Abstract
Background: Pain is a common symptom in patients who survive cancer and in those who live with progressive advanced disease. Systematic screening and documentation of pain are necessary to improve the quality of cancer pain treatment, because a key pain-related barrier is that patients are reluctant to discuss pain, due to fear that reporting pain will distract the healthcare professional from their cancer treatment. Methods: This study adopted an explanatory sequential mixed-methods design. Data collection incorporated three strands. The first strand involved a quantitative enquiry in which medical chart reviews of patients (n=100) attending the medical oncology outpatient clinic were examined. The second qualitative strand comprised of semi-structured interviews with patients (n=10) attending that service. The third strand was qualitative and consisted of focus group discussions with healthcare professionals (n=12). Results: All 100 patients had cancer. The quantitative findings confirmed the suboptimum assessment and subsequent recording of patient's pain, that seemed to afford a reality check for all healthcare professionals. For patients, the outcomes of the anti-cancer treatment were their priority, and pain was perceived as inevitable, being associated with a cancer diagnosis. There were multifaceted complexities voiced amongst healthcare professionals associated with balancing the benefits and harms aligned with treating cancer pain. Conclusions: Pain assessment in medical records was not systematically recorded by healthcare professionals. Patients were reluctant to self-report pain during their medical oncology outpatient review. The expectation that patients will self-report pain can be accommodated by healthcare professionals if a personalized pain goal is part of the cancer pain management plan during each clinical encounter. Healthcare professionals reported a need to take distinct responsibility for supplementing their dearth of knowledge, skills and beliefs regarding assessing and managing patients' cancer pain. Optimal pain management stems from an interprofessional approach that was applied in this study design.
Highlights
Cancer is a major health concern in Ireland, with one in two people being diagnosed with cancer in their lifetime
Systematic screening and documentation of pain are necessary to improve the quality of cancer pain treatment, because a key pain-related barrier is that patients are reluctant to discuss pain or to ask for pain medication, due to concerns about addiction and fear that reporting pain will distract the clinician from the treatment of their cancer (Glare et al, 2014)
Systematic screening and documentation of pain by clinicians with a valid pain measurement tool incorporating questions about patterns in pain scores and response to analgesic treatments at each visit are an essential standard for quality improvement of cancer pain treatment (Bennett et al, 2019; Fallon et al, 2018; Jensen et al, 2015), because a key pain-related barrier is that patients are reluctant to discuss pain with healthcare professionals or to ask for pain medication
Summary
Cancer is a major health concern in Ireland, with one in two people being diagnosed with cancer in their lifetime. The literature contends that systematic pain registration and assessment with a valid tool at each clinical encounter are essential precursors to effective cancer pain management. In this context, Prevost et al (2019) identified the main cause of the patient’s pain was cancer (75%), followed by treatment (25.0%) and mood (8.3%) while 30% thought that experiencing pain was “normal” with a cancer diagnosis. The expectation that patients will self-report pain can be accommodated by healthcare professionals if a personalized pain goal is part of the cancer pain management plan during each clinical encounter.
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