Abstract
Purpose
The purpose of this study was to evaluate patient-related attitudinal barriers and identify associated factors in Chinese cancer inpatients receiving opioids and to explore relationships between patient-related attitudinal barriers, analgesic adherence and pain relief.
Methods
A cross-sectional study was conducted. A total of 146 participants completed face-to-face surveys, including information about demographics, the Barriers Questionnaire-Chinese (BQ-C), analgesic adherence, average pain and breakthrough pain in the past 24 h. The Mann-Whitney U test and Kruskal-Wallis test were performed to test the differences in the attitudinal barrier scores between the adherence and nonadherence groups, the complete and incomplete pain relief groups and the groups based on demographics.
Results
The majority of participants in this study were men (67.8%), over half of all participants were less than 60 years old, gastrointestinal cancer (47.3%) was the most common diagnosis and 59 (40.4%) acquired comprehensive pain education from the last discharge guidance procedure. The total BQ-C mean (SD) score was 1.61 ± 0.94. A total of 87 (59.6%) patients with cancer pain were completely relieved. Most of the patients (73.3%) completely took analgesics by orders. There was no significant difference in the total BQ-C score between the adherence group and the nonadherence group (P > 0.05), but the difference was significant between the complete pain relief group and the incomplete pain relief group (P < 0.05).
Conclusion
The findings of this study support unsatisfactory pain management and moderate analgesic adherence for Chinese inpatients. It is suggested that patient-related attitudinal barriers do not play an undermining role in pain management by negatively affecting patients’ analgesic adherence. Conversely, patients’ beliefs are more likely to be shaped by under treatment rather than as a cause.
Similar content being viewed by others
References
National Comprehensive Cancer Network. NCCN Guidelines Version 1.2019 Adult Cancer Pain. Available from: https://www.nccn.org/professionals/physiciangls/default.aspx#age.
van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J (2007) Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 18(9):1437–1449. https://doi.org/10.1093/annonc/mdm056
Kwon JH (2014) Overcoming barriers in cancer pain management. J Clin Oncol 32(16):1727–1733. https://doi.org/10.1200/jco.2013.52.4827
Gunnarsdottir S, Sigurdardottir V, Kloke M, Radbruch L, Sabatowski R, Kaasa S, Klepstad P (2017) A multicenter study of attitudinal barriers to cancer pain management. Support Care Cancer 25(11):3595–3602. https://doi.org/10.1007/s00520-017-3791-8
Valeberg BT, Miaskowski C, Paul SM, Rustøen T (2016) Comparison of oncology patients' and their family caregivers' attitudes and concerns toward pain and pain management. Cancer Nurs 39(4):328–334. https://doi.org/10.1097/ncc.0000000000000319
Gunnarsdottir S, Donovan HS, Serlin RC, Voge C, Ward S (2002) Patient-related barriers to pain management: the Barriers Questionnaire II (BQ-II). Pain 99(3):385–396. https://doi.org/10.1016/s0304-3959(02)00243-9
Jung Hye K, Sung Yong O, Gary C, Jung-Ae L, Jae Jin L, Keon Woo P, Seung-Hyun N, Hun Ho S, Keehyun L, Dae Young Z (2013) Predictors of high score patient-reported barriers to controlling cancer pain: a preliminary report. Support Care Cancer 21(4):1175–1183. https://doi.org/10.1007/s00520-012-1646-x
Al-Atiyyat NMH, Vallerand AH (2018) Patient-related attitudinal barriers to cancer pain management among adult Jordanian patients. Eur J Oncol Nurs 33:56–61. https://doi.org/10.1016/j.ejon.2018.01.009
Shu-Yuan L, Kang-Pan C, Shiow-Luan T, Shu-Fang W, Yeu-Hui C, Tsae-Jyy W, Heng-Hsin T, Su-Fen C (2013) Relationship between belief about analgesics, analgesic adherence and pain experience in Taiwanese cancer outpatients. Asian Pac J Cancer Prevent Apjcp 14(2):713–716. https://doi.org/10.7314/APJCP.2013.14.2.713
Yeur-Hur L, Keefe FJ, Wei-Zen S, Lee-Yuan T, Ping-Ling C, Jeng-Fong C, Ling-Ling W (2002) Relationship between pain-specific beliefs and adherence to analgesic regimens in Taiwanese cancer patients: a preliminary study. J Pain Symptom Manag 24(4):415–423. https://doi.org/10.1016/S0885-3924(02)00509-2
Ward S, Goldberg N, Miller-McCauley V, Mueller C, Nolan A, Pawlik-Plank D, Robbins A, Stormoen D, Weissman D (1993) Patient-related barriers to management of cancer pain 52:319–324. https://doi.org/10.1016/0304-3959(93)90165-L
Lu Y, Youhui G, Yu W (2018) Hospice and palliative care in China: development and challenges. Asia-Pac J Clin Oncol 5(1):26–32. https://doi.org/10.4103/apjon.apjon_72_17
Zeng D, Li K, Lin X, Mizuno M (2019) Attitudinal barriers to pain management and associated factors among cancer patients in mainland China: implications for cancer education. J Cancer Educ. https://doi.org/10.1007/s13187-018-1463-0
Berrett-Abebe J, Levin-Russman E, Gioiella ME, Adams JM (2016) Parental experiences with a hospital-based bereavement program following the loss of a child to cancer. Palliat Support Care 15(3):11. https://doi.org/10.1017/S1478951516000821
Lin CC (2004) Effect of cancer pain on performance status, mood states, and level of hope among Taiwanese cancer patients. J Palliat Care 20(3):240–240. https://doi.org/10.1016/S0885-3924(02)00542-0
Du Pen SL, Du Pen AR, Polissar N, Hansberry J, Kraybill BM, Stillman M, Panke J, Everly R, Syrjala K (1999) Implementing guidelines for cancer pain management: results of a randomized controlled clinical trial. J Clin Oncol 17(1):361–370. https://doi.org/10.1200/jco.1999.17.1.361
Chang MC, Chang YC, Chiou JF, Tsou TS, Lin CC (2002) Overcoming patient-related barriers to cancer pain management for home care patients. A pilot study. Cancer Nurs 25(6):470–476. https://doi.org/10.1097/00002820-200212000-00012
Yates PM, Edwards HE, Nash RE, Walsh AM, Fentiman BJ, Skerman HM, Najman JM (2002) Barriers to effective cancer pain management: a survey of hospitalized cancer patients in Australia. J Pain Symptom Manag 23(5):393–405. https://doi.org/10.1016/S0885-3924(02)00387-1
Bagcivan G, Tosun N, Komurcu S, Akbayrak N, Ozet A (2009) Analysis of patient-related barriers in cancer pain management in Turkish patients. J Pain Symptom Manag 38(5):727–737. https://doi.org/10.1016/j.jpainsymman.2009.03.004
Meghani S (2013) Do self-reported analgesic barriers translate into objective analgesic adherence for cancer pain? J Pain 14(4):S38. https://doi.org/10.1016/j.jpain.2013.01.447
Ree D, Sellers DE, Spross JA, Jablonski ES, Hoyer DR, Solomon MZ (2005) Do patients' beliefs act as barriers to effective pain management behaviors and outcomes in patients with cancer-related or noncancer-related pain? Oncol Nurs Forum 32(2):363–374. https://doi.org/10.1188/05.ONF.363-374
Jacobsen R, Samsanaviciene J, Liuabarskiene Z, Sciupokas A (2010) Barriers to pain management among Lithuanian cancer patients. Pain Practice 10(2):145–157. https://doi.org/10.1111/j.1533-2500.2009.00333.x
Huang Y (2014) Clinical Epidemiology. Chaoyang, Beijing
Lu Y, Guan S, Ma S (2006) Effect evaluation behavior of attitude toward pain treatment for patients with cancer by health education. J Nurs Train 21(8):685–687
Yuhan L, Fan C, Yuhan L (2017) Cancer pain nursing. In: Palliative nursing: a practical guide for oncology nurses. Haidian, Beijing, p 41. https://doi.org/10.3969/j.issn.1002-6975.2006.08.006
Pain Treatment Quality Control and Improvement Center Cancer Pain Expert Group (2017) Cancer pain management standard in Beijing. Chin J Pain Med 23(12):881–889. https://doi.org/10.3969/j.issn.1006-9852.2017.12.001
Lou F, Shang S (2017) Attitudes towards pain management in hospitalized cancer patients and their influencing factors. Chin J Cancer Res 29(1):75–85. https://doi.org/10.21147/j.issn.1000-9604.2017.01.09
Lu Y, Ma S (2005) The survey of cancer patients’ concerns about pain treatment. J Nurs Train 20(10):882–884
Chen L, Miaskowski C, Dodd M, Pantilat S (2008) Concepts within the Chinese culture that influence the cancer pain experience. Cancer Nurs 31(2):103–108. https://doi.org/10.1097/01.ncc.0000305702.07035.4d
Chung J, Wong T, Jc (2000) The lens model: assessment of cancer pain in a Chinese context. Cancer Nurs 23 (6):454-461. https://doi.org/10.1097/00002820-200012000-00008
Huang Z, Zheng Y, Peng P, Xu D, Wang J (2009) Investigation into characteristics and treatment of cancer pain in Shanghai: a questionnaire survey in 2007. Cancer 29(12):992–996. https://doi.org/10.3781/j.issn.1000-7431.2009.10.016
Pang Y, Tang L, Song L (2013) A survey on malignant tumor pain patients and their family members. Chin J Pain Med 19(6):350–353. https://doi.org/10.3969/j.issn.1006-9852.2013.06.007
Cleary J, Radbruch L, Torode J, Cherny NI (2013) Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Asia: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 24(Supplement 11):24–32. https://doi.org/10.1093/annonc/mdt499
Manjiani D, Paul DB, Kunnumpurath S, Kaye AD, Vadivelu N (2014) Availability and utilization of opioids for pain management: global issues. Ochsner J 14(2):208–215
Meghani SH, Thompson AML, Chittams J, Bruner DW, Riegel B (2015) Adherence to analgesics for cancer pain: a comparative study of African Americans and Whites using an electronic monitoring device. J Pain 16(9):825–835. https://doi.org/10.1016/j.jpain.2015.05.009
Chou PL, Fang SY, Sun JL, Rau KM, Lee BO (2017) Gender difference in cancer patients' adherence to analgesics and related outcomes of pain management. Cancer Nurs 11:181–186. https://doi.org/10.1097/NCC.0000000000000532
Thomason TE, Mccune JS, Bernard SA, Winer EP, Tremont S, Lindley CM (1998) Cancer pain survey: patient-centered issues in control. J Pain Symptom Manag 15(5):275–284. https://doi.org/10.1016/S0885-3924(98)00016-5
Du PA, Du PS, Hansberry J, Millerkraybill B, Millen J, Everly R, Hansen N, Syrjala K (2000) An educational implementation of a cancer pain algorithm for ambulatory care. Pain Manag Nursing 1(4):116–128. https://doi.org/10.1053/jpmn.2000.19333
Ward S, Gatwood J (1994) Concerns about reporting pain and using analgesics. A comparison of persons with and without cancer. Cancer Nurs 17(3):200–206. https://doi.org/10.1097/00002820-199406000-00004
Ersek M, Kraybill BM, Pen AD (2010) Factors hindering patients' use of medications for cancer pain. Cancer Pract 7(5):226–232. https://doi.org/10.1046/j.1523-5394.1999.75007.x
Hackett J, Godfrey M, Bennett MI (2016) Patient and caregiver perspectives on managing pain in advanced cancer: a qualitative longitudinal study. Palliat Med 30(8):711–719. https://doi.org/10.1177/0269216316628407
Funding
This work was supported by Beijing Hospitals Authority (PX2017052).
Author information
Authors and Affiliations
Contributions
YHL, XXM, HY and WHY designed the study.
XXM, HY, WHY, XTH, RXG, YW and YRZ collected the clinical data.
YHL and XXM contributed to the data analysis and data interpretation.
XXM wrote the manuscript.
YHL approved the last version of the manuscript.
All the authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ma, X., Lu, Y., Yang, H. et al. Relationships between patient-related attitudinal barriers, analgesic adherence and pain relief in Chinese cancer inpatients. Support Care Cancer 28, 3145–3151 (2020). https://doi.org/10.1007/s00520-019-05082-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-019-05082-8