ABSTRACT: Clinicians’ Attitudes and Beliefs About Opioids Survey (CAOS): Instrument Development and Results of a National Physician Survey
Beliefs surrounding the use of opioids for chronic noncancer pain have vacillated over time. Concerns regarding long-term efficacy and adverse effects of opioids, along with increases in opioid prescribing, have contributed to many political, regulatory, and clinical responses. The present study was designed to 1) develop a reliable and valid measure (Clinicians’ Attitudes about Opioids Scale [CAOS]) to assess current and evolving beliefs regarding opioids and opioid use in patients with chronic pain; and 2) survey these beliefs in a nationally representative sample of providers from multiple medical specialties throughout the United States. We developed the questionnaire in 3 phases: 1) focus groups and content development; 2) pilot testing and subsequent revisions; and 3) formal survey (N = 1,535) and assessment of stability (N = 251). The resulting 38-item measure assessed 5 domains: 1) Impediments and Concerns; 2) Perceived Effectiveness; 3) Schedule II versus III Opioids; 4) Medical Education; and 5) Tamper Resistant Formulations. No significant differences were identified among geographical regions; however, several differences were observed among medical specialties. Orthopedists were most troubled by impediments/concerns from long-term opioid use and had the least confidence in opioid efficacy, whereas Pain Medicine specialists and Physical Medicine and Rehabilitation specialists were the most confident in efficacy. PERSPECTIVE: This article presents the psychometric properties of a new measure of clinicians’ beliefs surrounding opioid use for chronic pain. Using this measure, beliefs and behaviors of physicians across medical specialties and geographic regions using a nationally representative sample are presented, updating findings from a similar survey conducted 20 years ago.