Examining the attitudes and beliefs of family physicians toward the use of controlled-release opioids for the treatment of chronic non-malignant pain
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The purpose of this dissertation was to use a theoretical model to examine family physicians’ willingness to prescribe controlled-release opiate analgesics (CR opioids) to patients with moderate to severe chronic non-malignant pain (CNMP). The study explored the utility of the Theory of Planned Behavior (TPB) constructs (attitude, subjective norm, and perceived behavioral control), in addition to recent past behavior (RPB), in predicting physicians’ willingness to prescribe CR opioids to patients with CNMP. A web-based survey was developed from three structured focus group interviews, pretested, and e-mailed to 2,750 Texas family physicians. Based on responses from 267 physicians, the TPB constructs were significant predictors in assessing family physicians’ willingness to prescribe CR opioids for CNMP, accounting for 39 percent of the variance. Overall, two-thirds of physicians (N=179) indicated they were willing to prescribe CR opioids for CNMP. The attitude construct was found to be a key determinant of physicians’ willingness to prescribe. Physicians holding unfavorable attitudes tended to believe that prescribing CR opioids for CNMP would lead to patient abuse, addiction, and regulatory scrutiny. The subjective norm construct was also a significant predictor of physicians’ willingness. In general, a majority of physicians indicated that they were more likely to be influenced by regulatory agencies, pain specialty groups, other primary care physicians, and their patients when deciding whether to prescribe CR opioids for CNMP. The perceived behavioral control construct was also a significant predictor. Physicians indicated that possessing more knowledge in pain management, additional evidence-based studies, and access to pain management tools would improve their level of control over prescribing CR opioids for CNMP. The inclusion of recent past behavior significantly increased the explanatory power of the study model to 57 percent. In summary, this study identified some key factors that explained family physicians’ willingness to prescribe CR opioids for moderate to severe CNMP. Attitude, subjective norm, perceived behavioral control, and recent past behavior were strong predictors of physicians’ willingness. Factors identified from this study should be targeted to increase awareness and reduce the impact of barriers that affect prescribing of CR opioids for CNMP.