Opioid-Related Challenges Faced by Palliative Healthcare Providers in Both Hospital and Home Care Settings: A Multi-Center-Based Descriptive Cross-Sectional Study.
Mastura Kashmeeri, A N M Shamsul Islam, Palash Chandra Banik
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Abstract
Background: Palliative care aims to alleviate suffering and improve the quality of life for patients with life-limiting illnesses through effective pain management with opioids. Despite its global importance, opioid use in palliative care faces significant challenges, particularly in resource-poor settings like Bangladesh. In Bangladesh, opioid use is notably low, with disparities between urban and rural areas. Cultural stigmas, strict regulations, and inadequate healthcare provider training further obstruct effective pain management.
Objective: This study aims to explore the challenges healthcare providers face regarding opioid use in both hospital and home-based palliative care settings.
Method: A descriptive cross-sectional study was conducted using face-to-face semistructured interviews with 135 licensed healthcare providers from August to September 2022.
Results: The respondents, predominantly young (57% aged 20-39) and female (68.9%), primarily manage late-stage cancer patients (98.5%), with pain (100%) being the primary symptom treated. Morphine syrup is commonly used (68.1%), whereas oxycodone and buprenorphine are unavailable. Side effects such as deep sedation (43.7%) and addiction (34.1%) highlight the need for careful monitoring. Limited awareness (10.4%) of national opioid policies results in inconsistent practices (p = 0.001) and (p = 0.004). Prescribing restrictions (60.7%) and dispensing rights issues contribute to operational challenges, affecting patient access to pain management. Misconceptions about palliative care (32.6%) and inter-departmental non-cooperation (38.5%) hinder patient referrals (p = 0.001) and continuity of care.
Conclusion: Inconsistent awareness of opioid policies causes varied practices and attitudes. Addressing referral challenges and prescribing restrictions requires interdisciplinary solutions, enhanced education, better policy dissemination, and standardized guidelines for effective palliative care opioid management.
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