Advertisement

Barriers and Facilitators of Pain Self-Management Among Patients with Cancer: An Integrative Review

Published:January 16, 2023DOI:https://doi.org/10.1016/j.pmn.2022.12.009

      Abstract

      Background

      Defining the main barriers and facilitators of cancer pain self-management are essential to improve patients’ overall quality of life.

      Aim

      The main purpose of this review was to identify the main barriers and facilitators for cancer pain self-management.

      Method

      An integrative review guided by the five-stages framework that was identified by Souza et al. (2010) was used: (1) preparing the guiding question; (2) searching or sampling the literature; (3) data collection; (4) critical analysis of the studies; and (5) discussion of results. A comprehensive literature review was conducted using the electronic databases of PubMed/MEDLINE, CINAHL, Scopus, and Psych INFO.

      Results

      Twenty-two studies were identified. The main facilitators that foster the process of cancer pain self-management were supportive ambiances including family caregivers as well as health care providers, active participation of patients with cancer in health care including self-discovery and self-awareness, acquiring pain knowledge, and using a pain diary. The main barriers include concerns regarding the use of pain medications, knowledge deficit, negative beliefs and attitudes, unsupportive ambiance, and psychological distress. Some patients’ characteristics could be related to these barriers such as age, sex, race, marital status, educational level, level of pain, and presence of comorbidity.

      Conclusions

      Patients with cancer pain experience multiple barriers and facilitators when attempting to take on an active role in managing their pain.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Pain Management Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Al-Atiyyat N.M.H.
        • Vallerand A.H.
        Patient-related attitudinal barriers to cancer pain management among adult Jordanian patients.
        European Journal of Oncology Nursing. 2018; 33: 56-61
      1. American Cancer Society (ACS). (2019, January 3). Managing cancer pain at home. Retrieved January 3, 2019, from https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/pain/pain.html.

        • Babgi A.A.
        Pain coping behaviors of Saudi patients suffering from advanced cancer: a revisited experience.
        Asian Pacific Journal of Cancer Prevention. 2010; 11: 103-106
        • Bagcivan G.
        • Tosun N.
        • Komurcu Ş.
        • Akbayrak N.
        • Ozet A.
        Analysis of patient-related barriers in cancer pain management in Turkish patients.
        Journal of Pain and Symptom Management. 2009; 38: 727-737
        • Bair M.J.
        • Matthias M.S.
        • Nyland K.A.
        • Huffman M.A.
        • Stubbs D.L.
        • Kroenke K.
        • Damush T.M.
        Barriers and facilitators to chronic pain self-management: a qualitative study of primary care patients with comorbid musculoskeletal pain and depression.
        Pain Medicine. 2009; 10: 1280-1290
      2. Best Evidence Medical Education (BEME). (2021). The literature search. Retrieved Month Oct. 2021, from https://bemecollaboration.org/LiteratureSearch/.

        • Boaz A.
        • Ashby D.
        Fit for purpose? Assessing research quality for evidence based policy and practice.
        ESRC UK Centre for Evidence Based Policy and Practice, London2003
        • Butler R.
        • Monsalve M.
        • Thomas G.W.
        • Herman T.
        • Segre A.M.
        • Polgreen P.M.
        • Suneja M.
        Estimating time physicians and other health care workers spend with patients in an intensive care unit using a sensor network.
        American Journal of Medicine. 2018; 131 (972.e9-972.e15)
        • Chou P.L.
        • Fang S.Y.
        • Sun J.L.
        • Rau K.M.
        • Lee B.O.
        Gender difference in cancer patients’ adherence to analgesics and related outcomes of pain management.
        Cancer Nursing. 2018; 41: E11-E18
        • Chou P.L.
        • Rau K.M.
        • Lin C.C.
        Development and psychometric testing of a short version of the Barriers Questionnaire-Taiwan form for cancer patients.
        International Journal of Nursing Studies. 2011; 48: 1071-1079
        • Chou P.L.
        • Rau K.M.
        • Yu T.W.
        • Huang T.L.
        • Sun J.L.
        • Wang S.Y.
        • Lin C.C.
        Patient–clinician relationship seems to affect adherence to analgesic use in cancer patients: A cross sectional study in a Taiwanese population.
        International Journal for Quality in Health Care. 2017; 29: 935-940
        • Closs S.J.
        • Chatwin J.
        • Bennett M.I.
        Cancer pain management at home (II): Does age influence attitudes towards pain and analgesia?.
        Supportive Care in Cancer. 2009; 17: 781-786
        • Cooper H.
        The integrative research review: A systematic approach sage publications.
        Beverly Hills, 1986: 143 (1984Educational Researcher, 15(8), 17-18)
        • Cosio D.
        Family: Their Role and Impact on Pain Management.
        Practical Pain Management. 2019; 19: 18-22
        • Dabbous M.K.
        • Sakr F.R.
        • Bouraad E.P.
        • Safwan J.H.
        • Akel M.G.
        • Cherfan M.M.
        Pain assessment and management in cancer patients.
        Journal of Health Research and Reviews. 2017; 4: 8
        • Deeks J.J
        • Dinnes J.
        • D'Amico R.
        • Sowden A.J.
        • Sakarovitch C.
        • Song F
        • Petticrew M.
        • Altman D.G.
        • International Stroke Trial Collaborative Group; European Carotid Surgery Trial Collaborative Group
        Evaluating non-randomised intervention studies.
        Health Technology Assessment. 2003; 7: 1-73
        • Devan H.
        • Hale L.
        • Hempel D.
        • Saipe B.
        • Perry M.A.
        What works and does not work in a self-management intervention for people with chronic pain? Qualitative systematic review and meta-synthesis.
        Physical Therapy. 2018; 98: 381-397https://doi.org/10.1093/ptj/pzx029
        • Edrington J.
        • Sun A.
        • Wong C.
        • Dodd M.
        • Padilla G.
        • Paul S.
        • Miaskowski C.
        Barriers to pain management in a community sample of Chinese American patients with cancer.
        Journal of Pain and Symptom Management. 2009; 37: 665-675
        • Ekstedt M.
        • Rustøen T.
        Factors that hinder and facilitate cancer patients' knowledge about pain management—a qualitative study.
        Journal of Pain and Symptom Management. 2019; 57: 753-760
        • Fahey K.F.
        • Rao S.M.
        • Douglas M.K.
        • Thomas M.L.
        • Elliott J.E.
        • Miaskowski C.
        Nurse coaching to explore and modify patient attitudinal barriers interfering with effective cancer pain management.
        Oncology Nursing Forum. 2008; 35: 233-240
        • Ferrell B.R.
        Family caregiving and cancer pain management.
        Anesthesia & Analgesia. 2019; 129: 1408-1413
        • Gagliese L.
        • Gauthier L.R.
        • Rodin G.
        Cancer pain and depression: A systematic review of age-related patterns.
        Pain Research and Management. 2007; 12: 205-211
        • Galloway S.K.
        • Meadors P.
        • Boselli D.
        • Walsh D.
        Anxiety, depression, pain, and social support in a large representative cancer population.
        Journal of Clinical Oncology. 2019; 37 (-76): 76
        • Gomes B.
        • Higginson I.J.
        • Calanzani N.
        • Cohen J.
        • Deliens L.
        • Daveson B.A.
        • Bechinger-English D.
        • Bausewein C.
        • Ferreira P.L.
        • Toscani F.
        • Meñaca A.
        • Gysels M.
        • Ceulemans L.
        • Simon S.T.
        • Pasman H.R.W.
        • Albers G.
        • Hall S.
        • Murtagh F.E.M.
        • Haugen D.F.
        • Downing J.
        • Koffman J.
        • Pettenati F.
        • Finetti S.
        • Antunes B.
        • Harding R
        Preferences for place of death if faced with advanced cancer: A population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain.
        Annals of Oncology. 2012; 23: 2006-2015
        • Grady P.A.
        • Gough L.L.
        Self-management: A comprehensive approach to management of chronic conditions.
        American Journal of Public Health. 2014; 104: e25-e31
        • Gunnarsdottir S.
        • Donovan H.S.
        • Serlin R.C.
        • Voge C.
        • Ward S.
        Patient-related barriers to pain management: The Barriers Questionnaire II (BQ-II).
        Pain. 2002; 99: 385-396
        • Gunnarsdottir S.
        • Sigurdardottir V.
        • Kloke M.
        • Radbruch L.
        • Sabatowski R.
        • Kaasa S.
        • Klepstad P.
        A multicenter study of attitudinal barriers to cancer pain management.
        Supportive Care in Cancer. 2017; 25: 3595-3602
        • Haumann J.
        • Joosten E.B.A.
        • van den Beuken-van Everdingen M.H.J.
        Pain prevalence in cancer patients: Status quo or opportunities for improvement?.
        Current Opinion in Supportive and Palliative Care. 2017; 11: 99-104
      3. International Association for the Study of Pain (IASP). IASP announces revised definition of pain. Retrieved July 16, 2020, from https://www.iasp-pain.org/PublicationsNews/NewsDetail.aspx?ItemNumber=10475.

        • Jacobsen R.
        • Samsanaviciene J.
        • Liuabarskiene Z.
        • Sciupokas A.
        Barriers to pain management among Lithuanian cancer patients.
        Pain Practice. 2010; 10: 145-157
        • Jefferson K.
        • Quest T.
        • Yeager K.A.
        Factors associated with black cancer patients' ability to obtain their opioid prescriptions at the pharmacy.
        Journal of Palliative Medicine. 2019; 22: 1143-1148
      4. Joanna Briggs Institute (JBI). (2017). Critical appraisal tools. Retrieved Month June, 2019, from https://jbi.global/critical-appraisal-tools.

        • Kimberlin C.
        • Brushwood D.
        • Allen W.
        • Radson E.
        • Wilson D.
        Cancer patient and caregiver experiences: communication and pain management issues.
        Journal of Pain and Symptom Management. 2004; 28: 566-578
        • Kwon J.H.
        Overcoming barriers in cancer pain management.
        Journal of Clinical Oncology. 2014; 32: 1727-1733
        • Kwon J.H.
        • Hui D.
        • Chisholm G.
        • Hong W.T.
        • Nguyen L.
        • Bruera E.
        Experience of barriers to pain management in patients receiving outpatient palliative care.
        Journal of Palliative Medicine. 2013; 16: 908-914
        • Lin C.C.
        Barriers to the analgesic management of cancer pain: a comparison of attitudes of Taiwanese patients and their family caregivers.
        Pain. 2000; 88: 7-14
        • Lin C.C.
        When Cancer Care Becomes a Long-term Care Issue: Are We Ready?.
        Cancer Nursing. 2017; 40: 341-342
        • Lin C.C.
        • Ward S.E.
        Patient-related barriers to cancer pain management in Taiwan.
        Cancer Nursing. 1995; 18: 16-22
        • Lohr Kathleen K.N.
        Rating the strength of scientific evidence: Relevance for quality improvement programs.
        International Journal for Quality in Health Care. 2004; 16: 9-18
        • Lorig K.
        • Holman H.R.
        Self-management education: history, definition, outcomes, and mechanisms.
        Annals of Behavioral Medicine. 2003; 26: 1-7
        • Mann E.G.
        • Harrison M.B.
        • LeFort S.
        • VanDenKerkhof E.G.
        What Are the Barriers and Facilitators for the Self-Management of Chronic Pain with and without Neuropathic Characteristics?.
        Pain Management Nursing. 2017; 18: 295-308
        • McGuire D.B.
        Comprehensive and multidimensional assessment and measurement of pain.
        Journal of Pain and Symptom Management. 1992; 7: 312-319
        • Meghani S.H.
        • Bruner D.W.
        A pilot study to identify correlates of intentional versus unintentional nonadherence to analgesic treatment for cancer pain.
        Pain Management Nursing. 2013; 14: e22-e30
        • Meghani S.H.
        • Wool J.
        • Davis J.
        • Yeager K.A.
        • Mao J.J.
        • Barg F.K.
        When patients take charge of opioids: self-management concerns and practices among cancer outpatients in the context of opioid crisis.
        Journal of Pain and Symptom Management. 2020; 59: 618-625
        • Mertilus D.S.D.
        • Lengacher C.A.
        • Rodriguez C.S.
        A Review and Conceptual Analysis of Cancer Pain Self-Management.
        Pain Management Nursing. 2022; 23: 168-173
        • Mosher C.E.
        • DuHamel K.N.
        • Egert J.
        • Smith M.Y.
        Self-efficacy for coping with cancer in a multiethnic sample of breast cancer patients: associations with barriers to pain management and distress.
        Clinical Journal of Pain. 2010; 26: 227-234
        • Naga B.S.H.B.
        • Al-Atiyyat N.H.M.
        Pain Experience among Patients Receiving Cancer Treatment: A Case Study.
        Middle East Journal of Nursing. 2013; 7: 40-47
      5. National Comprehensive Cancer Network (NCCN). (2019, June 24). Adult cancer pain. Retrieved June 24, 2019, from https://jnccn.org/configurable/content/journals$002fjnccn$002f17$002f8$002farticle-p977.xml?t:ac=journals%24002fjnccn%24002f17%24002f8%24002farticle-p977.xml.

        • Nayak M.G.
        • George A.
        • Vidyasagar M.S.
        Perceived barriers to symptoms management among family caregivers of cancer patients.
        Indian Journal of Palliative Care. 2018; 24: 202-206
        • Nguyen L.M.T
        • Rhondali W.
        • De la Cruz M.
        • Hui D.
        • Palmer L.
        • Kang D.H.
        • Parsons H.A.
        • Bruera E
        Frequency and predictors of patient deviation from prescribed opioids and barriers to opioid pain management in patients with advanced cancer.
        Journal of Pain and Symptom Management. 2013; 45: 506-516
        • Oldenmenger W.H.
        • Geerling J.I.
        • Mostovaya I.
        • Vissers K.C.P
        • de Graeff A.
        • Reyners A.K.L
        • van der Linden Y.M.
        A systematic review of the effectiveness of patient-based educational interventions to improve cancer-related pain.
        Cancer Treatment Reviews. 2018; 63: 96-103
        • Ovayolu O.
        • Ovayolu N.
        • Aytac S.
        • Serce S.
        • Sevinc A.
        Pain in cancer patients: pain assessment by patients and family caregivers and problems experienced by caregivers.
        Supportive Care in Cancer. 2015; 23: 1857-1864
        • Peterson M.H.
        • Barnason S.
        • Donnelly B.
        • Hill K.
        • Miley H.
        • Riggs L.
        • Whiteman K.
        Choosing the best evidence to guide clinical practice: Application of AACN levels of evidence.
        Critical Care Nurse. 2014; 34: 58-68
        • Russell C.L.
        An overview of the integrative research review.
        Progress in Transplantation. 2005; 15: 8-13
        • Samuel C.A.
        • Mbah O.
        • Schaal J.
        • Eng E.
        • Black K.Z.
        • Baker S.
        • Cykert S.
        The role of patient-physician relationship on health-related quality of life and pain in cancer patients.
        Supportive Care in Cancer. 2020; 28: 2615-2626
        • Satija A.
        • Singh S.P.
        • Kashyap K.
        • Bhatnagar S.
        Management of total cancer pain: A case of young adult.
        Indian Journal of Palliative Care. 2014; 20: 153-156
        • Schumacher K.L.
        • Koresawa S.
        • West C.
        • Dodd M.
        • Paul S.M.
        • Tripathy D.
        • Koo P.
        • Miaskowski C.
        The usefulness of a daily pain management diary for outpatients with cancer-related pain.
        Oncology Nursing Forum. 2002; 29: 1304-1313
        • Soares C.B.
        • Hoga L.A.K.
        • Peduzzi M.
        • Sangaleti C.
        • Yonekura T.
        • Silva D.R.A.D.
        Integrative review: concepts and methods used in nursing.
        Revista da Escola de Enfermagem da USP. 2014; 48: 335-345
        • Souza M.T.D.
        • Silva M.D.
        • Carvalho R.D.
        Integrative review: what is it? How to do it?.
        Einstein (São Paulo). 2010; 8: 102-106
        • Stein K.D.
        • Alcaraz K.I.
        • Kamson C.
        • Fallon E.A.
        • Smith T.G.
        Sociodemographic inequalities in barriers to cancer pain management: a report from the American Cancer Society's Study of Cancer Survivors-II (SCS-II).
        Psycho-Oncology. 2016; 25: 1212-1221
        • Tegegn H.G.
        • Gebreyohannes E.A.
        Cancer pain management and pain interference with daily functioning among cancer patients in Gondar University Hospital.
        Pain Research and Management. 2017; 2017 (Available at)5698640
        • Valeberg B.T.
        • Miaskowski C.
        • Paul S.M.
        • Rustøen T.
        Comparison of oncology patients’ and their family caregivers’ attitudes and concerns toward pain and pain management.
        Cancer Nursing. 2016; 39: 328-334
        • Van Den Beuken-Van M.H.J
        • Hochstenbach L.M.J
        • Joosten E.A.J
        • Tjan-Heijnen V.C.G
        • Janssen D.J.A
        Update on prevalence of pain in patients with cancer: Systematic review and meta-analysis.
        Journal of Pain and Symptom Management. 2016; 51: 1070-1090https://doi.org/10.1016/j.jpainsymman.2015.12.340
        • Vallerand A.H.
        • Musto S.
        • Polomano R.C.
        Nursing's role in cancer pain management.
        Current Pain and Headache Reports. 2011; 15: 250-262
        • Ward S.E.
        • Goldberg N.
        • Miller-McCauley V.
        • Mueller C.
        • Nolan A.
        • Pawlik-Plank D.
        • Robbins A.
        • Stormoen D.
        • Weissman D.E.
        Patient-related barriers to management of cancer pain.
        Pain. 1993; 52: 319-324
        • Wells N.
        • Johnson R.L.
        • Wujcik D.
        Development of a short version of the Barriers Questionnaire.
        Journal of Pain and Symptom Management. 1998; 15: 294-297
        • Whittemore R.
        Rigour in integrative reviews.
        in: Webb C. Roe B. Reviewing research evidence for nursing practice: in systematic reviews. 1st ed. Wiley-Blackwell Publishing, Hoboken. NJ2007: 151
        • Whittemore R.
        • Chao A.
        • Jang M.
        • Minges K.E.
        • Park C.
        Methods for knowledge synthesis: an overview.
        Heart & Lung. 2014; 43: 453-461
        • Wilkie D.J.
        • Ezenwa M.O.
        • Yao Y.
        • Gill A.
        • Hipp T.
        • Shea R.
        • Miller J.
        • Carrasco J.
        • Shuey D.
        • Zhao Z.
        • Wang Z.W.
        Pain intensity and misconceptions among hospice patients with cancer and their caregivers: Status after 2 decades.
        American Journal of Hospice and Palliative Medicine. 2017; 34: 318-324
        • Yamanaka M.
        A concept analysis of self-management of cancer pain.
        Asia-Pacific Journal of Oncology Nursing. 2018; 5: 254-261