Knowledge, Attitudes and Barriers of Physicians, Policy Makers/regulators regarding Use of Opioids for Cancer Pain Management in Thailand

The efficacy of opioids for cancer pain has been proven and the World Health Organization (WHO) three-step ladder has been recommended for cancer pain relief. However, undertreatment of cancer pain has still been reported in Thailand. Identification of barriers to opioid use by the physicians and policy makers/regulators, and their level of knowledge and attitudes concerning its use are influential factors for cancer pain management (CPM). This study was performed to assess the knowledge and attitudes physicians and policy makers/regulators have regarding use of opioids for CPM. Barriers to opioid availability were also studied. A self-administered questionnaire was mailed to 300 physicians and distributed to 58 policy makers/regulators from September to October 2011. A total of 219 physicians and 47 policy makers/ regulators completed the questionnaire. Of the physicians 62.1% had inadequate knowledge and 33.8% had negative attitudes. Physicians who did not know the WHO three-step ladder were more likely to have less knowledge than those having used the WHO three-step ladder (OR = 13.0, p < 0.001). Policy makers/regulators also had inadequate knowledge (74.5%) and negative attitudes (66.0%). Policy makers/ regulators who never had CPM training were likely to have more negative attitudes than those having had training within less than one year (OR = 35.0, p = 0.005). Lack of training opportunities and periodic shortages of opioids were the greatest barriers to opioid availability for physicians and policy makers/ regulators, respectively. The strengthening of ongoing educational programs regarding opioid use for CPM, and cooperation among key groups are needed.