Exploration of Patient-Related Barriers to Effective Cancer Pain Management in a Diverse Multicultural Developing Country

Abstract

Context: Cancer pain prevalence is high despite well-established international guidelines on pain management and improved accessibility to treatment. Inadequate cancer pain management can be attributed to barriers related to patients, health care professionals, and health care system.

Objectives: To identify patient-related barriers to effective cancer pain management in a diverse multicultural developing country.

Design: A cross-sectional survey study was carried out using Brief Pain Inventory-Short Form to measure effectiveness of pain management and Barriers Questionnaire II to explore patient-related barriers to effective pain management.

Setting/participants: Patients on strong opioids treated in a comprehensive cancer unit of a public hospital in Sarawak, Malaysia.

Results: Among 133 subjects surveyed, 66% reported no pain or mild pain, 34% moderate pain, and 10% severe pain. Despite good pain control, 71% of patients still reported moderate-to-severe interference with daily activities. Fatalism scored the highest median Barriers Questionnaire II score among the four domains of patient-related barriers followed by harmful effects, physiological effects, and communication factor.

Conclusion: Cancer pain is generally well controlled with more than half of patients reporting mild pain. However, degree of interference with daily activities is still high despite good cancer pain control. Fatalistic mentality need to be addressed for effective cancer pain management. Further studies on health care professional-related barriers and health system-related barriers are urgently needed to provide a comprehensive approach of holistic pain management.

Keywords: Cancer pain management barriers; cross-sectional survey; effective cancer pain management; fatalism.