Prescribers’ experiences of, and attitudes to, use of morphine for palliative care at a tertiary hospital in Zambia

ABSTRACT

Objective

To explore medical doctors’ experiences of, and attitudes to, use of morphine for palliative care at a tertiary hospital in Zambia.

Methods

A qualitative, exploratory case study was undertaken. Semi-structured interviews were used to collect data from 14 medical doctors working in the fields of oncology, pediatrics, and internal medicine at a tertiary hospital in Lusaka, Zambia, regarding their experiences and attitudes to prescribing morphine for palliative care. Thematic analysis of interview transcripts was carried out to establish common themes in the data. The study was approved by BSMS and UNZA research ethics committees.

Results

All participants agreed that doctors were becoming more comfortable with the prescribing of morphine, although experiences were notably different for doctors working in oncology, compared to other departments. Themes of difficulty discussing end-of-life, poor recognition of pain, and fear of patient addiction, were more prominent in the responses of non-cancer doctors. Morphine use was generally restricted to cancer and sickle cell disease patients, with most non-cancer doctors stating that they rarely prescribe morphine for outpatient use. Training in pain management and the presence of a palliative care team were perceived to be facilitators to morphine prescribing.

Conclusions

Although there is an increased willingness to prescribe morphine, limited knowledge of pain management, especially for nonmalignant disease, underlies many of the findings in this study. Opportunity exists for professional development in pain management to further improve the acceptance and use of opioids in palliative care, especially for out-patients.

KEYWORDS:

• Morphine
• opioid
• palliative Care
• pain
• Zambia

Acknowledgments

The authors would like to acknowledge the academic support provided by the University of Zambia Department of Pharmacy and Brighton and Sussex Medical School. They would also like to personally thank Professor Brian Godman for his advice on journal selection for publication of this research, for which permission has been granted.

Author contributions

All authors were involved in the conception, design, and facilitation of the study, and the final approval of the version to be published. E.R was solely responsible for the collection, analysis, and interpretation of the data.

Declaration of interest

No potential conflict of interest was reported by the authors.

Declaration of financial/other relationships

At the time of data collection, contributors P. M and A. B were both employees of the health facility in which the study was conducted. E.R undertook this research while undertaking a master's degree in Global Health at Brighton and Sussex Medical School, UK.

Previous presentations

An abstract of this research was presented at the 5th Training Workshop and Symposium of the Medicine Utilization Research in Africa (MURIA) Group, held in Potchefstroom, South Africa, 8–11 July 2019.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

No sponsorship or funding was received for the undertaking of this study.