Opioid analgesics for cancer pain: symptom control for the living or comfort for the dying? A qualitative study to investigate the factors influencing the decision to accept morphine for pain caused by cancer.

BACKGROUND: Morphine and other opioids are the mainstay of cancer pain management, yet considerable fears surrounding them present barriers to pain control. Research in groups already using opioids has examined their concerns, but there is little evidence about how patients react when first offered opioids. We explored the factors influencing the decision to accept or reject morphine when first offered to patients with cancer. PATIENTS AND METHODS: A qualitative in-depth interview study nested within a cancer pain management trial. Interviews were conducted with 18 patients (nine females), aged 42-88 years.
RESULTS: The categories that surrounded decisions about commencement of opioids were: anticipation of death; morphine as a last resort; the role of the professional; and 'no choice' but to commence. Participants rejected morphine as a medical intervention to control pain and promote quality of life because they saw it only as a comfort measure for the dying. However, opioids were more acceptable if health care providers had confidence in opioids and side-effects were well managed.
CONCLUSION: Among cancer patients the idea that opioids represent a comfort measure for the dying and not legitimate analgesics may represent a greater barrier to their uptake than concerns about tolerance or addiction.