The perception of barriers of family caregivers in the use of oral opioids in older patients with cancer

Abstract

Background and Objective: Cancer pain remains poorly controlled in up to 90% of cancer patients. Untreated pain has detrimental effects on older patients and their caregivers. Fear of addition and concerns about side effects of the use of opioids are predominant patient barriers. Currently, there are very limited studies conducted to identify the barriers from the perspectives of family caregivers. This paper describes the barriers to the use of opioids perceived by family caregivers of older patients with cancer. Methods: Family caregivers of patients with cancer aged 55 or above, and received oral opioids for pain relief at homewere recruited from the National University Cancer Institute in Singapore. Measuring instruments included the Caregiver Pain Medicine Questionnaire (CMPQ). Results: Among the 17 caregivers who participated in the study, the median age was 45.0 years [interquartile range (IQR)=17.0]). Majority of them were female (70.6%), and were the patient's adult children (58.8%). Almost half of the caregivers (n=8, 47.0%) did not receive formal education, or were primary graduates. The median duration of care was 12.0 months (IQR 59.0). Most of the patients were female (58.8%), and the median age was 66.0 years (IQR=11.5). Majority of them were treated with a single type of oral opioids (n=15, 88.2%), with 8 (47.1%) receiving tramadol while 9 (52.9%) receiving morphine. About a quarter of patients were diagnosed with gastrointestinal cancer (n=4, 23.5%), and majority of them with metastatic diseases (n=11, 64.7). The median pain score was 7.0 out of 10 (IQR=5.8). The overall median score of CMPQ was 2.76 (IQR=0.6) (score range 1–5, with higher score representing high level of agreement, in which there is potential barrier to pain management). Subjects reported the highest potential barrier to pain management in “Fatalism” and “Concern about tolerance” (median=3.00, IQR=1.8), followed by “Concern about side effects” (median=2.86, IQR=0.4), and “Reluctance to administer” (median=2.83, IQR=0.8). A moderate significant negative relationshipwas found between the duration of care and “Reluctance to report/communicate about pain” (r=−0.530, p=0.029), suggesting that the longer the duration of caregiving, the more willing caregivers would be in reporting the patient's pain. Conclusion: Fatalism, concern about tolerance, and concern about side effects are the top three barriers to the use of opioids perceived by family caregivers of older patients with cancer. Empowerment and education programmes about pain management directed at family caregivers would be useful in improving their knowledge and attitudes about pain management and using oral opioids, and thus improve pain control of older patients with cancer. Nevertheless, the study was relatively small and limits the ability to generalise from the data, so a larger population group is required to confirm our findings.