Physicians' views of the use of morphine in palliative care: a cross-sectional survey from a tertiary care centre in Northern Sri Lanka.

Background: Palliative care is not readily available in many lower middle-income countries and Sri Lanka is not an exemption for this. Morphine is one of the key drug available for symptoms (pain and dyspnoea) alleviation among palliative care patients. However, due to various reasons, it was noted that morphine drug was underutilised in palliation. No studies have been done to identify reasons for underutilisation in Northern Sri Lanka. As such, this study attempts to identify factors that limit the usage of morphine in palliative care among physicians working at Teaching Hospital, Jaffna.

Methods: This cross-sectional survey was conducted among 216 physicians in March-April 2024 using a self-administrated questionnaire distributed to them. Data was analysed using SPSS (29). Self-rated physicians' confident level of morphine initiation in palliative care patients was assessed in the scale of 0-10 and reported in mean with standard deviation (SD).

Results: The majority were females (55.1%) and exactly half of the physicians (50.0%) had less than 5 years of working experience. The mean score of the confident level of physicians in initiating morphine for palliative care patients was 4.84+_2.74. Furthermore, mean score was less among females in comparison to males (P-0.005). Just above 50% of them (50.5%) reported that the undergraduate education about pharmacology and clinical usage regarding morphine may be adequate and 15.2% reported that it was not adequate at all.

Conclusion: There is a great need for training for physicians on morphine prescribing in palliative care in Northern Sri Lanka. Major reasons for not prescribing morphine among physicians were lack of confident or not familiar with palliative care, shortage of drugs, patient refusal and relative refusal.