BackgroundOpioid pain management in cancer survivorship is a complex and understudied topic.MethodsThe authors conducted in‐depth, qualitative interviews to understand clinician approaches to opioid pain management in chronic cancer pain and to generate ideas for improvement. They used a rigorous, inductive, qualitative, descriptive approach to examine clinician (n = 20) perspectives about opioid pain management in survivorship, including oncologists (n = 5), palliative care clinicians (n = 8), primary care clinicians (n = 5), and pain management specialists (n = 2).ResultsThe findings indicated that no consistent medical home exists for chronic pain management in cancer survivors and that there are fundamental differences in how each subspecialty approaches chronic pain management in survivorship (e.g., “Do we think of this as noncancer pain or cancer pain?… This is in this limbo zone—this gray zone—because it's cancer‐related pain, right?”). Simultaneously, clinicians are influenced by their peers' perceptions of their opioid prescribing decisions, sparking intraprofessional tension when disagreement occurs. In these instances, clinicians described overthinking and doubting their clinical decision‐making as well as a sense of judgment, pressure, and/or shame. Finally, clinicians acknowledged a fear of consequences for opioid prescribing decisions. Specifically, participants cited conflict with patients, sometimes escalating to aggression and threats of violence, as well as potential disciplinary actions and/or legal consequences.ConclusionsParticipants suggested that opportunities to improve chronic cancer pain care include developing clear, systematic guidance for chronic cancer pain management, facilitating clinician communication and consultation, creating tailored survivorship care plans in partnership with patients, and developing accessible, evidence‐based, complementary pain treatments.

中文翻译：

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“开药还是不开药，这就是问题”：治疗生存期疼痛的临床医生对阿片类药物治疗慢性癌症相关疼痛的看法

背景癌症生存中的阿片类药物疼痛管理是一个复杂且尚未得到充分研究的话题。方法作者进行了深入的定性访谈，以了解临床医生在慢性癌症疼痛中阿片类药物疼痛管理的方法，并产生改进的想法。他们使用严格的、归纳的、定性的、描述性的方法来检查临床医生（n= 20) 关于生存中阿片类药物疼痛管理的观点，包括肿瘤学家（n= 5), 姑息治疗临床医生 (n= 8), 初级保健临床医生 (n= 5) 和疼痛管理专家 (n= 2).结果研究结果表明，对于癌症幸存者的慢性疼痛管理，不存在一致的医疗机构，并且每个亚专科在幸存者中处理慢性疼痛的方式存在根本差异（例如，“我们认为这是非癌性疼痛还是癌症性疼痛”）疼痛？……这是在这个边缘地带——这个灰色地带——因为它是与癌症相关的疼痛，对吧？”）。同时，临床医生会受到同行对阿片类药物处方决定的看法的影响，当出现分歧时会引发专业内部的紧张气氛。在这些情况下，临床医生描述想太多怀疑他们的临床决策以及判断力、压力和/或羞耻感。最后，临床医生承认他们担心阿片类药物处方决定的后果。具体来说，参与者提到了与患者的冲突，有时升级为攻击和暴力威胁，以及潜在的纪律处分和/或法律后果。结论参与者认为，改善慢性癌症疼痛护理的机会包括为慢性癌症疼痛管理制定明确、系统的指导，促进临床医生的沟通和咨询，与患者合作制定量身定制的生存护理计划，并开发易于使用的、基于证据的补充性疼痛治疗方法。