Patient‐related barriers to cancer pain management: a systematic exploratory review

Abstract

The aim of this review was to systemically explore the current evidence regarding patient-related barriers to cancer pain management to find new areas that might be important for better understanding of patient barriers' phenomenon. The method used in this study was a computerised literature search, carried out in Cochrane Library, Medline (through PubMed), Web of Science and EMBASE databases for the period 1994-2005. Thirty-seven studies, dealing with cognitive, sensory and affective patient-related barriers, as well as studies, describing patients' pain communication and their adherence to analgesic regimen were included and analysed. The dominant part of articles studied cognitive patient-related barriers to cancer pain management, while affective, sensory barriers, as well as pain communication and pain medication adherence were studied in much less extend. However, the findings from different studies regarding relationships between cognitive barriers and pain intensity were not consistent. On the contrary, the quality of pain communication was consistently found to be not satisfactory in some key areas. The associations between more expressed attitudinal as well as sensory barriers and less optimal adherence were also consistent. In conclusions suggestion for the new research areas on patient-related barriers to cancer pain management are made. Firstly, further research is needed to differentiate the role of cognitive, affective and sensory factors with respect to their impact on pain relief, pain communication and medication adherence. Besides that, validated instruments to assess patients' pain communication and adherence to analgesic regimen are lacking.

Patient and caregiver perspectives on managing pain in advanced cancer: A qualitative longitudinal study

“…Reported in systematic reviews 16,17 and qualitative synthesis 18 , these include: fear of addiction and side effects, the desire to be seen as a "good patient", beliefs that pain signifies progression of the cancer and that pain is inevitable. The underpinning theory is that attitudes and beliefs inform behaviour and lead to poor adherence to medication regimens that in turn give rise to sub-optimal pain relief.…”

Knowledge, beliefs, and concerns about opioids, palliative care, and homecare of advanced cancer patients: a nationwide survey in Japan

“…Among them, multiple empirical studies have identified knowledge, beliefs, or concerns about opioids, palliative care, and homecare in the general population and cancer patients as potential barriers for quality palliative care [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Many surveys have shown that incorrect knowledge about cancer pain and opioids could interfere with optimal pain management, especially an unrealistic fear of addiction and life-shortening [2][3][4][5][6][7].…”

Effectiveness of a Clinical Intervention to Eliminate Barriers to Pain and Fatigue Management in Oncology

“…1,2 Patients are reluctant to report their pain due to fear of side effects, fatalism about the possibility of achieving pain control, fear of distracting physicians from treating the cancer, and belief that pain is indicative of progressive disease. [3][4][5][6][7][8][9][10][11][12][13] Physicians, nurses, and other members of the interdisciplinary team often fail to adequately assess pain or to recognize patient barriers. [14][15][16][17][18] Professionals lack knowledge of the principles of pain relief, side effect management, or understanding of key concepts such as addiction, tolerance, dosing, and communication.…”