Media Watch 538

Attached is the current issue of Media Watch (#538).

Of particular Interest:

Appeal to physicians – opioids have their place. Let’s avoid an unintended tragedy

CANADIAN MEDICAL ASSOCIATION JOURNAL | Online – 6 November 2017 – A well-known tragedy has occurred with respect to opioids – the crisis of overdose deaths from opioids that were obtained from various legitimate and illegitimate sources. This has necessitated urgent government and public action. A second, preventable tragedy is beginning to occur as an unintended consequence of the first. The stigma around opioid use has become so strong that patients, families, and health care practitioners are afraid to receive or prescribe them, leaving patients to suffer unnecessarily. We are referring specifically to palliative care (PC), a context where opioids are sometimes the most appropriate choice for pain and dyspnea management. This is clearly outlined in the Society’s ‘Position Statement on Access to Opioids for Patients Requiring Palliative Care.’1 The ‘Canadian Guideline for Opioids for Chronic Non-Cancer Pain’ made recommendations for opioid prescribing in the chronic non-cancer pain population based on a systematic review of the literature specific to that population.2 The guideline clearly states that exceptions are appropriate under some circumstances, including PC and cancer pain. Unfortunately, many physicians have misunderstood the guideline to apply to all patients, including those appropriately receiving a palliative approach to care. Many physicians have expressed reluctance to prescribe opioids for such patients, even those approaching the end of their lives. Some physicians have stopped ordering opioids altogether. Unaddressed and unnecessary suffering is the result. The Society believes patients with palliative needs who require appropriately prescribed opioids to manage symptoms should not have opioids withheld in an attempt to adhere to guidelines that are meant for a different patient population, or due to fear of regulatory oversight. 

     1. ‘Position Statement on Access to Opioids for Patients Requiring Palliative Care,’ Canadian Society of Palliative Care Physicians, August 2016. [Noted in Media Watch 15 August 2016 (#475, p.1)] 

     2. ‘The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain,’ College of Family Physicians of Canada, May 2017. 


What can we learn from simulation-based training to improve skills for end-of-life care? Insights from a national project in Israel

ISRAEL JOURNAL OF HEALTH POLICY RESEARCH | Online – 6 November 2017 – Simulation-based training of healthcare providers is an interesting and promising method to improve quality of end-of-life care (EoLC). A series of unanticipated consequences emerged: One participant conducted a study of preparedness to end of life (EoL) at nursing homes1 ... that was presented at the Ministry of Health and called forth a national survey of preparedness to EoL at hospitals. As a result, many institutions enacted guidelines and set up palliative care (PC) units. Participants spread by word of mouth the value of training for EoLC – resulting in demands for workshops from different disciplines: intensive care, dialysis, oncology, emergency and family medicine. Electronic media (including TV channels), newspapers and magazines covered the topic of EoLC with reference to the authors’ workshops. They are invited each year to present insights from their project in lectures at dozens of national professional conferences, PC courses, research seminars, and institutional staff meetings as well as at general public audiences. While the authors cannot determine causality, coverage by media and public discourse led in recent years to the erection of several national committees for improved policy, training and regulation of EoLC.