Junior doctors’ attitudes to opioids for refractory breathlessness in patients with advanced chronic obstructive pulmonary disease

Journal article


Smallwood, Natasha, Gaffney, Nicole, Gorelik, Alexandra, Irving, Louis, Le, Brian and Philip, Jennifer. (2017). Junior doctors’ attitudes to opioids for refractory breathlessness in patients with advanced chronic obstructive pulmonary disease. Internal Medicine Journal. 47(9), pp. 1050 - 1056. https://doi.org/10.1111/imj.13521
AuthorsSmallwood, Natasha, Gaffney, Nicole, Gorelik, Alexandra, Irving, Louis, Le, Brian and Philip, Jennifer
Abstract

Background: Refractory breathlessness is a common, distressing symptom in patients with advanced chronic obstructive pulmonary disease (COPD). The judicious, off‐licence prescription of opioids, together with other management strategies, can improve breathlessness, however, internationally there is profound reluctance to prescribe opioids for breathlessness in COPD. Aims: To understand Australian junior doctors’ knowledge and attitudes regarding the management of refractory breathlessness and the role of opioids in COPD. Methods: All junior doctors undertaking basic training in internal medicine in Victoria were invited to complete an online survey. Knowledge, willingness, and experience prescribing opioids to COPD patients with refractory breathlessness, were examined. Results: Of the 243 responses received, most trainees (193, 86.5%) believed opioids have a role in treating refractory breathlessness in stable COPD outpatients, with 143 (64.1%) recommending morphine as first‐line treatment for refractory breathlessness. One quarter (55, 24.7%) reported having themselves initiated an opioid and 102 (45.7%) had prescribed an opioid under senior supervision for management of breathlessness in COPD. Concern regarding adverse opioid effects was low, with 58 (26.0%) having no concerns prescribing an opioid to COPD patients. Conclusion: This is the first study of doctors to demonstrate high awareness, confidence, willingness and experience in prescribing opioids for the off‐licence indication of refractory breathlessness in COPD. These findings differ significantly from attitudes reported overseas and are unexpected given the doctors surveyed were recently qualified. The low awareness of possible adverse events and limited insight regarding knowledge gaps is concerning and highlights the significant need for greater education in palliative care.

KeywordsCOPD; dyspnoea; opioid; survey; attitude
Year2017
JournalInternal Medicine Journal
Journal citation47 (9), pp. 1050 - 1056
PublisherWiley-Blackwell
ISSN1444-0903
Digital Object Identifier (DOI)https://doi.org/10.1111/imj.13521
Scopus EID2-s2.0-85029080672
Page range1050 - 1056
Publisher's version
File Access Level
Controlled
Place of publicationAustralia
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Bower, Kelly, Louie, Julie, Landesrocha, Yoesph, Seedy, Paul, Gorelik, Alexandra and Bernhardt, Julie. (2015). Clinical feasibility of interactive motion-controlled games for stroke rehabilitation. Journal of NeuroEngineering and Rehabilitation (online). 12, pp. 1 - 12. https://doi.org/10.1186/s12984-015-0057-x
Physical therapists as primary practitioners in the emergency department: Six-month prospective practice analysis
de Gruchy, Adam, Granger, Catherine L. and Gorelik, Alexandra. (2015). Physical therapists as primary practitioners in the emergency department: Six-month prospective practice analysis. Physical Therapy. 95(9), pp. 1207 - 1216. https://doi.org/10.2522/ptj.20130552
Obesity is associated with retinopathy and macrovascular disease in type 1 diabetes
Price, Sarah A., Gorelik, Alexandra, Fourlanos, Spiros, Colman, Peter G. and Wentworth, John M.. (2014). Obesity is associated with retinopathy and macrovascular disease in type 1 diabetes. Obesity Research and Clinical Practice. 8(2), pp. e178 - e182. https://doi.org/10.1016/j.orcp.2013.03.007
IDH1 mutation is associated with seizures and protoplasmic subtype in patients with low-grade gliomas
Liubinas, Simon V., D'Abaco, Giovanna M., Moffat, Bradford M., Gonzales, Michael, Feleppa, Frank, Nowell, Cameron J., Gorelik, Alexandra, Drummond, Katharine J., O'Brien, Terence J., Kaye, Andrew H. and Morokoff, Andrew P.. (2014). IDH1 mutation is associated with seizures and protoplasmic subtype in patients with low-grade gliomas. Epilepsia. 55(9), pp. 1438 - 1443. https://doi.org/10.1111/epi.12662
Lifetime risk of total knee replacement and temporal trends in incidence by health care setting, socioeconomic status, and geographic location
Bohensky, Megan A., Ackerman, Ilana, Desteiger, Richard, Gorelik, Alexandra and Brand, Caroline A.. (2014). Lifetime risk of total knee replacement and temporal trends in incidence by health care setting, socioeconomic status, and geographic location. Arthritis Care and Research. 66(3), pp. 424 - 431. https://doi.org/10.1002/acr.22122
Lifetime risk of total hip replacement surgery and temporal trends in utilization: A population-based analysis
Bohensky, Megan A., Ackerman, Ilana, De Steiger, Richard, Gorelik, Alexandra and Brand, Caroline A.. (2014). Lifetime risk of total hip replacement surgery and temporal trends in utilization: A population-based analysis. Arthritis Care and Research. 66(8), pp. 1213 - 1219. https://doi.org/10.1002/acr.22279
Outcomes of ambulatory rehabilitation programmes following botulinum toxin for spas ticity in adults with stroke
Demetrios, Marina, Gorelik, Alexandra, Louie, Julie, Brand, Caroline A., Baguley, Ian J. and Khan, Fary. (2014). Outcomes of ambulatory rehabilitation programmes following botulinum toxin for spas ticity in adults with stroke. Journal of Rehabilitation Medicine. 46(8), pp. 730 - 737. https://doi.org/10.2340/16501977-1842
Drug-induced hepatotoxicity: Incidence of abnormal liver function tests consistent with volatile anaesthetic hepatitis in trauma patients
Lin, Jonathan, Moore, David, Hockey, Brad, Di Lernia, Rachel, Gorelik, Alexandra, Liew, Danny and Nicoll, Amanda J.. (2014). Drug-induced hepatotoxicity: Incidence of abnormal liver function tests consistent with volatile anaesthetic hepatitis in trauma patients. Liver International. 34(4), pp. 576 - 582. https://doi.org/10.1111/liv.12278
Predictors of health care use among patients with or at high risk of atherothrombotic disease: Two-year follow-up data
Ademi, Zanfina, Liew, Danny, Gorelik, Alexandra, Bohensky, Megan A., Zomer, Ella, Hollingsworth, Bruce, Steg, Gabriel, Bhatt, Deepak L. and Reid, Christopher M.. (2014). Predictors of health care use among patients with or at high risk of atherothrombotic disease: Two-year follow-up data. International Journal of Cardiology. 175(1), pp. 72 - 77. https://doi.org/10.1016/j.ijcard.2014.04.230
Long term follow-up after aortic valve replacement (Ross Procedure): Echocardiographic determinants of ventricular recovery
Wilson, William M., Grigg, Leeanne E., Gorelik, Alexandra and Skillington, Peter. (2014). Long term follow-up after aortic valve replacement (Ross Procedure): Echocardiographic determinants of ventricular recovery. Heart, Lung and Circulation. 23(2), pp. 132 - 143. https://doi.org/10.1016/j.hlc.2013.07.008
Geographical variation in incidence of knee arthroscopy for patients with osteoarthritis: A population-based analysis of Victorian hospital separations data
Bohensky, Megan A., Barker, Anna, Morello, Renata Teresa, De Steiger, Richard N., Gorelik, Alexandra and Brand, Caroline A.. (2014). Geographical variation in incidence of knee arthroscopy for patients with osteoarthritis: A population-based analysis of Victorian hospital separations data. Internal Medicine Journal. 44(6), pp. 537 - 545. https://doi.org/10.1111/imj.12438
Thyroid surgery and anticoagulation: Survey of practice of endocrine surgeons in Australia
Verma, Kunal Pradip, Gorelik, Alexandra and Miller, Julie A.. (2013). Thyroid surgery and anticoagulation: Survey of practice of endocrine surgeons in Australia. World Journal of Endocrine Surgery. 5(1), pp. 6 - 11. https://doi.org/10.5005/jp-journals-10002-1115
Primary angiitis of the central nervous system: Experience of a Victorian tertiary-referral hospital
Oon, S., Roberts, Carol, Gorelik, Alexandra, Wicks, I. and Brand, Caroline A.. (2013). Primary angiitis of the central nervous system: Experience of a Victorian tertiary-referral hospital. Internal Medicine Journal. 43(6), pp. 685 - 692. https://doi.org/10.1111/imj.12038
Outcomes and excess costs among patients with cardiovascular disease
Ademi, Zanfina, Liew, Danny, Zomer, Ella, Gorelik, Alexandra, Hollingsworth, Bruce, Steg, Philippe Gabriel, Bhatt, Deepak L. and Reid, Christopher M.. (2013). Outcomes and excess costs among patients with cardiovascular disease. Heart, Lung and Circulation. 22(9), pp. 724 - 730. https://doi.org/10.1016/j.hlc.2013.02.002
Epidemiology of hepatitis B-associated hepatocellular carcinoma in Victoria
Sinclair, M., Roberts, S., Kemp, W., Knight, V., Dev, A., Gow, P., Philpott, H., Kronborg, Ian, Arachchi, Niranjan J., Bell, Sally J., Lim, Lucy, Gorelik, Alexandra and Nicoll, Amanda J.. (2013). Epidemiology of hepatitis B-associated hepatocellular carcinoma in Victoria. Internal Medicine Journal. 43(5), pp. 501 - 506. https://doi.org/10.1111/imj.12068
Who, why and when: Stroke care unit patients seen by a palliative care service within a large metropolitan teaching hospital
Eastman, Peter, McCarthy, Gillian, Brand, Caroline A., Weir, Louise, Gorelik, Alexandra and Le, Brian. (2013). Who, why and when: Stroke care unit patients seen by a palliative care service within a large metropolitan teaching hospital. BMJ Supportive and Palliative Care. 3(1), pp. 77 - 83. https://doi.org/10.1136/bmjspcare-2012-000331