Teaching Pain Management in Serious Illness in the Era of the Opioid Epidemic: A Team-Based Intervention

INTRODUCTION: Despite the prevalence of pain in patients with serious illness, recent guidelines for opioid prescribing practices have largely excluded palliative care patients. In lieu of such guidelines, many have recommended adapting risk mitigation strategies from the chronic pain arena for palliative care and oncology populations. Teaching interventions are needed to demonstrate how these methods can be applied to patients with serious illness. METHODS: We developed a teaching intervention for fourth-year medical students to improve knowledge about safe opioid prescribing practices in palliative care patients and emphasized both effective and safe pain management. A secondary aim of the intervention was to demonstrate how a palliative care interdisciplinary team works together to care for a complex patient near the end of life. The intervention lasted 1 hour and consisted of an interdisciplinary case presentation as well as a slide presentation. RESULTS: Twenty-two medical students attended the session over 2 years. After the intervention, medical students better understood risk mitigation strategies and felt more strongly that opioids can be a useful tool in treating pain for patients with serious illness. Students' familiarity with palliative care interdisciplinary roles also improved after the intervention. DISCUSSION: This session was a useful part of a palliative care 2-week classroom elective and was well received by students. The development of a survey tool that assesses student attitudes around effective and safe pain management in patients with serious illness may be of use to others who teach pain management in palliative care populations.