Problematic Opioid Use Healthcare Professional Survey

Study Description

Study Title: A transatlantic study to explore the attitudes of palliative care physicians regarding the identification of problematic opioid use among patients with advanced cancer.

Study Team: Dr Fiona Kiely, Dr Jenny Lau, Dr Aoife Lowney, Dr Breffni Hannon, Dr Mary Miller, Dr Joseph Arthur and Dr Jessica Lee.

You are being invited to participate in a research study as a consultant palliative care physician who cares for patients with advanced cancer. The purpose of this study is to gain an understanding of how palliative care physicians evaluate patients who may be at risk of having or developing problematic opioid use.

Physicians working in Ireland, the United Kingdom, Canada and the United States of America will be invited to participate.

If you agree to participate you will be asked to proceed with this short online survey. This survey should take approximately 10 minutes to complete. Your participation in this study is completely voluntary. You may choose not to participate or to withdraw participation at any time.

Please see the Participant Information Leaflet attached in the invitation email for additional information. If you have any questions or concerns regarding the study, please write to Dr. Jessica Lee at jessicanicanlaoi@gmail.com.

We thank you for your time and participation.

Question Title

* 1. I have read the participant information, as above, and consent to proceed with this survey.

Yes

Question Title

* 2. I am a consultant or staff physician in palliative medicine who prescribes and/or gives advice on the prescribing of opioids for patients with advanced cancer

Yes

Question Title

* 3. In what country do you currently practice?

Ireland

United Kingdom

Canada

United States of America

Question Title

* 4. Gender

Female

Male

Rather not say

Other (please specify)

Question Title

* 5. Years working in palliative care

< 5 years

5 - 10

11 - 15

> 15

Question Title

* 6. Primary clinical setting of work

Hospice - Inpatient unit

Community Palliative Care

Acute hospital (consult service)

Outpatient palliative care clinic

Other

Please imagine that you are reviewing these patients in your usual day-to-day clinical work setting and ensure that you answer all vignettes based on your current practice.

Question Title

* 7. Case 1: 23 year old patient with a background of Stage 3 cervical cancer currently receiving chemoradiotherapy. Her past medical history is not significant for any other conditions. Referred to palliative care services by oncology for support in symptom management. Currently tolerating treatment well with good response demonstrated on most recent imaging. Shares that she was previously working as an apprentice hairdresser but has been unable to work throughout her treatment and is currently receiving unemployment benefit. Admits to binge-drinking with her friends most weekends and occasional social cocaine use.

Based on the information provided, in your current practice, how likely would you be to consider this patient having, or being at high risk for developing, problematic opioid use?

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

Question Title

* 8. Case 2: 38 year old patient with metastatic lung cancer to liver, bone and brain (EGFR negative, PDL <1%). No additional medical history of note. Referred to the Community Palliative Care Team for symptom management. Lives with his partner and 1 adult son. Financially stable with illness benefits being paid by his employer. History of alcohol use disorder. Smokes cannabis weekly and uses cocaine occasionally. Recent imaging confirms significant progression of disease with systemic treatment discontinued by oncology. Prognosis estimated as 3-6 months.

Based on the information provided, in your current practice, how likely would you be to consider this patient having, or being at high risk for developing, problematic opioid use?

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

Question Title

* 9. Case 3: 71 year old patient with a background of metastatic prostate cancer with undetectable PSA and testosterone. He was referred to palliative care services for pain management. History notable for ischaemic heart disease, diabetes and depression. Recently separated from partner and has moved out of the family home. Temporarily staying with a friend. Consumes four cans of beer most evenings to aid with sleep. Does not have any history of illegal drug use. Prognosis estimated to be years. Predominant issue on assessment is lower back pain. Imaging has been arranged by oncology to further investigate same.

Based on the information provided, in your current practice, how likely would you be to consider this patient having, or being at high risk for developing, problematic opioid use?

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

Question Title

* 10. Case 4: 58 year old patient with metastatic renal cell cancer. Referred to Palliative Care outpatients for symptom assessment and support. Low symptom burden on assessment. Continues to play squash regularly with friends. Works in banking. Married with two sons aged 13 and 15. Reports of consuming 3-4 large glasses of red wine nightly. Non-smoker with no history of illegal drug use. Medical background of hypertension managed with calcium channel blocker. Taking no other regular medications.

Based on the information provided, in your current practice, how likely would you be to consider this patient having, or being at high risk for developing, problematic opioid use?

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

Question Title

* 11. Case 5: 23 year old patient with metastatic anaplastic thyroid cancer referred to community palliative care services. Noted to have recent progression of disease with metastases to lungs, liver and right adrenal gland. Systemic anticancer treatment recently discontinued. Prognosis estimated as < 3 months. Known background of anxiety and anorexia. Issues including breathlessness, exacerbation of anxiety and fatigue. Living with parents. Had been training as a hairdresser but ceased apprenticeship three months previously due to deteriorating condition. Drinks alcohol occasionally and does share that she has previously used amphetamines and cocaine, particularly during the most challenging period of her illness related to anorexia nervosa. She denies any recent substance use.

Based on the information provided, in your current practice, how likely would you be to consider this patient having, or being at high risk for developing, problematic opioid use?

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

Question Title

* 12. Case 6: 54 year old patient with background of non-small cell lung cancer with small volume lung metastases admitted to hospital with a lower respiratory tract infection. Referred to Palliative Care services for support in symptom management. Precarious social situation on review - living in a homeless shelter intermittently and spending most nights sleeping on the streets. Actively smoking heroin. No history of alcohol use disorder. Background medical history of COPD. Not taking any regular prescribed medications. Predominant issues on admission include chest wall pain, shortness of breath and cough.

Based on the information provided, in your current practice, how likely would you be to consider this patient having, or being at high risk for developing, problematic opioid use?

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

Question Title

* 13. Case 7: 88 year old gentleman referred for admission to the inpatient hospice palliative care unit by community services. Background is notable for Metastatic Malignant Melanoma with brain metastases. Currently maintained on steroids with continued functional and cognitive decline. On admission to the hospice he is accompanied by his neighbour. His wife had died 10 years previously and he is estranged from his two adult children. Had been living in social housing with twice daily carers prior to hospice admission. On review he is confused and disorientated. He requires a hoist to transfer and assistance with eating and drinking. There is no evidence of pain or distress on review. He has no known background of alcohol or illegal drug use.

Based on the information provided, in your current practice, how likely would you be to consider this patient having, or being at high risk for developing, problematic opioid use?

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

Question Title

* 14. Case 8: 59 year old patient with metastatic colorectal cancer to liver, lymph nodes and lung. Rapid deterioration over recent weeks and admitted to hospice inpatient unit for ongoing care with estimated prognosis of days to weeks. History of depression managed by psychiatry services. Married with 3 children in their early twenties. Reports that affairs are all in order. No financial concerns. Complex pain managed with a combination of opioids, neuropathics and anti-inflammatory medications. No history of alcohol or illegal drug use.

Based on the information provided, in your current practice, how likely would you be to consider this patient having, or being at high risk for developing, problematic opioid use?

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

You have reached the end of this survey. Many thanks for your participation.