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Palliative care; Cancer patient; Pain therapy; Opiodophobia; Opioid analgesics

Introduction

Palliative care is a method that helps patients' (adults and children's) and their families' quality of life while they are dealing with issues brought on by a life-threatening disease. Through the early detection, accurate evaluation, and treatment of pain and other issues, whether they be physical, psychological, or spiritual, it avoids and alleviates suffering. Suffering must be addressed on more than just a physical level. Patients and their carers are supported by palliative care through a team approach. This comprises attending to practical requirements and offering bereavement counselling. It provides a system of assistance to assist patients in remaining as active as possible until death. The human right to health specifically recognizes palliative care. It needs to be delivered through person-centered, integrated health services that pay close attention to each person's unique requirements and preferences.

For a large number of disorders, palliative care is necessary. Adults who require palliative care typically have chronic illnesses such diabetes (4.6%), chronic respiratory disorders (10.3%), AIDS (5.7%), cardiovascular diseases (38.5%), and cancer (34%). Numerous additional illnesses, such as congenital abnormalities, drug-resistant TB, chronic liver disease, multiple sclerosis, Parkinson's disease, rheumatoid arthritis, neurological illness, and multiple sclerosis, may also call for palliative treatment. Two of the most common and critical symptoms of people in need of palliative care are pain and respiratory problems. For instance, 67% of people with cardiovascular illness or chronic obstructive pulmonary disease and 80% of those with cancer or AIDS would feel moderate to severe pain towards the end of their lives. Opioids are necessary for pain management.

Additionally, typical physically unpleasant symptoms like dyspnea can be treated with opioids. It is morally required to treat such symptoms as soon as they appear in order to minimise suffering and uphold a persons dignity.

The term “palliative” can have negative connotations for doctors, patients, and their caretakers, contributing to a delay in treatment referral and uptake, including for interventions aimed at pain management. The opinions and attitudes of patients towards pain treatment are important factors in the success of the treatment process. One important source of these beliefs is patients’ contact with doctors over the course of treatment. Patients' thoughts on opioid analgesics in this review revealed a lack of understanding of this type of therapy. According to a recent systematic review of research on the use of opioid analgesics for the treatment of dyspnea, relationships between a doctor and patient as well as within the family have a significant impact on how well-tolerated an opioid-based treatment regimen is [1]. The purpose of this study is to give a brief opinion on the usage of opioid analgesics in cancer patients receiving palliative care. Medical staff guidelines for patient education in the treatment of cancer are well-defined, regarded as the most effective, and help to increase treatment compliance. The medical profession is more equipped to address the issues of the opioid crisis than the general population, not only by easing its burden but also by supplying, and in some countries restoring, effective pain therapy for cancer patients [2]. Physician views on the use of opioid analgesics influence not just the attitudes and opinions of patients and their families, but also and perhaps most significantly the opioid regimens recommended and the therapeutic experiences of the patients. We discovered that patients and doctors generally shared the same level of opioidophobia, or the conviction that opioids are harmful and hazardous in addition to their therapeutic usefulness. Future research on the use of analgesics in accordance with guidelines for opioid reduction and any revisions thereto [3] will enable a thorough evaluation of their effects on patient experiences in nations like Poland, where the opioid crisis has not yet had a chance to take hold. It is possible that the variety and unpredictability of advice made in relation to the opioid epidemic may serve to reinforce the caution and mistrust that Polish physicians have regarding opioids, as shown in this study.

The propensity of medical professionals to ignore the requirement to diagnose pain and gauge its severity based on patients' accounts may be a sign of weak knowledge, a poor therapeutic alliance, or at the very least, poor communication with patients. In addition, the concern expressed about patients using opioids for non-medical treatments may reflect a lack of confidence in the accuracy of their assessment of pain, a lack of confidence in the effectiveness of opioids in managing pain, or a concern about their potential for abuse and quick addiction. These results are consistent with other analyses that identified inadequate patient education, mistakes in therapy, and inaccurate measurement and reporting of pain levels as key obstacles to effective pain management [4,5].

The likelihood of misuse was cited by the majority of doctors in this research (53.3%) as another significant reason for concern regarding non-medical opioid usage. The usage of morphine and opium in Europe in the late 19th and early 20th centuries is when the stigmatisation of patients receiving opioid-based therapy first emerged [6]. Stigma, although being historically and culturally acceptable, causes misery for today's cancer sufferers. In our study, patients also mentioned this when discussing their contacts with pain management specialists. Physician worries stated regarding patient and family unhappiness when opioid analgesics are administered were equivalent to those expressed about administrative challenges and risks of regulatory oversight.

Discussion

We discovered that both patients and doctors had a comparable level of concern about addiction. This is consistent with evaluations done in the last 20 years that show an increase in opioid misuse prevalence [7]. Both research groups highlighted the negative connotations that the word "morphine" has. This supports the stigmatisation of patients utilising opioid analgesics in the setting of addiction fear. The statement that pain management can hasten the development of cancer, on the other hand, revealed the greatest disparity between the two groups, with nearly a fifth of doctors (19.8%) agreeing with it compared to only about a tenth of patients (11,5%), and nearly half (47,9%) of patients stating that they had no opinion on the subject. The groups views on the legality of using opioids to treat pain were the ones that were most seldom in agreement. Patients may not be aware of the types of pain that necessitate the usage of opioids in certain cases. Opinions on the low dependability of patients' assessments of their level of pain may be an indication that doctors don't have faith in their patients. It could also be connected to patients' concerns about being labelled as addicts or their desire to use opioids for purposes other than analgesia. The assertion that opioid pain management is a "necessary evil" or "lesser evil" was shown to have the widest gap in patient and physician opinion. In all, 42.3% of patients and just 10.7% of physicians agreed with this assertion.

Patients may not be aware of the challenges in managing opioid use-related adverse effects, which may be one cause of the disparities we discovered in our study. Patients who claim that they didn't get such information from their doctors help to corroborate this in part. Another explanation might be that, in spite of their beliefs and anxieties, individuals who are in pain are willing to utilise opioids. Therefore, rather than being less likely to express their concerns about the use of opioids, patients are more likely to have a lower priority for pain. Studies undertaken in the US during the opioid epidemic revealed similar results [8].

Palliative medicine's major objective is to cure uncomfortable cancer-related symptoms and treatment-related side effects in order to enhance patients' perceived quality of life [9]. Both opiodophobia and the opioid crisis may be alleviated by a strategy that considers the possible risks and advantages of opioid drugs in chronic therapy as well as one-time treatments [10]. Access to palliative care, which goes beyond end-of-life care and focuses on balancing opioid use, reducing side effects, managing analgesia effectiveness, and educating patients, may have a positive effect on the alignment of views on the use of opioid analgesics among patients and doctors from various specialties.

There are various restrictions, but the most significant one is the disparity in sample sizes between the groups examined. Particularly, the physician group was twice as big as the patient group, which made it more difficult to draw valid comparisons and connections between the two groups. Another significant disadvantage was the study's retrospective design and analyses of pain treatment over the course of the disease. This could have contributed to the overrepresentation of reactions linked to upsetting events and the reduced representation of responses linked to fading pain memories. The responses given by respondents were not always congruent with real facts, despite all efforts being made to infer conclusions from competent statistical analysis.

Conclusion

90% of the patients polled reported experiencing pain at some point during their sickness and treatment. After the primary therapy is over, cancer patients in Poland typically only receive palliative care at the end of their lives. However, the population's ageing and the increase in cancer patient life expectancy provide important new obstacles.

Acknowledgement

Not applicable.

Conflict of Interest

The authors declare no conflict of interest.

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