Views and experiences of opioid access amongst palliative care providers and public representatives in a low-resource setting: a qualitative interview study.

Clark, Joseph

Abstract

Opioids (e.g. morphine) are affordable, effective interventions for cancer-related pain. However, equity of access to this key medication remains a global challenge, particularly in low- and middle-income countries. We aimed to explore views of palliative care providers and public-representatives about opioid analgesia access in two States in India. We conducted a qualitative study using semi-structured interviews. Transcribed audio-recordings were subjected to thematic analysis using a Framework Approach. Palliative care providers and public-representatives were purposively sampled from services reporting consistent opioid availability and prescribing (≥4kg per annum) from Karnataka and Kerala. Twenty participants (doctors (10), nurses (4), pharmacists (2), service managers (2) and public-representatives (2) were interviewed. Three themes were identified: 1) Attitudes and awareness: opioid treatments are perceived as end-of-life (last days/weeks) interventions; fears of addiction and misunderstanding of pain management goals limit access. 2) Expected and unexpected inequities: patients/carers from lower socioeconomic strata accept doctor recommendations if opioids are affordable, more educated patients/families have reservations about opioids, delay access and perceive expensive medicines as better. Non-palliative care specialist doctors have negative entrenched views and require specialist training. 3) Experiential learning – positive experiences can positively alter attitudes (e.g., participants in Kerala report improved attitudes, awareness and understanding influenced by exposure and community awareness, but experience can also reinforce perceptions as end-of-life care. Entrenched negative views are reinforced by poor experiences while positive experiences improve attitudes. To promote access, opioid prescribing must be needs-based rather than prognosis-based. Addressing the lack of training for non-palliative care workforce would help overcome a major barrier.

Citation

Clark, J. Views and experiences of opioid access amongst palliative care providers and public representatives in a low-resource setting: a qualitative interview study. [Dataset]

• Deposit Date: Jul 26, 2023
• Public URL: https://hull-repository.worktribe.com/output/4343089
• Type of Data: Anonymised interview transcripts (n=21).
• Collection Date: Jul 16, 2021
• Collection Method: Qualitative interview.
• Additional Information: Access to our data will be provided in response to reasonable requests by bona fide researchers once a contract is in place in order to protect the anonymity of our participants and their colleagues.; ; To request access, contact the study authors, or [e-mail].