Assessment of Knowledge Attitudes and Practice of Analgesic Use Among Doctors and Adequacy of Pain Management in Cancer Patients in Kenyatta National Hospital

Abstract

Background Pain in cancer is one of the most common and most feared symptom and is an important determinant of the patient‟s quality of life. Despite multiple protocols being set for pain management in cancer patients, studies show that the prevalence of pain in cancer patients is still high, with significant under-treatment for those patients on analgesia. This study aims to assess the knowledge, attitude and practices of doctors and the adequacy of pain management in cancer patients. Objectives To assess the knowledge, attitudes and practice of analgesic use among Senior House Officers and Medical Officers and adequacy of pain management among cancer patients in Kenyatta National Hospital. Methods This was a descriptive, cross-sectional study which was carried out over a five-month period in the various clinics in the Kenyatta National Hospital. They included the haemato-oncology clinic, radio-oncology clinic, surgical out-patient clinics and gynaecology out-patient clinics. The study participants included both doctors and patients attending these clinics. The doctors were given a self-administered Knowledge and Attitude Survey on Pain (KASP) questionnaire and a questionnaire to assess current practice to complete. The KASP questionnaire consists of questions that assess both knowledge and attitude of healthcare providers regarding cancer pain management with only one correct answer from the choices given. The second questionnaire collected data on current practice of doctors with regards to prescribing analgesics. Each patient was interviewed using the Brief Pain Inventory questionnaire which collected information on the patient‟s current and past pain level, their current prescribed analgesia and the effect of the pain on their daily life. Results Between October 2016 and March 2017, a survey on 144 doctors from the various clinics was conducted. Overall score of the KASP questionnaire was 66.5%. There was good theoretical knowledge on pain assessment which, however, did not translate to good practice. Knowledge on the pharmacology of analgesic medication, especially opioids was poor. Knowledge on the adverse effects of opioid medication was also poor with an inflated fear of addiction. Although majority (66.5%, n=144) of the doctors frequently assessed for pain, they seldom used an objective assessment tool. 43.2% (n=144) frequently referred to the WHO pain ladder when xii prescribing analgesics. Most (90.6%, n=144) frequently reviewed the efficacy of the analgesics prescribed but only 50.7% regularly assessed for adverse effects of the medication. Of the 350 patients were recruited from the various clinics, 70.6% were found to be undertreated for their pain. Patients attended to in the surgical, gynaecology and haemato-oncology clinics were more likely to be adequately managed for pain than those in the ENT and radio-oncology clinics. No relationship was found between the knowledge and attitude of doctors and their practice patterns. Conclusion There is inadequate knowledge and poor attitude by doctors on cancer pain and its management. There are suboptimal practice patterns regarding objective pain assessment and adherence to pain management guidelines, translating to poor pain control among the patients attended to in the various clinics. Recommendations We recommend current education strategies on cancer pain management be re-evaluated. We recommend increase in awareness and use of formal pain assessment tools by clinicians and emphasis on adhering to clinical practice guidelines on cancer pain management. Further studies should be carried out on system related and patient related barriers on pain management at KNH.