Patient-related barriers to management of cancer pain

Abstract

Patients' reluctance to report pain and to use analgesics are considered major barriers to pain management. To explore this problem, 270 patients with cancer completed a 27-item self-report questionnaire (BQ) that assessed the extent to which they have concerns about reporting pain and using pain medication. The 8 specific concerns included fear of addiction, beliefs that 'good' patients do not complain about pain, and concern about side effects. Patients also completed a measure of pain severity and pain interference (the BPI). The percentages of patients having concerns assessed by the BQ ranged from 37% to 85%. Those who were older, less educated, or had lower incomes were more likely to have concerns. Higher levels of concern were correlated with higher levels of pain. Based on their reports of pain medications used in the past week and on their reports of pain severity, patients were categorized as under-medicated versus adequately medicated. Those who were under-medicated reported significantly higher levels of concern. The data are discussed in terms of implications for research and practice.

Chinese version of the M. D. Anderson Symptom Inventory

“…Lack of such an instrument impedes successful symptom research and improvements in routine symptom management during cancer care. 2,25 The MDASI-C, the first validated multisymptom assessment tool in China, can be applied in both clinical practice and clinical trials to evaluate the effectiveness of treatment interventions and in epidemiologic studies to estimate the prevalence of symptoms. With psychometric properties comparable to those of the MDASI-J and the original MDASI, the MDASI-C should also be widely applicable in the United States, where Chinese-speaking persons are the second largest foreign-born resident group.…”

Psychometric properties of pain intensity scales comparing among postoperative adult patients, elderly patients without and with mild cognitive impairment in China

“…This may be due to that the older and less well-educated persons were not adequately informed about their rights to receive pain relief. Ward et al (1993) found that the misconceptions and barriers to effective pain management were found to be more in the subjects with fewer years' education.…”

Overcoming Barriers to Cancer Pain Management: An Institutional Change Model

“…4,8,10 In this study, we found that subjects who are currently receiving active treatment with chemotherapy were more reluctant to communicate their pain experience to their health care professionals. Future pain interventions with cancer patients, particularly those in active treatment, should address and facilitate the communication of symptoms between patient and health care professionals.…”

“…was developed by Ward and colleagues 8 to measure patient-reported barriers to pain management. Significant (t=−2.16, P<0.05) construct validity and a factor analysis revealed four factors: 1) physiologic effects, 2) fatalism, 3) communication, and 4) harmful effects.…”

“…3,4 Patients are reluctant to report their pain for reasons including fear of side effects, fatalism about the possibility of achieving pain control, fear of distracting physicians from treating cancer, and belief that pain is indicative of progressive disease. [4][5][6][7][8][9] There are also significant health care professional barriers to adequate pain relief. Physicians, nurses, and other members of the interdisciplinary team often fail to adequately assess the patient's pain or to recognize patient barriers.…”