Opioid Prescriber Related Barriers to Pain Management in Palliative Care

Abstract

Aim: Establishing opioid prescriber- related barriers to pain management in palliative care. Introduction: Millions of people suffering from Non-communicable diseases e.g. cancer live and die with severe pain and other debilitating symptoms, which can be effectively treated and managed at affordable cost. Unfortunately, they typically lack access to medication, appropriate technology and palliative care services. Satisfactory pain management is an essential component of palliative care both in the healthcare setting and in home based care. Palliative care emphasizes on pain and symptom management in life-limiting disease management. Unfortunately, many barriers interfere with the pain and symptom management process. Barriers could be patient or healthcare related. Though nurses do not prescribe opioid analgesics they play, a pivotal role in pain management using the medication hence delay of prescription does affect nursing care. Methodology: A cross sectional study was conducted in Embu and Machakos level five hospitals and the hospices targeting 238 nurses working in these institutions. These facilities are located in the Eastern region of Kenya. Systematic Random Sampling was done to identify participants and the data collected by use of questionnaires, exported using Epidata 3.1, cleaned and coded; then analyzed using Stata version 14. Hypothesis testing was done by use of Chi – squared Test with 95% Confidence Interval. Presentation was done using tables and charts. Results: The prescriber- related barriers to pain management by use of opioids included: Delayed prescription, failure to prescribe the medication, shortage of prescribers and inadequate pain assessment. Conclusion and recommendation: Previous studies had identified some of the barriers in other countries. Many barriers interfere with the pain and symptom management process, frustrating efforts to assess and control the said symptoms. Unlike other analgesics, opioids require prescription for them to be dispensed hence prescribers are key to pain management by use of this class of drugs. Most of the barriers identified in the study could be addressed by the Government through investing in employment of prescribers, continued professional development as well as change in legislation.