:England; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D010166:Palliative Care / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology; D017060:Patient Satisfaction; D010817:Physician-Patient Relations
chemical_list: D009020:Morphine