Analgesic prescribing habits and patterns of Canadian chief urology residents: A national survey

INTRODUCTION: Prior studies have identified significant knowledge gaps in acute and chronic pain management among graduating urology residents as of five years ago. Since then, there has been increasing awareness of the impact of excessive opioid prescribing on long-term narcotic use and development of adverse narcotic-related events. However, it is unclear whether the attitudes and experience of graduating urology residents have changed. We set out to evaluate the attitudes and experience of graduating urology residents in prescribing opioid/non-opioid analgesia for acute (AP), chronic non-cancer (CnC), and chronic cancer (CC) pain. METHODS: Graduating urology residents were surveyed at a review course in 2018. The survey consisted of open-ended and close-ended five-point Likert scale questions. Descriptive statistics, Mann-Whitney U-test, and Student's t-test were performed. RESULTS: A total of 32 PGY5 urology residents completed our survey (92% response rate). The vast majority agreed that formal training in managing AP/CnC/CC to be valuable (91/78/81%). Most find their training in CnC/CC management to be inadequate and are unaware of any opioid prescribing guidelines; 66% never counsel patients on how to dispose of excess opioids. In general, 88% are comfortable prescribing opioids, whereas most are very uncomfortable prescribing cannabis or antidepressants (100%/78%). Residents reported the Acute Pain Service as the highest-rated resource for information, and dedicated textbooks the least. CONCLUSIONS: This survey demonstrated that experience in pain management remains variable among urology residents. Knowledge gaps remain, particularly in the management of chronic cancer/non-cancer pain.