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.

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

Question Title

* 3. In what country do you currently practice?

Question Title

* 4. Gender

Question Title

* 5. Years working in palliative care

Question Title

* 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.

Question Title

* 7. Case 1: 68 year old patient with advanced metastatic pancreatic cancer referred to palliative care services by oncology team for symptom management and psychosocial support. Recent oncology review with decision not for further systemic anticancer treatment and prognosis of 3-6 months outlined. History notable for hypertension, osteoarthritis and generalised anxiety disorder. Shares that she has been struggling with anxiety more recently following separation from her husband. Currently living with a friend on a temporary basis and hoping to move into rented accommodation pending access to financial support. Reports to drinking a half a bottle of wine at night over recent months to aid with sleep and smokes cannabis occasionally to promote relaxation. Remote history of cocaine use also noted. 

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?

Question Title

* 8. Case 2: 58 year old patient with colorectal cancer with limited metastatic disease to liver on chemotherapy seen in the out-patient palliative care clinic for symptom management. Most recent imaging shows partial response to treatment. Issues with intermittent constipation and decreased appetite described. Background of depression and anxiety with previous suicide attempt. Has used alcohol and illegal drugs in the past in an attempt to manage anxiety. Lives with her husband and describes a very supportive extended family.

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?

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?

Question Title

* 10. Case 4: 51 year old patient with advanced metastatic ovarian cancer admitted to the hospice for symptom management of bowel obstruction and end of life care. Issues including abdominal pain, nausea and vomiting. Maintained on subcutaneous infusion of morphine, haloperidol and hyoscine butylbromide. Single lady with no children. Previously worked in the service industry but was made redundant during the covid-19 pandemic and has been unable to return to work since due to illness. Unfortunately she has no sick pay entitlements. Known and supported by homelessness services in this time period.  Drinks alcohol to help get to sleep at night. Has been less able to tolerate recently secondary to nausea and is receiving chlordiazepoxide to manage potential withdrawal features. No history of illegal drug use. No other significant medical history of note. 

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?

Question Title

* 11. Case 5:  68 year old patient with background of metastatic renal cell cancer to lymph nodes maintained on immunotherapy with stable disease on most recent imaging. Referred to Palliative Medicine outpatient clinic for symptom assessment and supportive management with estimated prognosis of months - years. Lives with wife in their own home. 3 supportive adult children with 4 grandchildren. Enjoys fishing and hiking. Retired session musician. Describes issues with lower back pain with recent imaging confirming retroperitoneal nodal mass. When discussing a proposed management plan of commencing low dose regular opioid the patient shares that he is concerned regarding opioid addiction. Following exploration he shares that he previously had a cocaine problem in his 40s and is worried that he has “an addictive personality”. Does not drink alcohol and is a non-smoker.

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?

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?

Question Title

* 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?

Question Title

* 14. Case 8: 58 year old patient with metastatic breast cancer to bone on hormonal treatment. No other medical background of note. Attending out-patient palliative care services for management of hip pain and psychosocial support. Married with 3 teenage children. Working part-time as an administrative clerk. Drinks alcohol occasionally and has never used illegal drugs. Continues to lead an active life and enjoys walking and cycling. Reports excellent support from family and friends. Current medications include a modified release opioid and neuropathic agent. 

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.

T