Nurses’ knowledge, perceived barriers, and practices regarding cancer pain management: a cross-sectional study from Palestine

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Abstract

Background

Accurate knowledge and good pain evaluation and documentation practices should be present for efficient pain management. In this study, we aimed to assess the knowledge and practices of nurses relating to the management of cancer pain in Palestine, and to determine the barriers to efficient pain control in cancer patients.

Methods

A cross-sectional survey took place at 8 hospitals across Northern West Bank. A convenience sample of 220 Nurses working in governmental and private hospitals in West Bank/Palestine was studied. For that purpose, a questionnaire was developed to assess knowledge, practices, perceived barriers, and delaying processes relating to cancer pain management (CPM).

Results

In total, 220 questionnaires were completed with a response rate of 88%. Participants’ mean age was 30.34 years. Overall, 69.5% worked in governmental hospitals, 26.8% worked in the private sector and the remainder worked in both governmental and private sectors. The correct response rate to questions that assess knowledge relating to cancer pain control was calculated and a mean knowledge score was found to be 5.1 with a standard deviation of 2.1. A relationship between the knowledge score and the sample characteristics was made and showed that males scored significantly higher ( p = 0.001) than females with median scores of 6 [4–7] and 5 [3–6] for males and females, respectively. Inadequate pain assessment (76.8%), insufficient knowledge of pain control (70.5%) and strict regulation on opioid use (69.5%) were the most frequently perceived barriers. Nurses reported that they would assess pain on every round and check all items related to pain assessment. Contacting the physician for the prescription of opioids was cited as the main delaying process by 56.4% of participants.

Conclusions

This study allowed us to recognise the knowledge deficit and the barriers to effective management. On the other hand, the analysis has shown good pain documentation practices among nurses. Those knowledge deficits demonstrate the need for more education about CPM. The improvement of coordination and communication between physicians and nurses seems to play a crucial role in CPM, as contacting physicians was cited as the most delaying process in CPM by nurses.

Electronic supplementary material

The online version of this article (10.1186/s12909-019-1613-z) contains supplementary material, which is available to authorized users.

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Most cited references 19

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Physician attitudes and practice in cancer pain management. A survey from the Eastern Cooperative Oncology Group.

K Pandya, C Cleeland, R Gonin … (1993)

The Eastern Cooperative Oncology Group (ECOG) conducted a groupwide survey to determine the amount of knowledge about cancer pain and its treatment among physicians practicing in ECOG-affiliated institutions and to determine the methods of pain control being used by these physicians. Survey. A questionnaire was sent to all ECOG physicians with patient care responsibilities (medical oncologists, hematologists, surgeons, and radiation therapists), practicing in university institutions, Community Clinical Oncology Program (CCOP) institutions, and Cooperative Group Outreach Programs (CGOP) institutions. A physician cancer pain questionnaire developed by the Pain Research Group at the University of Wisconsin was used. The questionnaire was designed to assess physicians' estimates of the magnitude of pain as a specific problem for cancer patients, their perceptions of the adequacy of cancer pain management, and their report of how they manage pain in their own practice setting. The study analyzed responses to 897 of 1800 surveys. In regard to the use of analgesics for cancer pain in the United States, 86% felt that the majority of patients with pain were undermedicated. Only 51% believed pain control in their own practice setting was good or very good; 31% would wait until the patient's prognosis was 6 months or less before they would start maximal analgesia. Adjuvants and prophylactic side-effect management should have been used more frequently in the treatment plan. Concerns about side-effect management and tolerance were reported as limiting analgesic prescribing. Poor pain assessment was rated by 76% of physicians as the single most important barrier to adequate pain management. Other barriers included patient reluctance to report pain and patient reluctance to take analgesics (both by 62%) as well as physician reluctance to prescribe opioids (61%). Professional education needs to focus on the proper assessment of pain, focus on the management of side effects, and focus on the use of adjuvant medications. A better understanding of the pharmacology of opioid analgesics is also needed. Physicians also need to educate patients to report pain and to effectively use the medications that are prescribed for pain management.

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Cancer pain management according to WHO analgesic guidelines.

Stephan Schug, Detlev Zech, Ulrike Dörr (1990)

On admission to a pain management unit, 92.5% of 174 cancer patients suffered from more than moderate pain despite prior treatment. This inefficacy was mainly due to underdosage of drugs, inadequate intake schedule, and hesitation to use strong opioids. Following introduction of an oral drug therapy based on World Health Organization (WHO) guidelines, more than 80% of all patients described their pain as ranging between "none" and "moderate" on a six-step verbal rating scale at all times. To obtain these results, it was necessary to adapt the therapy to increasing pain in the course of terminal disease. Step III (strong opioids) gained more and more importance with time, and step I (nonopioids) was finally useful only in a minority of patients. Side effects played a minor role as a reason to change therapy. Oral drug therapy following these guidelines led to sufficient pain control in most patients over the whole study period (7,400 days); only 11% of the patients required other methods of pain management.

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A survey on physician knowledge and attitudes towards clinical use of morphine for cancer pain treatment in China.

W Ling, Liu Chang, ZHANG LEI … (2010)

The WHO's three-step guideline for cancer pain management has been introduced in China; however, there remain large differences in the standards of cancer pain management between China and other developed countries. This survey was carried out to determine the degree of physician knowledge on morphine use and the factors that impede morphine use in clinical practice in China. A self-reported questionnaire was designed and administered to randomly selected physicians in four tertiary hospitals in the cities of Changchun and Changsha in China. Statistical analyses were conducted using SPSS statistical software. Two hundred and one clinical physicians participated in the survey. Physicians who reported having received training in cancer pain management and drug use demonstrated a significantly higher mean score of basic knowledge compared to physicians who reported not having received training (9.31 ± 2.88:8.23 ± 2.70, u = 2.74, p < 0.001). The top three cited impediments to widespread clinical use of morphine for cancer pain were: (1) lack of professional knowledge and training; (2) fear of opioid addiction; and (3) physicians' personal preferences to select other drugs. Medical staffs lack the basic knowledge and harbor misconceptions about the clinical use of morphine for cancer pain treatment. Creating training opportunities for medical staffs is necessary to increase their awareness and knowledge of effective cancer pain management.

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Author and article information

Contributors

Haneen A. Toba: Haneen_toba@yahoo.com

Ahmad M. Samara: ahmadmsamara15@gmail.com

Sa’ed H. Zyoud:

ORCID: http://orcid.org/0000-0002-7369-2058

saedzyoud@yahoo.com , saedzyoud@najah.edu

Journal

Journal ID (nlm-ta): BMC Med Educ

Journal ID (iso-abbrev): BMC Med Educ

Title: BMC Medical Education

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6920

Publication date (Electronic): 23 May 2019

Publication date PMC-release: 23 May 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 167

Affiliations

[1 ]ISNI 0000 0004 0631 5695, GRID grid.11942.3f, Department of Medicine, College of Medicine and Health Sciences, , An-Najah National University, ; Nablus, 44839 Palestine

[2 ]ISNI 0000 0004 0631 5695, GRID grid.11942.3f, Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, , An-Najah National University, ; Nablus, 44839 Palestine

[3 ]ISNI 0000 0004 0631 5695, GRID grid.11942.3f, Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, , An-Najah National University, ; Nablus, 44839 Palestine

Author information

Sa’ed H. Zyoud http://orcid.org/0000-0002-7369-2058

Article

Publisher ID: 1613

DOI: 10.1186/s12909-019-1613-z

PMC ID: 6533684

PubMed ID: 31122222

SO-VID: d45ed5f3-5862-4cd1-bde2-001c74e3b2e1

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 23 February 2018

Date accepted : 17 May 2019

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ScienceOpen disciplines: Education

Keywords: cancer pain,nurses,knowledge,practices,perceived barriers,palestine

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ScienceOpen disciplines: Education

Keywords: cancer pain, nurses, knowledge, practices, perceived barriers, palestine

Nurses’ knowledge, perceived barriers, and practices regarding cancer pain management: a cross-sectional study from Palestine

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Most cited references 19

Physician attitudes and practice in cancer pain management. A survey from the Eastern Cooperative Oncology Group.

Cancer pain management according to WHO analgesic guidelines.

A survey on physician knowledge and attitudes towards clinical use of morphine for cancer pain treatment in China.

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