Hematology and oncology fellows' attitude and knowledge in cancer pain management.

Abstract

178 Background: The American Society of Clinical Oncology considers palliative care an integral part of cancer therapy. Our Hematology and Oncology fellowship at the University of Arkansas for Medical Sciences (UAMS) began a year-long palliative care curriculum to improve symptom management education. In this pilot study we evaluate fellows’ attitude and knowledge in cancer pain management before and after implementing a pain management curriculum. Methods: Hematology and Oncology Fellows were divided into three groups. Each group delivered a one hour lecture in pain management for a total of 3 didactic lectures. We adopted “Evidence based Practice of Palliative Medicine by Goldstein and Morrison” as the main textbook. Fellows answered a 30 item questionnaire to address attitudes and knowledge in pain management. Answers were scored using a 5 point Likert scale (1 = strongly disagree and 5 = strongly agree). Results: 11 fellows participated; six males, five females, median age 34 (R 28-40), one US graduate, and ten foreign graduates. More fellows felt comfortable managing acute (M = 4.3, SD = 0.48) compared to chronic (M = 3.8, SD 0.78) cancer related pain. Most believe that if they were taught the principle of pain management they would feel more comfortable managing pain (M = 4.6, SD = 0.51). Post pain management module, there was a statistically significant improvement in fellow’s knowledge in pain management in the setting of renal failure (P = 0.02) and bone pain (P = 0.006), and a trend towards statistically significant in both opioid rotation and conversion (P = 0.06). Fellows did poorly on opioid-drugs interaction and management of neuropathic pain. Fellows valued palliative medicine service as a great resource for their patients but most believe that they should not refer all their patients to palliative medicine for pain management. Conclusions: Pain management skills are eroding among Oncology fellows and efforts should be made to enhance symptom and pain management education in oncology training programs. This curriculum improved knowledge and self-efficacy in pain management and revealed areas for further improvement. More research is needed to address whether fellows use and apply pain management skills in the clinical setting.