Opioid-related challenges faced by palliative health care providers in both hospital and home care settings: A multi-center based descriptive cross-sectional study
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Background: Palliative care is dedicated to mitigating suffering and enhancing the quality of life primarily through the effective pain management. Despite being globally recognition it faces significant challenges in Bangladesh. Low-income countries face difficulties with accessibility and regulatory barriers. In Bangladesh, opioid consumption is strikingly low, with notable disparities between urban and rural areas. Cultural stigmas, regulatory controls, and a lack of healthcare provider training further impede effective pain management. Method: This multicenter-based, descriptive cross-sectional study aims to explore the psycho-spiritual challenges faced by palliative care providers. Data was collected from 160 licensed healthcare providers, through face-to-face semi-structured interviews conducted from August to September 2022. Result: Most respondents are aged 20-39 years (57%), suggesting a young workforce likely influenced by contemporary medical education. The gender distribution skews towards females (68.9%), reflecting trends in healthcare professions. Predominantly, respondents manage late-stage cancer patients (98.5%), highlighting opioids' critical role in palliative care. Pain (100%) is the primary symptom, emphasizing opioids' centrality in symptom management. Morphine syrup (68.1%) is favored, while Oxycodone and Buprenorphine are never used due to availability issues. Side effects like deep sedation (43.7%) and addiction (34.1%) underscore the challenges in opioid use, necessitating careful monitoring. Limited awareness (10.4%) of national policies and guidelines on opioid use leads to inconsistent practices and attitudes among healthcare providers, impacting patient care and safety. Issues with prescribing restrictions (60.7% support) and dispensing rights (predominantly SSNs, pharmacists) contribute to operational challenges and may influence patient access to adequate pain management. Challenges in patient referral due to misconceptions about palliative care (32.6%) as end-of-life and non-cooperation (38.5%) between departments highlight communication gaps that hinder seamless patient transitions and continuity of care. Conclusion: Inconsistencies in awareness about opioid policies lead to different attitudes and practices. Difficulties in referring patients and restrictions on prescribing reflect systemic barriers that require interdisciplinary solutions for better patient outcomes. Tackling these challenges involves comprehensive strategies, such as improved education on opioid use, better dissemination of policies, interdisciplinary collaboration, and standardized guidelines to ensure safe and effective opioid management in palliative care settings.
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Study design and settings, sample size, and criteria: This research was a descriptive cross-sectional study involving 135 participants selected using the census method from an estimated staff population of 148. Data collection occurred from August to September 2022. The study focused on licensed healthcare providers, including doctors, nurses, palliative care assistants, ward staff, and PCAs actively involved in clinical patient care, with at least one year of experience in providing palliative care in various healthcare facilities in Dhaka City, Bangladesh. The study excluded providers who were physically or mentally unfit or not involved in clinical patient care. Data was collected from BSMMU, Dhaka Medical College & Hospital, Delta Medical College & Hospital, National Institute of Cancer Research Hospital, and community-based palliative care projects of BSMMU in collaboration with WHPCA in Korail and Narayanganj City Corporation. Field data was verified immediately post-interview. Data collection process and analysis: Face-to-face semi-structured interviews were conducted based on predetermined variables. The questionnaire was developed in English and then translated into Bangla. The private interviews lasted about 30 minutes each, and participation was voluntary. Data processing involved categorizing, coding, summarizing, and entering data into SPSS software. Categorical and numerical variables, by using 5-point Likert scale, were treated separately: a "Never" response was scored as "0," a "Almost never" as "1," “Sometimes” as “2”, “Fairly often” as “3” and "Very often " as "4." Descriptive statistics were used for qualitative and quantitative variables, while inferential statistics were applied to determine relationships among variables.