Dear HIFA-Zambia colleagues,
Below are the citation and abstract of a paper on 'Prescribers’ experiences of, and attitudes to, use of morphine for palliative care'. There is increasing acceptance of morphine, but limited knowledge of pain management.
CITATION: Prescribers’ experiences of, and attitudes to, use of morphine for palliative care at a tertiary hospital in Zambia
Emma Robertson, Andrew Bambala, Aubrey C. Kalungia, Sarah Marshall, Patience Mbozi & Derick Munkombwe
Published online: 26 Feb 2020 (restricted access)
Download citation https://doi.org/10.1080/21548331.2020.1733318
ABSTRACT
Objective: To explore medical doctors’ experiences of, and attitudes to, use of morphine for palliative care at a tertiary hospital in Zambia.
Methods: A qualitative, exploratory case study was undertaken. Semi-structured interviews were used to collect data from 14 medical doctors working in the fields of oncology, pediatrics, and internal medicine at a tertiary hospital in Lusaka, Zambia, regarding their experiences and attitudes to prescribing morphine for palliative care. Thematic analysis of interview transcripts was carried out to establish common themes in the data. The study was approved by BSMS and UNZA research ethics committees.
Results: All participants agreed that doctors were becoming more comfortable with the prescribing of morphine, although experiences were notably different for doctors working in oncology, compared to other departments. Themes of difficulty discussing end-of-life, poor recognition of pain, and fear of patient addiction, were more prominent in the responses of non-cancer doctors. Morphine use was generally restricted to cancer and sickle cell disease patients, with most non-cancer doctors stating that they rarely prescribe morphine for outpatient use. Training in pain management and the presence of a palliative care team were perceived to be facilitators to morphine prescribing.
Conclusions: Although there is an increased willingness to prescribe morphine, limited knowledge of pain management, especially for nonmalignant disease, underlies many of the findings in this study. Opportunity exists for professional development in pain management to further improve the acceptance and use of opioids in palliative care, especially for out-patients.
Best wishes, Neil
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HIFA-Zambia profile: Neil Pakenham-Walsh is the coordinator of HIFA-Zambia and the HIFA campaign (Healthcare Information For All - www.hifa.org ). Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org
