Oncology nurses' perception of cancer pain: A qualitative exploratory study

Abstract

IntroductionPain is one of the most distressing symptoms experienced by patients with cancer undergoing active treatment (Stark, Tofthagen, Visovsky, & McMillan, 2012). Despite advances in understanding the aetiology of cancer pain, pharmacological developments, pain assessment tools and management guidelines, pain often remains poorly managed. Many patients with cancer continue to experience severe and unrelieved pain resulting in unnecessary suffering (Dulko, Hertz, Julien, Beck, & Money, 2010; Fairchild, 2010; Huntoon, 2009). Acute pain can be triggered by surgery and diagnostic procedures such as bone marrow aspirations and repeated intravenous cannulations for chemotherapy drugs (Chapman, 2011). Treatment effects such as chemotherapy-induced neuropathy may also contribute to reported pain (De Grandis, 2007; Lavoie Smith, Cohen, Pett, & Beck, 2010).Barriers to effective pain management are commonly reported throughout health care systems and may relate to the system, health professionals, and patients themselves (Bennett, Flemming, & Closs, 2011). With regard to nursing oncology practice, a lack of knowledge surrounding opioid delivery and its effects contribute to pain prevalence (Voshall, Dunn, & Shelestak, 2013). Yildirim, Cicek, and Uyar (2008) found that oncology nurses possessed inaccurate knowledge about commonly used analgesics and consequently exaggerated anxiety about the potential for psychological dependence occurring. Furthermore, patients themselves are often reluctant to report pain related to concerns about the impact of subsequent treatment decisions, personal cost, and their own fears of addiction and dependence (Simone, Vapiwala, Hampshire, & Metz, 2012).Oncology nurses are noted as being at the frontline of cancer pain management (Aycock & Boyle, 2009). Nurses perform and evaluate many interventions for pain management and have an essential role in deciding when changes in plans are required (Bernardi, Catania, Lambert, Tridello, & Luzzani, 2007; Chapman, 2011). This study explored how oncology nurses perceive, experience and assess cancer pain in their patients and, subsequently highlighted factors affecting the delivery of effective pain management strategies.MethodsA qualitative descriptive exploratory study was conducted using semi-structured interviews in order to achieve a detailed exploration of oncology nurses' perceptions of cancer pain in patients were receiving chemotherapy. A purposive sampling method was used to include experienced participants who had knowledge of the phenomenon in question (Berg, 2009; Sandelowski, 2010). The participants were five second-level chemotherapy-certified oncology nurses. The age of participants ranged from 32 to 55 years, with an average time of ten years working in the oncology field. All the available participants were female.Data were collected using one-to-one semi-structured interviews. Interviews are commonly used to gather in-depth exploration of nurse's perceptions, views, feelings, and experiences (Garton & Copland, 2010). Questions were open-ended to allow flexibility and encourage a richer narrative. Examples of the included questions were: What does pain mean to you?, How do you perceive cancer pain?, Does the pain reported by your patients have any impact on your practice?, How do you feel when your patient is in pain?, How well prepared do you feel to effectively manage a patients pain?. Further prompts, where needed, were used in order to clarify and to extend related concepts of cancer pain management.The interviews were audio-taped to ensure data accuracy. Once transcribed, inductive thematic analysis was conducted to identify codes, categories and themes relevant to the research question (Fereday & Muir-Cochrane, 2006). A Framework Analysis approach was applied (Richie & Spencer, 1994). Immersion in the raw data was achieved by listening to the interview tapes and then repeated reading of the transcripts to ensure familiarity with the data. …