The effect of education and clinical practice on knowledge enlightenment to and attitudes toward the use of analgesics for cancer pain among physicians and medical students.

Background: Insufficient education and limited clinical practice on the part of physicians may contribute to the undertreatment of cancer pain in Taiwan. To address these concerns, a survey among physicians and fifth-year medical students relevant to cancer pain management (CPM) was carried out in a medical school and its principal teaching hospital.

Methods: A questionnaire on CPM was sent to 97 physicians and 78 fifth-year medical students (equivalent to the third-year medical students in the United States). The same questionnaire was delivered again to these 78 fifth-year medical students after they had completed a modified curriculum of anesthesiology with a 4-hour course on introduction to clinical pharmacology of CPM.

Results: The physicians knowledgeable on pain (physicians of anesthesiology, hematology-oncology, or radiation oncology), physicians unfamiliar with pain (outside of anesthesiology, hematology-oncology, or radiation oncology), and the 5th-yr medical students took similar negative attitudes (24-92%, 33-89%, and 23-94%) toward the optimal use of analgesics for CPM. As compared, the mean score on knowledge of prescribing opioids of pain-knowledgeable physicians was 3.60, the highest of all as against 2.61 of other physicians and 2.54 of 5th-yr medical students. On attitudes toward prescribing opioids, both pain-knowledgeable physicians and other physicians scored a higher means, respectively of 3.52 and 2.91 as opposed to 2.68 of 5th-yr medical students, the lowest of all. However, seniority or length of clinical practice did not improve knowledge or affect attitudes toward CPM. In addition, this 4-hour course did enable the 5th-yr medical students to take a more positive attitude toward and become more knowledgeable on CPM than pain-knowledgeable physicians, as a comparison was made.

Conclusions: The effect of accumulation of clinical experience and seniority of clinical practice on CPM was limited among general physicians, except for clinical specialty on anesthesiology, hematology-oncology, or radiation oncology. In Taiwan, the knowledge of and positive attitude toward CPM could only be conveyed to physicians through undergraduate, post graduate or on-job education.