The use of opioids at the end of life: the knowledge level of Dutch physicians as a potential barrier to effective pain management

<p>Abstract</p> <p>Background</p> <p>Pain is still one of the most frequently occurring symptoms at the end of life, although it can be treated satisfactorily in most cases if the physician has adequate knowledge. In the Netherlands, almost 60% of the patients with non-acute illnesses die at home where end of life care is coordinated by the general practitioner (GP); about 30% die in hospitals (cared for by clinical specialists), and about 10% in nursing homes (cared for by elderly care physicians).</p> <p>The research question of this study is: what is the level of knowledge of Dutch physicians concerning pain management and the use of opioids at the end of life?</p> <p>Methods</p> <p>A written questionnaire was sent to a random sample of physicians of specialties most often involved in end of life care in the Netherlands. The questionnaire was completed by 406 physicians, response rate 41%.</p> <p>Results</p> <p>Almost all physicians were aware of the most basal knowledge about opioids, e.g. that it is important for treatment purposes to distinguish nociceptive from neuropathic pain (97%). Approximately half of the physicians (46%) did not know that decreased renal function raises plasma concentration of morphine(-metabolites) and 34% of the clinical specialists erroneously thought opioids are the favoured drug for palliative sedation.</p> <p>Although 91% knew that opioids titrated against pain do not shorten life, 10% sometimes or often gave higher dosages than needed with the explicit aim to hasten death. About half felt sometimes or often pressured by relatives to hasten death by increasing opioiddosage.</p> <p>The large majority (83%) of physicians was interested in additional education about subjects related to the end of life, the most popular subject was opioid rotation (46%).</p> <p>Conclusions</p> <p>Although the basic knowledge of physicians was adequate, there seemed to be a lack of knowledge in several areas, which can be a barrier for good pain management at the end of life. From this study four areas emerge, in which it seems likely that an improvement can improve the quality of pain management at the end of life for many patients in the Netherlands: 1)palliative sedation; 2)expected effect of opioids on survival; and 3) opioid rotation.</p

Use of SMS texts for facilitating access to online alcohol interventions: a feasibility study

A41 Use of SMS texts for facilitating access to online alcohol interventions: a feasibility study In: Addiction Science & Clinical Practice 2017, 12(Suppl 1): A4

Quantitative modelling of why and how homeowners decide to renovate energy efficiently

Understanding homeowners' renovation decisions is essential for policy and business activity to improve the efficiency of owner-occupied housing stock. This paper develops, validates and applies a novel modelling framework for explaining renovation decisions, with an emphasis on energy efficiency measures. The framework is tested using quantitative data from a nationally-representative survey of owner-occupied households in the UK (n=1028). The modelling advances formal representations of renovation decisions by including background conditions of domestic life to which renovating is an adaptive response. Path analysis confirms that three conditions of domestic life are particularly influential on renovation decisions: balancing competing commitments for how space at home is used; signaling identity through homemaking activities; and managing physical vulnerabilities of household members. These conditions of domestic life also capture the influence of property characteristics (age, type) and household characteristics (size, composition, length of tenure) on renovation decisions but with greater descriptive realism. Multivariate probit models are used to provide rigorous, transparent and analytically tractable representations of the full renovation decision process. Model fits to the representative national sample of UK homeowners are good. The modelling shows that renovation intentions emerge initially from certain conditions of domestic life at which point energy efficiency is not a distinctive type of renovation. The modelling also shows clearly that influences on renovation decisions change through the decision process. This has important implications for policy and service providers. Efficiency measures should be bundled into broader types of home improvements, and incentives should target the underlying reasons why homeowners decide to renovate in the first place