PubMed · 10927695
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C Rayner. 2000. Informed consent.. https://doi.org/10.1054/bjps.2000.3403
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Changing Childbirth has been a central focus of maternity care policy in England. The objective of this study was to determine whether different professional groups involved in maternity care-hospital and community midwives, general practitioners and obstetricians-had different professional attitudes to a local implementation scheme. Data were obtained using a postal questionnaire, based on an agenda developed from focus groups. Whilst general practitioners appeared to be somewhat less optimistic than were midwives, there existed clear differences of opinion within the midwifery profession itself, depending upon whether the midwife worked in the community or in hospital. All professionals appeared conscious of the gap between the service ideals and the limited resources available to achieve them, and expressed uncertainty over future directions and ways of working.
We report the results of a cancer pain survey mailed to Quebec hematologist-oncologists and palliative care physicians in 1999. The survey was designed to sample views on the current status of pain management and on obstacles to the provision of adequate pain relief for patients. The survey, formulated by an ethics network centered at the Clinical Research Institute of Montreal, was distributed to all members of the Association of Hematologist-Oncologists of Quebec and to all physician members of the Quebec Palliative Care Association. Responses were obtained from 138 Palliative Care Association members (response rate 61%) and 76 hematologist-oncologists (response rate 45%). Major obstacles reported included inadequate assessment of both contributory psychosocial issues and severity of pain, patient reluctance to take opioids, and inadequate access to non-drug techniques for pain relief. Access to opioids was not regarded as a problem. Both groups felt generally competent in their ability to manage various aspects of cancer pain therapy. They gave little credit to their formal medical school or residency training. Fifty-six percent of the palliative care group and 57% of the hemato-oncologists rated their medical school experience as only "poor" or "fair" on a 4-point scale. Residency ratings were modestly better. We conclude that medical faculties should assign a high priority to teaching health professionals patient assessment techniques. Simple symptom assessment scales should be routinely used in oncology/palliative care practice. Medical school training in pain management is not highly regarded and should be enhanced. We also note that, based on response to the scenario of a patient presenting with severe pain, many physicians, while feeling competent in the use of opioids, may be overly conservative in their initial use.