Knowledge and attitudes of health-care providers toward cancer pain management: a comparison of physicians, nurses, and pharmacists in the state of New Hampshire.

The knowledge and attitudes toward cancer pain management of physicians, nurses, and pharmacists in the state of New Hampshire were examined through the use of a statewide survey. Many of the providers who completed the survey, and thus indicated that they treated patients with cancer pain on a regular basis, were not pain or oncology specialists. Most of these providers were quite well informed about the fundamentals of cancer pain management. Approximately 90% of providers in all three groups were not concerned about addiction among cancer patients. Yet, there was a small percentage of providers who responded in less than optimal ways to items dealing with opioid pharmacology, pain assessment, and the importance of pain relief. Comparison of responses among provider groups indicated that nurses were the most knowledgeable and pharmacists the least knowledgeable about pain assessment. Physicians were the most knowledgeable regarding opioid pharmacology but seemed the least committed to providing optimal pain relief. Further analysis identified a small group of physicians that included a disproportionately high percentage of family practitioners and surgeons who consistently responded in less than optimal ways to items dealing with the importance of pain relief. The results of this study indicate a continuing need for broad-based educational programs in cancer pain management and for new initiatives focused on practitioners who see relatively few cancer patients and may have difficulty accessing traditional educational programs.

Oncology patients in critical care: ethical dilemmas.

Although ICU care encompasses many important ethical dilemmas, the care of oncology patients in ICU can be particularly troublesome. This article explores some of the common ethical issues related to oncology patients in critical care: informed consent, allocation of resources, and no code policies.

Prediction and prevention of patient falls.

Falls are a major cause of injury in hospitalized patients. To date, the focus of research has been on developing risk profiles to predict fallers and developing interventions to prevent falls. This paper presents and critiques these efforts. The authors conclude that (a) no high-risk profiles have yet been developed with adequate sensitivity and specificity to be useful as predictive instruments; (b) current fall interventions are rarely research-based; and (c) the few intervention studies conducted to date seem to reduce falls primarily through consciousness raising rather than specific changes in practice.