225 | P a g e 29. SYNNOTT 2015 [194]: Limited role in dealing with the cognitive, psychological and social factors - Concerns about training, expertise and exceeding professional scope of practice I don’t have the skills to influence psychosocial factors. I feel pessimism about the potential for therapy to help. It is beyond my professional role and scope of practice. I am pessimistic about these ‘difficult’ patients and this has an impact on my job satisfaction and confidence. HEALTHCARE PROFESSIONALS 30. TOYE 2017[197]: Walking a fine line We walk at a fine line. I have to balance the benefits and adverse effects. If I focus on the adverse it might lead to unnecessary pain on the other hand, I don’t want to cause harm or contribute to substance abuse. However, pain control is the priority. Misuse is better than pain. In theory a person’s age should not affect my decisions, but in practise, it does. What if they fell down the stairs and died? You have to assess on an individual basis. HEALTHCARE PROFESSIONALS 31. TOYE 2017[197]: Social guardianship Our culture is very hostile to opioid use and there is a professional taboo about prescribing opioids. I am worried about being judged by peers. I have a personal responsibility to protect society from the consequences of opioid misuse. I am worried that they will give opioids to others. I am suspicious if someone loses their prescription or requests more opioids. However, this might actually mean that pain is out of control. I have to make the decision whether the pain is real. HEALTHCARE PROFESSIONALS 32. TOYE 2017[197]: Should I, shouldn‘t I? I am uncertain about when to prescribe opioids and don’t know about the effects. Other doctors seem to make different decisions. Am I wrong? It is even more difficult if I don’t know why they have pain. My clinical education did not prepare me for this. Specialist referrals are restricted or unproductive. I need more support in my decisions. HEALTHCARE PROFESSIONALS
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