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.

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

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* 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

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* 3. In what country do you currently practice?

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* 4. Gender

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* 5. Years working in palliative care

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* 6. Primary clinical setting of work

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.

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* 7. Case 1: 70 year old patient with hormone sensitive metastatic prostate cancer to bone currently managed with androgen deprivation therapy. Stable disease and tolerating treatment well. Referred to palliative care services for pain management. History of depression and hypertension. Pain predominantly affecting the right hip consistent with known metastatic bone disease located in right iliac crest. Prescribed regular opioid and neuropathic agents for the management of same. Drinks four pints of beer per day and shares that he has used cocaine occasionally in the past but denies any recent use. Currently living with son, from whom he was previously estranged, and awaiting allocation of suitable social housing accommodation. 

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?

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* 8. Case 2: 55 year old patient with tonsillar carcinoma reviewed in the acute hospital setting by the specialist palliative care consult service. Noted to have excellent response to treatment on most recent imaging. He has completed radiation therapy and continues on adjuvant chemotherapy. Background of peptic ulcer disease, depression and anxiety. During assessment reports that his predominant concern is regarding accommodation. Currently living with a friend and has been unable to afford alternative housing arrangements. Significant daily alcohol intake – approximately 8 units. Smokes non-medicinal cannabis daily and reveals that he occasionally uses cocaine and ecstasy. 

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?

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* 9. Case 3: 71 year old patient with background of non-small cell lung cancer with contralateral lung metastases. Currently maintained on targeted therapies (tyrosine kinase inhibitor) under the care of Oncology services and has had partial response to treatment on most recent imaging. Referred to Palliative Care services for symptom management and support. No additional medical history of note. On review in out-patient clinic he shares that the past month has been particularly challenging following his separation from his partner. He has been drinking alcohol more heavily than previous as a result and this is causing relationship issues with his son who he is temporarily living with. No history of illegal drug use. He is maintained on low dose opioid and adjuvants and describes pain as controlled presently. 

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?

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* 10. Case 4: 54 year old patient with metastatic non-small cell lung cancer to lymph nodes, bone and liver admitted to hospital with severe back pain, constipation and declining mobility. Imaging confirms significant disease progression with malignant spinal cord compression and blood work-up reveals hypercalcaemia. History of hypertension. Well supported by her partner and 2 adult children. Reports drinking 3 or 4 vodka and tonics most evenings as finds this a helpful distraction from her pain. Had wondered whether to cut down as feels guilty about drinking at times and wondering if it has contributed to her being more fatigued and less physically active than previously. No history of illegal drug use outlined.  

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?

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* 11. Case 5:  24 year old with background of Glioblastoma Multiforme admitted to the inpatient hospice palliative care unit for ongoing care with estimated prognosis of weeks. Noted increasing symptoms of headaches, somnolence and vomiting in the community. Accompanied on admission by mother and father. You note from community records that this patient has a background of occasional illegal drug use but no other medical background of note. No history of excessive alcohol 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?

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* 12. Case 6: 59 year old patient with a background of metastatic prostate cancer is referred to palliative care services for symptom support.  He lives with his wife and 4 children and works as chief financial officer in a large multinational company. He has recently modified his job role at work and is currently planning early retirement. He has no financial concerns. On review in clinic he reports occasional right hip pain with correlation of bone disease in this region on recent imaging. When discussing any previous alcohol or drug use on his assessment he shares that he took cocaine regularly for approximately 15 years. He has no history of alcohol use disorder and last used cocaine prior to his diagnosis 12 months ago. He has requested that this information remain confidential as his wife and family are unaware. He describes low appetite, early satiety and abdominal discomfort. 

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?

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* 13. Case 7: 19 year old patient with background of glioblastoma multiforme referred by the hospital oncology team in context of recent rapid deterioration with imaging confirming progression of disease and limited treatment options. Prognosis estimated as short months. On review, patient reports significant headaches, nausea and photophobia. She has a background history of generalised anxiety disorder and is under regular review of psychiatry services. Noted recent steroid related psychosis requiring in-patient admission. She describes a challenging relationship with her parents and she moved out of the family home 2 years ago and currently lives with a friend. Reports that she has never drank alcohol nor taken illegal drugs. You note that the community social work team have been closely involved since diagnosis 18 months ago. 

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?

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* 14. Case 8: 47 year old lady with metastatic non-small cell lung cancer to bone. Admitted to Hospice in-patient unit for period of assessment and pain management with plan to discharge home post same. Continues on efgr inhibitor with stable disease on recent imaging. Previous radiotherapy to vertebral disease at T12. Significant issues with radicular back pain requiring complex medication regimen and recent insertion of an intrathecal pump. Background history of depression and anxiety and is followed by community mental health services. Married with 2 children with a supportive extended family. Drinks the occasional beer. No history of 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?

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

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