Opioid-related challenges faced by palliative health care providers in both hospital and home care settings: A multi-center based descriptive cross-sectional study

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.

背景：姑息治疗（Palliative Care）致力于通过有效的疼痛管理缓解患者病痛、提升生活质量。尽管该疗法已获得全球广泛认可，但在孟加拉国却面临诸多严峻挑战。低收入国家普遍存在医疗可及性不足与监管壁垒等问题。在孟加拉国，阿片类药物（Opioid）使用量显著偏低，且城乡之间存在显著差距。文化污名化、监管管控以及医护人员培训的缺失，进一步掣肘了有效的疼痛管理实践。
方法：本项多中心描述性横断面研究（multicenter-based descriptive cross-sectional study）旨在探究姑息治疗医护人员所面临的精神心理挑战。研究于2022年8月至9月期间开展，通过面对面半结构化访谈（face-to-face semi-structured interviews），从160名持证医护人员中收集研究数据。
结果：多数受访者年龄介于20-39岁之间（占比57%），提示该年轻医护队伍可能受到当代医学教育的影响。性别分布偏向女性（占比68.9%），这与全球医护行业的整体趋势相符。绝大多数受访者负责接诊晚期癌症患者（占比98.5%），凸显了阿片类药物在姑息治疗中的核心作用。疼痛（100%）为最主要的临床症状，进一步强调了阿片类药物在症状管理中的核心地位。吗啡糖浆（68.1%）为临床首选药物，而羟考酮与丁丙诺啡则因供应问题从未被使用。深度镇静（43.7%）与成瘾（34.1%）等不良反应，凸显了阿片类药物使用过程中的潜在挑战，亟需开展严密监测。仅10.4%的受访者了解阿片类药物使用的国家政策与指南，这导致医护人员的临床实践与态度存在不一致，进而影响患者照护质量与安全。约60.7%的受访者支持处方限制政策，而配药权主要由SSNs与药剂师掌握，此类问题加剧了临床运营挑战，并可能影响患者获得充分疼痛管理的机会。由于将姑息治疗误解为临终关怀（占比32.6%）以及科室间协作不畅（占比38.5%），患者转诊面临重重困难，这一沟通壁垒阻碍了患者的顺畅转诊与照护连续性。
结论：对阿片类药物政策的知晓不一致，导致医护人员的态度与临床实践存在差异。患者转诊困难与处方限制反映出系统性壁垒，亟需多学科解决方案以改善患者转归。应对这些挑战需要采取综合干预策略，例如强化阿片类药物使用相关教育培训、优化政策传播与普及、推进多学科协作以及制定标准化指南，以确保姑息治疗场景下阿片类药物的安全规范管理。