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Annals of Oncology Advance Access published online on April 27, 2005
Annals of Oncology, doi:10.1093/annonc/mdi180
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© 2005 European society of Medical Oncology
Received October 3, 2004
Revised January 9, 2005
Accepted January 10, 2005

Original article

Predictors of prescription of morphine for severe cancer pain by physicians in Korea

Y. H. Yun 1, S. M. Park 1, K. Lee 2, Y. J. Chang 3, D. S. Heo 4, S.-Y. Kim 5, Y. S. Hong 6, and B. Y. Huh 2*

1 Quality of Cancer Care Branch, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea;
2 Department of Family Medicine, Seoul National University, Seoul, Korea;
3 Cancer Information Branch, Research Institute, National Cancer Center, Goyang, Gyeonggi, Korea;
4 Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea;
5 Department of Internal Medicine, Kyunghee University Hospital, Seoul, Korea;
6 Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea

* To whom correspondence should be addressed.
B. Y. Huh, E-mail: bongyul{at}plaza.snu.ac.kr


  Abstract

Background: This study was undertaken to identify predictors of the prescription of strong opioids, which are important for the management of severe cancer pain, by Korean physicians.

Methods: A questionnaire based on a hypothetical case designed to assess the prescription of morphine by physicians was administered to 800 specialists in the Korea Cancer Association, of whom 147 (18.4%) responded, and to 2200 specialists in the Korean Academy of Family Medicine, of whom 388 (17.6%) responded. We used a multidimensional approach to identify the predictors of prescription of morphine by physicians.

Results: In the hypothetical case scenario, only 16.5% of the respondents stated that they would prescribe morphine for severe cancer pain. Multiple logistic regression analysis showed that physicians with a positive attitude regarding opioid addiction [odds ratio (OR) 2.62; 95% confidence interval (CI) 1.54-4.46], experience of pain assessment (OR 2.09; 95% CI 1.13-3.87), recent residency training (OR 2.27; 95% CI 1.30-4.0) and positive self-evaluation as an oncology specialist (OR 2.60; 95% CI 1.41-4.78) were more likely to prescribe morphine. None of the 13 variables in the knowledge dimension significantly predicted prescription of morphine for severe cancer pain.

Conclusions: The results of the survey suggest that we need to develop strategies to develop a positive attitude toward opioids, to increase experience in pain assessment and to improve cancer pain management training among Korean physicians.

Keywords: cancer pain; morphine; physician; prescription.
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