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Published in: Journal of Cancer Education 2/2020

Open Access 01-04-2020 | Addiction

Managing Pain in People with Cancer—a Systematic Review of the Attitudes and Knowledge of Professionals, Patients, Caregivers and Public

Authors: Salim M. Makhlouf, Simon Pini, Shenaz Ahmed, Michael I. Bennett

Published in: Journal of Cancer Education | Issue 2/2020

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Abstract

Cancer pain is a common symptom experienced by patients, caused either by the disease or its treatment. Morphine remains the most effective and recommended treatment for cancer pain. However, cancer patients still do not receive appropriate management for their pain, and under-treatment is common. Lack of knowledge and negative attitudes towards cancer pain and analgesia among professionals, patients and family caregivers are reported as one of the most common barriers to effective cancer pain management (CPM). To systematically review research on the nature and impact of attitudes and knowledge towards CPM, a systematic literature search of 6 databases (the Cochrane library, MEDLINE, PsycINFO, CINAHL, Web of Science and EMBASE) was undertaken in July 2018. Additionally, hand-searching of Google, Google Scholar and reference lists was conducted. The inclusion criteria were adult (18–65 years of age), studies which included attitudes and knowledge towards CPM, studies written in English, published literature only and cross-sectional design. Included studies were critically appraised by two researchers independently using the Joanna Briggs Institute Analytical Cross Sectional Studies Assessment (JBI-ACSSA). A total of 36 studies met the inclusion criteria. The main finding was that among professionals, patients, caregivers and the public there were similar attitudinal barriers to effective CPM. The most commonly cited barriers were fear of drug addiction, tolerance of medication and side effects of opioids. We also found differences between professional groups (physicians versus nurses) and between different countries based on their potential exposure to palliative care training and services. There are still barriers to effective CPM, which might result in unrelieved cancer pain. Therefore, more educational programmes and training for professionals on CPM are needed. Furthermore, patients, caregivers, and the public need more general awareness and adequate level of knowledge about CPM.
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Literature
5.
go back to reference Alnems A (2012) Oncology nurses’ cultural competence, knowledge, and attitudes toward cancer pain. Published doctoral thesis, San Diego, Ann Arbor, USA Alnems A (2012) Oncology nurses’ cultural competence, knowledge, and attitudes toward cancer pain. Published doctoral thesis, San Diego, Ann Arbor, USA
7.
go back to reference American Cancer Society (2011) Global Cancer: facts & figures. American Cancer Society, Atlanta Accessed 11 Oct 2016 American Cancer Society (2011) Global Cancer: facts & figures. American Cancer Society, Atlanta Accessed 11 Oct 2016
10.
go back to reference Bennett MI, Graham J, Schmidt-Hansen M, Prettyjohns M, Arnold S (2012) Prescribing strong opioids for pain in adult palliative care: summary of NICE guidance. BMJ:344 Bennett MI, Graham J, Schmidt-Hansen M, Prettyjohns M, Arnold S (2012) Prescribing strong opioids for pain in adult palliative care: summary of NICE guidance. BMJ:344
15.
go back to reference Burls A (2009) Evidence-based medicine: what is critical appraisal? Hayward Medical Communications Burls A (2009) Evidence-based medicine: what is critical appraisal? Hayward Medical Communications
16.
go back to reference Butler A, Hall H, Copnell B (2016) A guide to writing a qualitative systematic review protocol to enhance evidence-based practice in nursing and health care. Worldviews Evid-Based Nurs 13(3):241–249CrossRef Butler A, Hall H, Copnell B (2016) A guide to writing a qualitative systematic review protocol to enhance evidence-based practice in nursing and health care. Worldviews Evid-Based Nurs 13(3):241–249CrossRef
17.
go back to reference Centre for Reviews and Dissemination. 2009. Systematic reviews: CRD’s guidance for undertaking reviews in health care. York: Centre for Reviews & Dissemination, University of York Centre for Reviews and Dissemination. 2009. Systematic reviews: CRD’s guidance for undertaking reviews in health care. York: Centre for Reviews & Dissemination, University of York
19.
go back to reference Cohen MZ, Musgrave CF, McGuire DB, Strumpf NE, Munsell MF, Mendoza TR, Gips M (2005) The cancer pain experience of Israeli adults 65 years and older: the influence of pain interference, symptom severity, and knowledge and attitudes on pain and pain control. Support Care Cancer 13(9):708–714. https://doi.org/10.1007/s00520-005-0781-z CrossRefPubMed Cohen MZ, Musgrave CF, McGuire DB, Strumpf NE, Munsell MF, Mendoza TR, Gips M (2005) The cancer pain experience of Israeli adults 65 years and older: the influence of pain interference, symptom severity, and knowledge and attitudes on pain and pain control. Support Care Cancer 13(9):708–714. https://​doi.​org/​10.​1007/​s00520-005-0781-z CrossRefPubMed
20.
go back to reference Colak D, Oguz A, Yazilitas D, Imamoglu IG, Altinbas M (2014) Morphine: patient knowledge and attitudes in the Central Anatolia part of Turkey. Asian Pac J Cancer Prev 15(12):4983–4988CrossRef Colak D, Oguz A, Yazilitas D, Imamoglu IG, Altinbas M (2014) Morphine: patient knowledge and attitudes in the Central Anatolia part of Turkey. Asian Pac J Cancer Prev 15(12):4983–4988CrossRef
27.
go back to reference Eftekhar Z, Mohaghegh MA, Yarandi F, Eghtesadi-Araghi P, Moosavi-Jarahi A, Gilani MM, Tabatabeefar M, Toogeh G, Tahmasebi M (2007) Knowledge and attitudes of physicians in Iran with regard to chronic cancer pain. Asian Pac J Cancer Prev 8(3):383–386PubMed Eftekhar Z, Mohaghegh MA, Yarandi F, Eghtesadi-Araghi P, Moosavi-Jarahi A, Gilani MM, Tabatabeefar M, Toogeh G, Tahmasebi M (2007) Knowledge and attitudes of physicians in Iran with regard to chronic cancer pain. Asian Pac J Cancer Prev 8(3):383–386PubMed
31.
go back to reference Ferlay J, Shin H-R, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127(12):2893–2917CrossRef Ferlay J, Shin H-R, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127(12):2893–2917CrossRef
32.
go back to reference Furstenberg CT, Ahles TA, Whedon MB, Pierce KL, Dolan M, Roberts L, Silberfarb PM (1998) Knowledge and attitudes of health-care providers toward cancer pain management: a comparison of physicians, nurses, and pharmacists in the state of New Hampshire. J Pain Symptom Manag 15(6):335–349. https://doi.org/10.1016/S0885-3924(98)00023-2 CrossRef Furstenberg CT, Ahles TA, Whedon MB, Pierce KL, Dolan M, Roberts L, Silberfarb PM (1998) Knowledge and attitudes of health-care providers toward cancer pain management: a comparison of physicians, nurses, and pharmacists in the state of New Hampshire. J Pain Symptom Manag 15(6):335–349. https://​doi.​org/​10.​1016/​S0885-3924(98)00023-2 CrossRef
33.
go back to reference Gallagher R, Hawley P, Yeomans W (2004) A survey of cancer pain management knowledge and attitudes of British Columbian physicians. Pain Res Manag 9(4):188–194CrossRef Gallagher R, Hawley P, Yeomans W (2004) A survey of cancer pain management knowledge and attitudes of British Columbian physicians. Pain Res Manag 9(4):188–194CrossRef
35.
go back to reference Goldsmith MR, Bankhead CR, Austoker J (2007) Synthesising quantitative and qualitative research in evidence-based patient information. J Epidemiol Community Health 61(3):262–270CrossRef Goldsmith MR, Bankhead CR, Austoker J (2007) Synthesising quantitative and qualitative research in evidence-based patient information. J Epidemiol Community Health 61(3):262–270CrossRef
37.
go back to reference Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto S, Apolone G (2014) Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Clin Oncol 32(36):4149–4154CrossRef Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto S, Apolone G (2014) Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Clin Oncol 32(36):4149–4154CrossRef
38.
go back to reference Hollen CJ, Hollen CW, Stolte K (2000) Hospice and hospital oncology unit nurses: a comparative survey of knowledge and attitudes about cancer pain. Oncol Nurs Forum 27(10):1593–1599PubMed Hollen CJ, Hollen CW, Stolte K (2000) Hospice and hospital oncology unit nurses: a comparative survey of knowledge and attitudes about cancer pain. Oncol Nurs Forum 27(10):1593–1599PubMed
39.
go back to reference Hooten WM, Bruce BK (2011) Beliefs and attitudes about prescribing opioids among healthcare providers seeking continuing medical education. J Opioid Manag 7(6):417–424CrossRef Hooten WM, Bruce BK (2011) Beliefs and attitudes about prescribing opioids among healthcare providers seeking continuing medical education. J Opioid Manag 7(6):417–424CrossRef
40.
go back to reference Howell D, Butler L, Vincent L, Watt–Watson J, Stearns N (2000) Influencing nurses’ knowledge, attitudes, and practice in cancer pain management. Cancer Nurs 23(1):55–63CrossRef Howell D, Butler L, Vincent L, Watt–Watson J, Stearns N (2000) Influencing nurses’ knowledge, attitudes, and practice in cancer pain management. Cancer Nurs 23(1):55–63CrossRef
41.
go back to reference Huang H-Y, Wilkie DJ, Chapman CR, Ting L-L (2003) Pain trajectory of Taiwanese with nasopharyngeal carcinoma over the course of radiation therapy. J Pain Symptom Manag 25(3):247–255CrossRef Huang H-Y, Wilkie DJ, Chapman CR, Ting L-L (2003) Pain trajectory of Taiwanese with nasopharyngeal carcinoma over the course of radiation therapy. J Pain Symptom Manag 25(3):247–255CrossRef
42.
go back to reference Jacobsen, Ramune, Sjogren P, Moldrup C, Christrup L (2007) Physician-related barriers to cancer pain management with opioid analgesics: a systematic review. J Opioid Manag 3(4):207–214CrossRef Jacobsen, Ramune, Sjogren P, Moldrup C, Christrup L (2007) Physician-related barriers to cancer pain management with opioid analgesics: a systematic review. J Opioid Manag 3(4):207–214CrossRef
46.
go back to reference Kassa RN, Kassa GM (2014) Nurses’ attitude, practice and barrier s toward cancer pain management, Addis Ababa, Ethiopia. J Cancer Sci Ther 6(12):483–487 Kassa RN, Kassa GM (2014) Nurses’ attitude, practice and barrier s toward cancer pain management, Addis Ababa, Ethiopia. J Cancer Sci Ther 6(12):483–487
47.
go back to reference Keefe FJ, Abernethy AP, C. Campbell L (2005) Psychological approaches to understanding and treating disease-related pain. Annu Rev Psychol 56:601–630CrossRef Keefe FJ, Abernethy AP, C. Campbell L (2005) Psychological approaches to understanding and treating disease-related pain. Annu Rev Psychol 56:601–630CrossRef
49.
go back to reference Lai Y-H, Chen M-L, Tsai L-Y, Lo L-H, Wei L-L, Hong M-Y, Hsiu L-N, Hsiao-Sheen S-T, Chen S-C, Kao C-C, Huang T-W, Chang S-C, Chen L, Guo S-L (2003) Are nurses prepared to manage cancer pain? A national survey of nurses' knowledge about pain control in Taiwan. J Pain Symptom Manag 26(5):1016–1025. https://doi.org/10.1016/S0885-3924(03)00330-0 CrossRef Lai Y-H, Chen M-L, Tsai L-Y, Lo L-H, Wei L-L, Hong M-Y, Hsiu L-N, Hsiao-Sheen S-T, Chen S-C, Kao C-C, Huang T-W, Chang S-C, Chen L, Guo S-L (2003) Are nurses prepared to manage cancer pain? A national survey of nurses' knowledge about pain control in Taiwan. J Pain Symptom Manag 26(5):1016–1025. https://​doi.​org/​10.​1016/​S0885-3924(03)00330-0 CrossRef
53.
go back to reference Liberati, Alessandro, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100CrossRef Liberati, Alessandro, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100CrossRef
54.
go back to reference 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):7–14CrossRef 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):7–14CrossRef
56.
go back to reference Lockwood C, Munn Z, Porritt K (2015) Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. Int J Evid Based Healthcare 13(3):179–187CrossRef Lockwood C, Munn Z, Porritt K (2015) Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. Int J Evid Based Healthcare 13(3):179–187CrossRef
61.
go back to reference McDarby G, Evans DS, Kiernan R (2017) Patient barriers to adequate analgesia among Irish palliative care patients. J Palliat Care Pediatr McDarby G, Evans DS, Kiernan R (2017) Patient barriers to adequate analgesia among Irish palliative care patients. J Palliat Care Pediatr
62.
go back to reference Meeker MA, Finnell D, Othman AK (2011) Family caregivers and cancer pain management: a review. J Fam Nurs 17(1):29–60CrossRef Meeker MA, Finnell D, Othman AK (2011) Family caregivers and cancer pain management: a review. J Fam Nurs 17(1):29–60CrossRef
63.
go back to reference Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097CrossRef Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097CrossRef
64.
go back to reference Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, Currie M et al (2017) Systematic reviews of etiology and risk. In: Aromataris E, Munn Z (eds) Joanna Briggs Institute Reviewer’s Manual. The Joanna Briggs Institute Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, Currie M et al (2017) Systematic reviews of etiology and risk. In: Aromataris E, Munn Z (eds) Joanna Briggs Institute Reviewer’s Manual. The Joanna Briggs Institute
65.
go back to reference Narayan MC (2010) Culture's effects on pain assessment and management. AJN The American Journal of Nursing 110(4):38–47CrossRef Narayan MC (2010) Culture's effects on pain assessment and management. AJN The American Journal of Nursing 110(4):38–47CrossRef
67.
go back to reference O’Brien S, Dalton JA, Konsler G, Carlson J (1996) The knowledge and attitudes of experience oncology nurses regarding the management of cancer-related pain. Oncol Nurs Forum 23(3):515–521PubMed O’Brien S, Dalton JA, Konsler G, Carlson J (1996) The knowledge and attitudes of experience oncology nurses regarding the management of cancer-related pain. Oncol Nurs Forum 23(3):515–521PubMed
70.
go back to reference Omran S, Al Qadire M, Ali NAL, Al Hayek MF (2014) Knowledge and attitudes about pain management: a comparison of oncology and non-oncology Jordanian nurses. Nurs Health 2(4):73–80 Omran S, Al Qadire M, Ali NAL, Al Hayek MF (2014) Knowledge and attitudes about pain management: a comparison of oncology and non-oncology Jordanian nurses. Nurs Health 2(4):73–80
72.
go back to reference Pearson A, Robertson-Malt S, Rittenmeyer L (2011) Synthesizing qualitative evidence. Lippincott-Joanna Briggs Institute, Philadelphia Pearson A, Robertson-Malt S, Rittenmeyer L (2011) Synthesizing qualitative evidence. Lippincott-Joanna Briggs Institute, Philadelphia
73.
go back to reference Portenoy RK, Lesage P (1999) Management of cancer pain. Lancet 353(9165):1695–1700CrossRef Portenoy RK, Lesage P (1999) Management of cancer pain. Lancet 353(9165):1695–1700CrossRef
74.
go back to reference Poudel P, Griffiths R, Wong VW, Arora A, Flack JR, Khoo CL, George A (2018) Oral health knowledge, attitudes and care practices of people with diabetes: a systematic review. BMC Public Health 18(1):577CrossRef Poudel P, Griffiths R, Wong VW, Arora A, Flack JR, Khoo CL, George A (2018) Oral health knowledge, attitudes and care practices of people with diabetes: a systematic review. BMC Public Health 18(1):577CrossRef
75.
go back to reference Reis-Pina P, Lawlor PG, Barbosa A (2015) Cancer-related pain management and the optimal use of opioids. Acta Medica Port 28(3):376–381CrossRef Reis-Pina P, Lawlor PG, Barbosa A (2015) Cancer-related pain management and the optimal use of opioids. Acta Medica Port 28(3):376–381CrossRef
77.
go back to reference Riddell A, Fitch MI (1997) Patients’ knowledge of and attitudes toward the management of cancer pain. Oncol Nurs Forum 24(10):1775–1784PubMed Riddell A, Fitch MI (1997) Patients’ knowledge of and attitudes toward the management of cancer pain. Oncol Nurs Forum 24(10):1775–1784PubMed
78.
go back to reference Riesenberg LA, Justice EM (2014) Conducting a successful systematic review of the literature, part 1. Nursing2018 44(4):13–17CrossRef Riesenberg LA, Justice EM (2014) Conducting a successful systematic review of the literature, part 1. Nursing2018 44(4):13–17CrossRef
82.
go back to reference Salim, Nazar, Nijmeh, Al-Attyat, Tuffaha M, Hadan AN, Brant J (2017) Knowledge and attitude of oncology nurses toward cancer pain management: a review. iMedPub J Salim, Nazar, Nijmeh, Al-Attyat, Tuffaha M, Hadan AN, Brant J (2017) Knowledge and attitude of oncology nurses toward cancer pain management: a review. iMedPub J
84.
go back to reference Shahriary S, Shiryazdi SM, Shiryazdi SA, Arjomandi A, Haghighi F, Vakili FM, Mostafaie N (2015) Oncology nurses knowledge and attitudes regarding cancer pain management. Asian Pac J Cancer Prev 16(17):7501–7506CrossRef Shahriary S, Shiryazdi SM, Shiryazdi SA, Arjomandi A, Haghighi F, Vakili FM, Mostafaie N (2015) Oncology nurses knowledge and attitudes regarding cancer pain management. Asian Pac J Cancer Prev 16(17):7501–7506CrossRef
85.
86.
go back to reference Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65(1):5–29CrossRef Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65(1):5–29CrossRef
89.
go back to reference Stern C, Jordan Z, McArthur A (2014) Developing the review question and inclusion criteria. AJN The American Journal of Nursing 114(4):53–56CrossRef Stern C, Jordan Z, McArthur A (2014) Developing the review question and inclusion criteria. AJN The American Journal of Nursing 114(4):53–56CrossRef
92.
go back to reference Thinh DHQ, Sriraj W, Mansor M, Tan KH, Irawan C, Kurnianda J, Nguyen YP et al (2018) Patient and physician satisfaction with analgesic treatment: findings from the analgesic treatment for cancer pain in Southeast Asia (ACE) study. Pain Res Manag 2018:8–8. https://doi.org/10.1155/2018/2193710 CrossRef Thinh DHQ, Sriraj W, Mansor M, Tan KH, Irawan C, Kurnianda J, Nguyen YP et al (2018) Patient and physician satisfaction with analgesic treatment: findings from the analgesic treatment for cancer pain in Southeast Asia (ACE) study. Pain Res Manag 2018:8–8. https://​doi.​org/​10.​1155/​2018/​2193710 CrossRef
93.
go back to reference Ung A, Salamonson Y, Hu W, Gallego G (2016) Assessing knowledge, perceptions and attitudes to pain management among medical and nursing students: a review of the literature. Br J Pain 10(1):8–21CrossRef Ung A, Salamonson Y, Hu W, Gallego G (2016) Assessing knowledge, perceptions and attitudes to pain management among medical and nursing students: a review of the literature. Br J Pain 10(1):8–21CrossRef
95.
go back to reference Vallerand AH, Collins-Bohler D, Templin T, Hasenau SM (2007) Knowledge of and barriers to pain management in caregivers of cancer patients receiving homecare. Cancer Nurs 30(1):31–37CrossRef Vallerand AH, Collins-Bohler D, Templin T, Hasenau SM (2007) Knowledge of and barriers to pain management in caregivers of cancer patients receiving homecare. Cancer Nurs 30(1):31–37CrossRef
99.
go back to reference Wiffen PJ, Wee B, Andrew Moore R (2016) Oral morphine for cancer pain. Cochrane Database Syst Rev 4 Wiffen PJ, Wee B, Andrew Moore R (2016) Oral morphine for cancer pain. Cochrane Database Syst Rev 4
101.
go back to reference Yates P, Aranda S, Edwards H, Nash R (2004) Family caregivers’ experiences and involvement with cancer pain management. J Palliat Care 20(4):287–296CrossRef Yates P, Aranda S, Edwards H, Nash R (2004) Family caregivers’ experiences and involvement with cancer pain management. J Palliat Care 20(4):287–296CrossRef
103.
go back to reference Zeppetella G, Davies AN (2013) Opioids for the management of breakthrough pain in cancer patients. Cochrane Database Syst Rev (10) Zeppetella G, Davies AN (2013) Opioids for the management of breakthrough pain in cancer patients. Cochrane Database Syst Rev (10)
Metadata
Title
Managing Pain in People with Cancer—a Systematic Review of the Attitudes and Knowledge of Professionals, Patients, Caregivers and Public
Authors
Salim M. Makhlouf
Simon Pini
Shenaz Ahmed
Michael I. Bennett
Publication date
01-04-2020
Publisher
Springer US
Published in
Journal of Cancer Education / Issue 2/2020
Print ISSN: 0885-8195
Electronic ISSN: 1543-0154
DOI
https://doi.org/10.1007/s13187-019-01548-9

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