Opiophobia in Emergency Department Healthcare Providers: A Survey in Western Switzerland.

Sarah Bertrand,Olivier T Rutschmann,Vincent Frochaux,Yvan Fournier,Daniel Fishman,Gabriel Meynet,Patrick Taffé,Olivier Hugli,Vincent Della Santa,Vincent Ribordy

doi:10.3390/jcm10071353

Abstract

Opiophobia contributes to oligoanalgesia in the emergency department (ED), but its definition varies, and its association to healthcare providers’ personality traits has been scantly explored. Our purpose was to study the different definitions of opiophobia and their association with two personality traits of doctors and nurses working in EDs, namely the stress from uncertainty and risk-taking. We used three online questionnaires: the ‘Attitude Towards Morphine Use’ Score (ATMS), the Stress From Uncertainty Scale (SUS) and the Risk-Taking Scale (RTS). Doctors and nurses from nine hospital EDs in francophone Switzerland were invited to participate. The ATMS score was analyzed according to demographic characteristics, SUS, and RTS. The response rate was 56%, with 57% of respondents being nurses and 63% women. Doctors, less experienced and non-indigenous participants had a significantly higher ATMS (all p ≤ 0.01). The main contributors of the ATMS were the fear of side effects and of addiction. In multivariate analysis, being a doctor, less experience and non-indigenous status were predictive of the ATMS; each point of the SUS increased the ATMS by 0.24 point. The fear of side effects and of addiction were the major contributors of opiophobia among ED healthcare providers; opiophobia was also associated with their personality traits.

Highlights

Pain relief is one of the priority tasks of the emergency department (ED)
Survey questions included demographics and three validated questionnaires: (1) the “Attitudes Towards Morphine” Score (ATMS) [18], composed of 19 statements related to the use of morphine and grouped into five subscales: risk of addiction/dependence, operational reasons for not using morphine, risk of escalating doses, risks other than addiction and other non-operational reasons (Appendix A); (2), the translation, validated in French, of the ‘Stress from Uncertainty Scale’ (SUS), which evaluates the emotional reaction in the face of uncertainty [15,19], and is composed of eight items grouped into two subscales: the anxiety due to uncertainty and the concern about bad outcome; (3) the Risk Taking Scale (RTS), a six-item scale adapted from the Jackson
Head doctors of each ED emailed to every nurse or doctor an information letter inviting them to participate in the study, containing the internet

Summary

Introduction

Opiates are sometimes not administered or only in subtherapeutic doses [4] This reluctance to use narcotic analgesics has been reported in a majority of ED doctors [5], due to a lack of knowledge and training of ED doctors, or even prejudice against the use of opioid analgesics. This prejudice, or opiophobia, is defined variously in the literature as underutilization linked to the irrational fear of addiction [6], to an exaggerated fear of side effects [7], to moral reasons or to the legal risks associated with their prescription [8,9,10]. Opiophobia contributes to oligoanalgesia [6,7]

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Discussion

Conclusion