Barriers to cancer pain management in Danish and Lithuanian patients treated in pain and palliative care units.

The prevalence of cancer-related pain is high despite available guidelines for the effective assessment and management of that pain. Barriers to the use of opioid analgesics partially cause undertreatment of cancer pain. The aim of this study was to compare pain management outcomes and patient-related barriers to cancer pain management in patient samples from Denmark and Lithuania. Thirty-three Danish and 30 Lithuanian patients responded to, respectively, Danish and Lithuanian versions of the Brief Pain Inventory pain scale, the Barriers Questionnaire II, the Hospital Anxiety and Depression Scale, the Specific Questionnaire On Pain Communication, and the Medication Adherence Report Scale. Emotional distress and patient attitudes toward opioid analgesics in cancer patient samples from both countries explained pain management outcomes in the multivariate regression models. Pain relief and pain medication adherence were better in Denmark, and the country of origin significantly explained the difference in the regression models for these outcomes. In conclusion, interventions in emotional distress and patient attitudes toward opioid analgesics may result in better pain management outcomes generally, whereas poor adherence to pain medication and poor pain relief appear to be more country-specific problems.

Barriers to cancer pain management: a review of empirical research.

Patient-, physician-, and health care system-related barriers of cancer pain management in patients with malignant diseases are a recognized and widely investigated issue. The purpose of this review is to summarize the main findings of empirical research on these barriers in the literature. The most significant patient-related barriers were patient reluctance to report pain and adhere to treatment recommendations. Besides that, cognitive, affective, and sensory patient-related barriers to cancer pain management with opioid analgesics have been studied using quantitative and qualitative research methods. The Barriers Questionnaire and its shortened and modified versions were the most commonly used instruments in the context of research on patient-related barriers to cancer pain management. The most prominent physician-related barriers were insufficient physicians' knowledge about cancer pain management, inadequate patterns of pain assessment, and inadequate opioid prescription. The methodologies used to conduct the majority of the studies on physician-related barriers were weak. Nevertheless, physician knowledge of pain management guidelines, the quality of pain assessment and opioid prescription have been shown to be obviously better in a few Western countries. Institutional and health care system-related barriers were relevant only in countries with restrictive opioid prescription regulations. The evaluation of the influence of cultural-social-economical background on cancer pain management could probably help to obtain better insight into the problems of unrelieved cancer pain.

[Issues of the practical value of ethics in healthcare]. / Praktines etikos vertes klausimai sveikatos prieziuroje.

In November 2006, the "Journal of Medical Ethics" published an article where prominent medical specialists stated that medical ethics, as a teaching and a theory, has no practical value. The article was based on the physicians' clinical experience and view that the theory of ethics has little in common with its application in daily practice and provides generalized guidelines for behavior, but is ineffective in decision-making in individual cases. At the same time, when describing conflict situations in healthcare, Lithuanian public press raises the role of ethics to the absolute and states that the lack or violation of ethics is the sole cause of all problems in healthcare, and there would be no problems if physicians behaved morally. From the viewpoint of an ethics professional, both controversial opinions deserve attention, and this paper is devoted to the analysis of these opinions. Ethical collisions and conflicts emerging in providing healthcare are not signs of the helplessness of medical ethics. Both viewpoints - the one disclaiming the role of medical ethics and the one attributing the absolute role to medical ethics - are equally erroneous. Decisions of the society and physicians are aggravated by health policy and the organization of healthcare in the country, as well as by a concrete individual's level of ethical thinking, worldview, and knowledge. Sometimes ethical collisions arise when there is a conflict among ethical principles themselves, and healthcare specialists have to decide which principle should be given priority. There are cases where setting priorities is impossible, and one has to admit that one single specialist is unable to solve the problem without his/her colleagues' assistance. Collective and collegial professionals' work helps to solve such ethical collisions.

[What kind of information do family physicians provide to their patients about possible side effects of contraceptive pills?]. / Kokia informacija teikia seimos gydytojai apie salutini kontraceptiku poveiki moterims?

The aim of our survey was to investigate the extent to which family physicians in Lithuanian inform their patients about possible side effects of contraceptive pills. We also aimed to examine the relation between physicians' estimation of the severity and frequency of these side effects and their willingness to inform patients spontaneously. A survey was conducted in Lithuania in 2004 using the methodology and questionnaire developed by the researchers of Department of Medical Philosophy and Clinical Theory, University of Copenhagen. A computerized stratified random sampling was drawn using the list of Territorial Sick Funds. A total of 500 family physicians have been questioned in the survey. Response rate was 64%. Family physicians (83%) informed their patients more frequently when the side effect was regarded as frequent and serious than it was regarded as rare and trivial. Only 2.9% of all the respondents would inform their patients about the all possible side effects. Half of the respondents (51%) would inform about the side effects in order to enable the patients to react appropriately to every side effect. The most common reason (29%) for not informing the patients was an effort to avoid unnecessary patients' anxiety.

[Patient confidence in health care]. / Pacientu pasitikejimas sveikatos prieziura.

The aim of the study was to evaluate patient confidence in organization of health care and health care policy. The study material was gathered using self-administrated anonymous questionnaire in November-December, 2001. The patients were recruited from therapeutic departments of Kaunas 2nd hospital and Alytus S. Kudirka hospital. The data was analyzed using Microsoft Excel and SPSS program data package. Chi-square test was used to compare observed results with expected results. The hypothesis was statistically significant at the p<0.05. More patients in Alytus hospital (31%) than in Kaunas hospital (22%) predicated as being non-confident in health care policy. Statistical significant difference between patients of two hospitals was obtained comparing opinion about health care reform. Alytus S. Kudirka hospital patients were more optimistic about health care reform than patients in Kaunas hospital. Thirty percent of patients in Alytus hospital and 19% in Kaunas hospital were confident that reform has improved their treatment (p<0.05). More patients in Kaunas hospital (22%) than in Alytus hospital (9%) confirmed that health care reform aggravated their treatment. The majority of Alytus hospital patients (62%) and 40% of Kaunas hospital patients were satisfied with health care services. More than half respondents were not confident in health care system but they trusted physicians. Gender and education level had impact on patient confidence in health care. The most part of the respondents were satisfied with health care in hospital. More patients in Alytus hospital compared with Kaunas hospital patients confirmed that they did not trust health care policy, however were more satisfied with health care reform and services in hospital.