Cancer pain management : an exploration of psychological barriers in physicians and the general public

Abstract

Given the large proportion of the population affected by cancer and the proportion of these who are affected by pain, it is important to understand any barriers to providing pain management to these people. These barriers could be regulatory, resource- related, or the result of problematic attitudes and beliefs held by health professionals (particularly physicians) and patients. Previous research has shown that these barriers often differ extensively between countries and change over time. This research explored the psychological barriers to optimal pain management for cancer patients in New Zealand. This research was conducted in a series of three studies; one with physicians and two with members of the general public. The first study involved a mail survey of 131 general practitioners (GPs) and 18 pain ‘specialists’ using a questionnaire that has been used extensively in similar studies overseas. The second study used a questionnaire that has been used in much of the literature to measure psychological barriers to cancer pain management in 406 members of the general public. The third study involved interviewing 13 participants from the second study, in order to validate and expand the findings of the second study. The results of the first study showed that New Zealand physicians’ beliefs and attitudes toward cancer pain management generally compared favourably to physicians who have participated in previous studies in other countries. There were a concerning minority, however, who demonstrated attitudes and beliefs that would be likely to impede their ability to provide optimal pain management to cancer patients. The adoption and promotion of a national pain strategy, including cancer pain management guidelines, is suggested as a way of addressing these issues. The results of the second study showed that the general public in New Zealand have similar concerns to cancer patients and their caregivers in previous studies from other countries. There were some barriers that were very common and would be likely to reduce the adequacy of pain management in a large proportion of cancer patients. These included: concerns about addiction to, and side effects from, pain medications; fear of injections; concerns about developing tolerance to pain medications; and the fear that increased pain indicates disease progression. A national awareness campaign or focused patient education is suggested as a way of addressing these issues. The third study provided some validation and extrapolation of the results from the second study, but also indicated some possible methodological issues with the use of the Barrier Questionnaire used in the second study. Further research is needed to explore the validity of the methods for assessing barriers to pain management. The results of this series of studies have shown that there are a number of serious barriers to optimal pain management in New Zealand. A concerning proportion of both physicians and the general public hold beliefs and have attitudes that are incompatible with some of the most effective pain management strategies, including pharmacologic and non-pharmacologic approaches. It is important that New Zealand joins other countries that now have a nationwide strategy for addressing many of the issues raised in this research.