Home » Research » Palliative Care Research Studies » Problematic Opioid Use

Problematic Opioid Use - Transatlantic comparison of how physicians identify at risk patients

Research Project Title

A transatlantic study to explore the attitudes of palliative care physicians regarding the identification of problematic opioid use among patients with advanced cancer.


Problematic opioid use, International, Advanced Cancer, Palliative Care


Opioids are an integral component in the management of moderate to severe cancer-related pain and breathlessness in patients with advanced cancer. Problematic opioid use is a term used to describe a dysfunctional behaviour in relation to opioid use. This includes when a person uses opioids which have not been prescribed for them or uses them in a manner that is not instructed or intended by their doctor or pharmacist. It also includes using illegal opioids. There is growing evidence illustrating that problematic opioid use poses a more significant risk to patients with advanced cancer than previously believed. The management of opioid related risk in the palliative care context has been highlighted as an important area for future research. This includes the need for palliative care physicians to employ strategies to identify those at risk of problematic opioid use in their clinical practice. A number of risk factors for the development of problematic opioid use in patients receiving palliative care have been identified by expert consensus. It is unclear, however, if or how palliative care physicians interpret and utilise these factors in their clinical practice. It is also unclear if geographical and cultural contexts influence palliative care physicians’ attitudes towards problematic opioid use. The majority of work to date in this area has originated from North American centres in the context of the opioid epidemic and little is known about the respective attitudes of palliative care physicians in North America and Europe, and whether there are differences or commonalities in their awareness and identification of the risk of problematic opioid use among patients with advanced cancer.

Research Project aims and methods

This research project aims to assess and compare the attitudes of palliative care physicians in Ireland, the United Kingdom, the United States of America and Canada regarding the identification of patients with advanced cancer who have, or are at risk of, problematic opioid use.

This will be performed via a physician survey consisting of basic demographic information followed by patient vignettes (hypothetical clinical cases) embedded with risk factors felt to indicate patients who are at high risk of having or developing problematic opioid use. This series of clinical vignettes have been developed using the fractional factorial survey approach. In this survey respondents review vignettes that have been made with a varying number and combination of risk factors. They are then asked to indicate (on a scale) if they feel this hypothetical patient would be at risk for problematic opioid use. In order to ensure all the risk factor combinations feature, 64 separate vignettes were created. This is too many for each clinician to review and therefore a fractional factorial technique was employed where each clinician answers a portion of the total number of vignettes. This approach is widely used in healthcare as it is believed to more closely reflect real-life behaviours and scenarios than traditional questionnaires and surveys, through the incorporation of more complex considerations, and by limiting socially desirable responses.

Taking part:  This study is open to Palliative care physicians currently practising as consultant or staff physicians in Ireland, the United Kingdom, the United States of America and Canada who prescribe or advise in the prescribing of opioid medications for patients with advanced cancer.  If you are eligible, and would like to take part, you can do so at this link.

Public, patient and personal involvement (PPI)

Our PPI plan is currently being reviewed, and we look forward to updating this section shortly.

Key Findings & Recommendations

Data Collection ongoing


October 2022 – April 2024

Research Team

This is a collaborative study between Marymount University Hospital and Hospice in Cork, Ireland and the Princess Margaret Cancer Centre in Toronto, Canada with additional sites including the Oxford University Hospital Foundation Trust (United Kingdom) and MD Anderson Cancer Centre (United States of America).

Research Team:
Dr Fiona Kiely – Consultant Physician in Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland.

Dr Jenny Lau – Medical Director, Harold and Shirley Lederman Palliative Care Centre, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.

Dr Jessica Lee – Specialist Trainee in Palliative Medicine, Ireland.

Dr Aoife Lowney – Consultant Physician in Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland.

Dr Breffni Hannon – Palliative Care Site Lead, Princess Margaret Cancer Centre; Assistant Professor, Department of Medicine, Divisions of Palliative Medicine and Medical Oncology, University of Toronto, Canada.

Dr Mary Miller – Consultant in Palliative Medicine, Oxford University Hospitals NHS Trust, United Kingdom.

Dr Joseph Arthur – Associate Professor, Department of Palliative Care and Rehabilitation Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.

Funding & Support

This study was awarded the International Collaborative Research Grant issued by the Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), the University of Toronto Division of Palliative Medicine (DPM), and the Dalla Lana School of Public Health (DLSPH) in October 2023.

Research Project Outputs:

For Further Information Contact: