Background: Effective pain management is closely related to nurses' knowledge and attitudes toward pain. Limited studies have been performed related to nurses' knowledge and attitudes toward pain in hospitals in low-income areas. Aims: This study surveyed the knowledge and attitudes of nurses toward pain management in county hospitals from low-income areas in Hunan Province, China. Setting and participants: The study included 4,668 registered nurses working in 48 county hospitals in low-income areas in China. Methods: A cross-sectional study examined the knowledge and attitudes of nurses with regard to pain using the Chinese version of the Knowledge and Attitude Survey Regarding Pain (KASRP) via the WeChat application. Results: The 4,668 registered nurses completed the survey; of these, 43.6% indicated they had never received continuing education for pain. The mean percentage score for KASRP was (40.3 ± 7.95), and none of the respondents achieved a percentage score of >80%. Further, of the 40 items, only two had a correct rate of >80%. Continuing pain education did not significantly affect KASRP. Multiple stepwise linear regression showed that education level, ethnicity, professional title, position, and department were independent influencing factors for KASRP scores. Conclusion: Almost all nurses in county hospitals of low-income areas had deficiencies in various aspects of pain management knowledge. Better educated nurses with higher professional title or management position, those from the Han ethnicity, and those from the oncology department had higher mean KASRP scores. Current continuing education programs for pain did not improve the pain management capability of the nurse. High-quality and standardized pain educational programs should be implemented to improve pain management.

ObjectiveThe purpose of this qualitative study was to describe the experiences of pain acceptance in Chinese cancer patients with chronic pain.MethodsTwelve hospitalized cancer patients with chronic pain participated in this qualitative descriptive study from August to November 2017. In-person semi-structured interviews were conducted, recorded, transcribed, and analyzed using Colaizzi’s seven-step method.ResultsThe following four main themes and 15 subthemes emerged. Theme 1 (adaptation): pain is overwhelming and pain relief is a top priority, avoidance of pain-inducing factors, and resignation; theme 2 (emotional reactions to pain): feeling misunderstood, hopelessness, frustration, irritability, and concern for loved ones; theme 3 (functional limitations): daily life activities, social communication, and work; theme 4 (coping strategies): pharmacological therapies, behavioral strategies, social support strategies, and spiritual strategies.ConclusionsThis study provides a description of cancer patients’ experiences related to the need for pain acceptance. These findings provide insight into the essential role of pain acceptance and underline the need to apply acceptance-based cognitive behavioral interventions as adjunctive non-pharmacological alternatives for chronic cancer pain.

Background. Pain acceptance is associated with disability, pain interference, depression, and anxiety. Few studies have been conducted on the acceptance of cancer pain and its correlates. Objectives. The aim of this study was to examine the level and correlates of pain acceptance in cancer patients from mainland China. Setting and Participants. The study comprised 156 cancer patients in a tertiary cancer hospital in Hunan Province of China. Design. The study is based on a cross-sectional survey design. Subjects and Methods. The 8-item Chronic Pain Acceptance Questionnaire (CPAQ-8) was completed by 156 cancer patients with chronic pain from a tertiary cancer hospital. Demographics, pain, and negative mood assessed by the Hospital Anxiety and Depression Scale (HADS) were explored in relation to the CPAQ-8 scores using descriptive univariate analysis. Results. For the 156 patients, the mean CPAQ-8 score was 25.99 (SD = 8.56; range: 9 to 44). The scores were associated with age, gender, marital status, pain duration, number of pain sites, and duration of taking analgesics. The total scores on the CPAQ-8 and its two subscales (activity engagement and pain willingness) were negatively correlated with the HADS scores. Conclusions. The findings suggest that the prevalence of pain acceptance is relatively low for Chinese cancer patients. The cancer pain acceptance is affected by age, gender, pain duration, number of pain sites, and duration of taking analgesics. The acceptance of cancer pain is negatively correlated with depression and anxiety. Therefore, patients with risk factors for low pain acceptance should receive more attention in Chinese medical settings.

Background Cancer-related chronic pain is reported by many patients during treatment. There are very few Chinese tools for measuring psychological inflexibility caused by cancer pain, particularly with regard to psychological processes that might influence pain severity and function disorder during cancer treatment. Objective To culturally adapt the Psychological Inflexibility in Pain Scale (PIPS) to Chinese cancer patients experiencing chronic pain, including the determination of psychometric properties of the translated PIPS. Methods This cross-sectional study included 2 phases: (1) translation and cultural adaptation and (2) determination of psychometric properties of the translated PIPS. In total, 389 cancer patients with several types of cancer experiencing chronic pain enrolled from May to September 2018 at a tertiary cancer hospital in Yuelu District of Hunan Province, China. Results The Chinese PIPS version was semantically equivalent to the original. It had a 2-factor structure with satisfactory content validity (content validity index = 0.78–1.00), convergent and discriminant validity (composite reliability and average variance extracted at 0.41–0.89, P < .001), criterion-related validity ( r = 0.54 and 0.41, P < .001), Cronbach’s α coefficients ( α = .87), and test-retest reliability (0.9 ≤ r ≤ 0.98). Conclusions The Chinese PIPS version has been culturally adapted and has strong psychometric properties. The scale is a psychometrically sound assessment of psychological inflexibility that can be used for future studies of pain and pain management for cancer patients. Implications for Practice The study provides a vital tool for the psychological management of cancer patients with chronic pain.

Objective:To translate the English work-related acceptance and action questionnaire (WAAQ), make cross-cultural adaptations, and examine its psychometric properties when used by Chinese oncology nurses.Methods:After translation, the psychometric properties of the Chinese WAAQ were analyzed among 417 nurses, and content validity was determined by six experts.Results:Item-level content validity index (CVI) values were between 0.83 and 1.00; scale-level CVI/universal agreement (S-CVI/UA) and S-CVI/average were 0.86 and 0.98, respectively, which implicated a good content validity. The correlation of the Chinese WAAQ with AAQ-II (rs = −0.247, P < 0.001) suggested criterion validity, and those with General Health Questionnaire-12 (−0.250, <0.001) and general self-efficacy scale (0.491, <0.001) and Utrecht work engagement scale (UWES) (0.439, <0.001) suggested convergent validity. Exploratory factor analysis identified a seven-item, one-factor structure of WAAQ. The Chinese version of WAAQ had high internal consistency (Cronbach's α = 0.920), with an item-total correlation coefficient of 0.702–0.828 (P < 0.05), split-half reliability of 0.933, and test-retest reliability of 0.772.Conclusions:The Chinese WAAQ is a reliable and valid tool for assessing psychological flexibility in Chinese oncology nurses.

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The Cancer-related Psychological Flexibility Questionnaire (CPFQ) was developed and validated for assessing cancer patients’ psychological flexibility, including attitudes and behavior toward cancer. In a systematic process, the CPFQ identified four factors through principal component analysis and confirmatory factor analysis: Cancer Acceptance, Cancer Avoidance, Activity Engagement, and Valued Action. The results of this study reveal that the CPFQ has a clear factor structure and good psychometric properties. The specific nature of cancer and the need for a specific measure of cancer patient psychological flexibility make this questionnaire valuable for research on psychological flexibility in cancer patients.

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