Attitudinal Barriers to Pain Management and Associated Factors Among Cancer Patients in Mainland China: Implications for Cancer Education

Journal of Cancer Education volume 35, pages284–291(2020)Cite this article

Abstract

Attitudinal barriers to pain management are supposed to contribute to the uncontrolled cancer pain in mainland China. The purpose of this study was (1) to investigate the attitudinal barriers to pain management among cancer patients in mainland China, (2) to examine relationships between the attitudinal barriers and patients’ pain management conditions in the light of medication adherence and adequacy of analgesic use, and (3) to identify factors associated with the attitudinal barriers. A cross-sectional questionnaire survey, including the Barriers Questionnaire-Chinese (BQ-C) and two scales that measure the medication adherence and the adequacy of analgesic use, was carried out among patients with a variety of cancers. The questionnaires were completed by 246 cancer patients (response rate 94.6%); their mean age was 51.5 years (SD = 11.7). Almost all the patients had various attitudinal barriers to pain management. The mean scores for the total scale and several subscales of the BQ-C were significantly different by the patients’ characteristics, the medication adherence, and the adequacy of analgesic use. The associations with these variables for a given subscale, e.g., the subscale regarding concerns about side effects, were different from those for other subscales, e.g., the subscale regarding fatalism that cancer pain is uncontrollable. The findings suggest that a nurse-led educational program in the light of patients’ characteristics is required for overcoming the attitudinal barriers to pain management among cancer patients in mainland China.

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References

  1. 1.

    van den Beuken-van MHJ, Hochstenbach LMJ, Joosten EAJ, Tjan-Heijnen VCG, Janssen DJA et al (2016) Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symp Manag 51(6):1070–1090

    Article  Google Scholar 

  2. 2.

    Ward SE, Goldberg N, Miller-McCauley V, Mueller C, Nolan A, Pawlik-Plank D, Robbins A, Stormoen D, Weissman DE (1993) Patient-related barriers to management of cancer pain. Pain 52(3):319–324

    CAS  Article  Google Scholar 

  3. 3.

    Lin C-C (2000) Barriers to the analgesic management of cancer pain: a comparison of attitudes of taiwanese patients and their family caregivers. Pain 88(1):7–14

    CAS  Article  Google Scholar 

  4. 4.

    Lin C-C, Ward SE (1995) Patient-related barriers to cancer pain management in Taiwan. Cancer Nurs 18 (1):16–22

    CAS  Article  Google Scholar 

  5. 5.

    Lin C-C, Wang P, Lai Y-L, Lin C-L, Tsai S-L, Chen TT (2000) Identifying attitudinal barriers to family management of cancer pain in palliative care in Taiwan. Palliat Med 14(6):463–470

    CAS  Article  Google Scholar 

  6. 6.

    Beck AT (1979) Cognitive therapy of depression. Guilford Press, New York

    Google Scholar 

  7. 7.

    Chen CH, Tang ST, Chen CH (2012) Meta-analysis of cultural differences in Western and Asian patient-perceived barriers to managing cancer pain. Palliat Med 26(3):206–221

    Article  Google Scholar 

  8. 8.

    Li Y-X, Yu J-Q, Tang L, Xu B, Fang F, Nie Hx-X, Dai X-Y, Zhang Y, Li L, Zhou L-J et al (2013) Cancer pain management at home: voice from an underdeveloped region of China. Cancer Nurs 36(4):326–334

    CAS  Article  Google Scholar 

  9. 9.

    Wills BSH, Wootton YSY (1999) Concerns and misconceptions about pain among Hong Kong Chinese patients with cancer. Cancer Nurs 22(6):408–413

    CAS  Article  Google Scholar 

  10. 10.

    Chung TK, French P, Chan S (1999) Patient-related barriers to cancer pain management in a palliative care setting in Hong Kong. Cancer Nurs 22(3):196–203

    CAS  Article  Google Scholar 

  11. 11.

    Xia Z (2017) Cancer pain management in China: current status and practice implications based on the acheon survey. J Pain Res 10:1943

    Article  Google Scholar 

  12. 12.

    Lu Y, You L, Ma S, Guo M, Li Z, Wen L (2004) The study of cancer patients’ concerns about pain treatments and their compliance (in Chinese). Chin J Pain Med 10(6):335–337

    Google Scholar 

  13. 13.

    Morisky DE, Green LW, Levine DM (1986) Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 24(1):67–74

    CAS  Article  Google Scholar 

  14. 14.

    Tzeng JI, Chang C-C, Chang H-J, Lin C-C (2008) Assessing analgesic regimen adherence with the Morisky Medication Adherence Measure for Taiwanese patients with cancer pain. J Pain Symptom Manag 36(2):157–166

    Article  Google Scholar 

  15. 15.

    Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA, Pandya KJ (1994) Pain and its treatment in outpatients with metastatic cancer. England J Med 330(9):592–596

    CAS  Article  Google Scholar 

  16. 16.

    Keppel G, Wickens T D (2004) Design and Analysis: A Researcher’s Handbook, 4th edn. Pearson Prentice Hall, Upper Saddle River

    Google Scholar 

  17. 17.

    Lou F, Shang S (2017) Attitudes towards pain management in hospitalized cancer patients and their influencing factors. Chin J Cancer Res 29(1):75

    Article  Google Scholar 

  18. 18.

    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

    Article  Google Scholar 

  19. 19.

    Jing W, Otten H, Sullivan L, Lovell-Simons L, Granek-Catarivas M, Fritzsche K (2013) Improving the doctor-patient relationship in China: the role of balint groups. Int J Psychiatry Med 46(4):417–427

    Article  Google Scholar 

  20. 20.

    Edrington J, Sun A, Wong C, Dodd M, Padilla G, Paul S, Miaskowski C (2009) Barriers to pain management in a community sample of Chinese American patients with cancer. J Pain Symptom Manag 37 (4):665–675

    Article  Google Scholar 

  21. 21.

    Zhao Y (2012) World class learners: Educating creative and entrepreneurial students. Corwin Press, Newbury Park

    Google Scholar 

  22. 22.

    Al-Atiyyat NMH, Vallerand AH (2018) Patient-related attitudinal barriers to cancer pain management among adult Jordanian patients. Europ J Oncol Nurs 33:56–61

    Article  Google Scholar 

  23. 23.

    Zhou L, Liu X-L, Tan J-Y, Yu H-P, Pratt J, Peng Y-Q (2015) Nurse-led educational interventions on cancer pain outcomes for oncology outpatients: a systematic review. Int Nurs Rev 62(2):218–230

    CAS  Article  Google Scholar 

  24. 24.

    Alnajar MK, Darawad MW, Alshahwan SS, Samarkandi OA (2017) Knowledge and attitudes toward cancer pain management among nurses at oncology units. J Cancer Educ. https://doi.org/10.1007/s13187-017-1285-5

    Article  Google Scholar 

  25. 25.

    Bouya S, Balouchi A, Maleknejad A, Koochakzai M, AlKhasawneh E, Abdollahimohammad A (2018) Cancer pain management among oncology nurses: knowledge, attitude, related factors, and clinical recommendations: a systematic review. J Cancer Educ. https://doi.org/10.1007/s13187-018-1433-6

    Article  Google Scholar 

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Acknowledgments

We thank all the cancer patients who participated in this study, and Dr. Sasahara Tomoyo for helpful suggestions.

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Affiliations

  1. Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, 305-8577, Japan

    Dongyan Zeng

  2. School of Nursing, Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China

    Dongyan Zeng, Kun Li & Xiyin Lin

  3. Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8577, Japan

    Michiyo Mizuno

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  1. Dongyan Zeng
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  2. Kun Li
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  3. Xiyin Lin
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  4. Michiyo Mizuno
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Correspondence to Kun Li.

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Zeng, D., Li, K., Lin, X. et al. Attitudinal Barriers to Pain Management and Associated Factors Among Cancer Patients in Mainland China: Implications for Cancer Education. J Canc Educ 35, 284–291 (2020). https://doi.org/10.1007/s13187-018-1463-0

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Keywords

  • Attitude
  • Pain management
  • Cancer
  • Barriers questionnaire
  • Mainland China