Cancer pain management needs and perspectives of patients from Chinese backgrounds: a systematic review of the Chinese and English literature

Ecology of End-of-life Medical Care for Advanced Cancer Patients in China

AIMS

Cancer is a leading cause of death worldwide. Approximately 30% of global cancer-related deaths occur in mainland China. However, there is a paucity of information regarding the end-of-life care-seeking behavior of patients with advanced cancer in China. Our study was to investigate end-of-life care-seeking behavior and to quantify the association between sociodemographic characteristics and the location and pattern of end-of-life care.

METHODS

We conducted a mortality follow-back survey using caregivers' interviews to estimate the number of individuals pre 1000 who died between 2013 and 2021 in the last 3 months of life. We collected data on hospitalization, outpatient visits, cardiopulmonary resuscitation, palliative care and hospice utilization, and place of death, stratified by age, gender, marital status, household income, residential zone, insurance type, and the primary end-of-life decision-maker of the decedents.

RESULTS

We analyzed data from 857 deceased cancer patients, representing an average of 1000 individuals. Among these patients, 861 experienced at least moderate or more severe pain, 774 were hospitalized at least once, 468 received intensive treatment, 389 had at least one outpatient visit, 270 died in the hospital, 236 received cardiopulmonary resuscitation and 99 received specialist hospice care.

CONCLUSIONS

Our study provides insights into the end-of-life care-seeking behavior of advanced cancer patients in China and our findings serve as a useful benchmark for estimating the use of end-of-life medical care. It highlights the need for the establishment of an accessible and patient-centered palliative care and hospice system.

Exploring Central and Bridge Symptoms in Patients with Lung Cancer: A Network Analysis

OBJECTIVES

This study aimed to identify symptom clusters in lung cancer patients undergoing chemotherapy and the central and bridge symptoms within each symptom cluster.

METHODS

In this cross-sectional study, 1,255 patients with lung cancer were recruited through convenience sampling at Nanfang Hospital. Patient symptom burden was assessed using the M.D. Anderson Symptom Inventory (MDASI) and the Lung Cancer module of the MDASI (MDASI-LC). Symptom clusters were identified using the Walktrap algorithm, and central and bridge symptoms in the symptom clusters were identified by network analysis.

RESULTS

The patients included 818 (65.18%) males and 437 (34.82%) females with a mean age of 56.56 ± 11.78 years. Four symptom clusters were identified: fatigue, gastrointestinal, psychoneurological and respiratory. Their central symptoms were fatigue, vomiting, distress and hemoptysis, respectively, and their bridge symptoms were pain, vomiting, dry mouth and shortness of breath.

CONCLUSIONS

Lung cancer symptoms show certain strong correlations with each other, resulting in symptom clusters. Central symptoms may influence other symptoms within a symptom cluster, and bridge symptoms might impact the density of the symptom network. This study identified central and bridge symptoms in lung cancer patients undergoing chemotherapy. Targeting these symptoms with interventions for symptom clusters could make symptom management more precise and effective.

IMPLICATIONS FOR NURSING PRACTICE

In clinical settings, the burden of symptom clusters may be reduced by intervening against the central symptoms of these symptom clusters. Alternatively, if the objective is to diminish the connections between different symptom clusters and holistically alleviate the overall burden, interventions focused on bridge symptoms may be employed.

The role of social support among caregivers of people with cancer from Chinese and Arabic communities: a qualitative study

PURPOSE

Cancer caregivers from culturally and linguistically diverse (CALD) communities have reported significant unmet emotional support needs. This study aimed explore the role of social support to manage emotional wellbeing among cancer caregivers from Arabic and Chinese communities in Australia.

METHODS

Semi-structured interviews were conducted with Chinese (n = 12) and Arabic (n = 12) speaking cancer caregivers. Participants' mean age was 40.6 years; majority were female (83%) and providing care to a parent (41.67%).

RESULTS

Using thematic analysis to analyse interview data, five overarching themes emerged describing caregivers' perspectives on social support. Themes were related to the following: (1) receiving emotional support from social networks, (2) barriers to accessing emotional support from social networks, (3) isolation and loss of connection following the cancer diagnosis, (4) faith as a source of support, and (5) utility of support groups and caregiver advocates. Several caregivers relied on social networks for emotional support; however, caregivers identified key cultural and generational barriers to seeking support from their social networks which prevented caregivers from disclosing their emotions and caregiving situation. Caregivers also reported being isolated from their support system.

CONCLUSION

Empirical testing of culturally appropriate strategies that improve social support seeking among caregivers from CALD communities is recommended.

Changes in wound symptoms and quality of life of patients with newly diagnosed malignant fungating wounds

OBJECTIVE

This study examined changes in wound symptoms and the health-related quality of life (HRQoL) of patients with newly diagnosed malignant fungating wounds, and explored the factors that impacted the changes in HRQoL.

METHOD

This prospective longitudinal study included patients from three hospitals in China who had been diagnosed with malignant fungating wounds. Questionnaires were used to assess patients' HRQoL and their wound symptoms at the time of diagnosis (T0), as well as at one, three and six (T1, T2 and T3, respectively) months following the treatment period. Factors related to changes in HRQoL were analysed using generalised estimating equation models.

RESULTS

A total of 162 patients were included in the study. The patients reported low overall HRQoL. In three health-related dimensions (functional status, social relations and mental health), patients reported lower functional status at the time of wound diagnosis (T0), which then increased slowly with treatment over time. A lower QoL was associated with odour, exudate, bleeding, pruritus, a low performance status and the need for the dressing of wounds.

CONCLUSION

The HRQoL of patients with malignant fungating wounds exhibited significant changes across different periods. It is thus of great importance to formulate pragmatic, patient and family-centred palliative wound care management strategies.

Patients' Experiences of Cancer Pain: A Descriptive Qualitative Study

OBJECTIVE

The aim of this study was to explore the cancer pain experiences of Iranian patients.

DESIGN

A qualitative descriptive design was used.

METHODS

This qualitative descriptive study was performed on 17 participants between December 2020 and September 2021. Data were collected using semistructured interviews and analyzed by Graneheim and Lundman's content analysis method.

RESULTS

Three main categories emerged in relation to patients' experiences of cancer pain. Categories included (1) characteristics of cancer pain, (2) pain self-management strategies, and (3) influence of pain on patient and her/his family.

CONCLUSIONS

Most patients believe that pain is God's will, and family members, doctors, and nurses can assist patients cope with pain by respecting this belief and supporting spiritual healing. Strengthening pain management strategies, expanding social networks, and convincing the patients that they are not an interruption to their families can all help patients maintain their fighting spirit and pain tolerance. To provide holistic care, healthcare providers, particularly nurses, should consider the physical, sociocultural, and spiritual aspects of cancer pain.

Factors associated with adherence to guidelines in cancer pain management among adult patients evaluated at oncology unit, in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Introduction

Cancer pain is one of the most important deleterious and distressing symptoms suffered by patients with cancer which disturb their quality of life, especially in the last part of their life. Alleviating pain is a primary goal of prognosis of cancer pain management and pain symptoms must be prevented, treated as a priority, and considered an independent part of cancer management. Despite the presence of guidelines for cancer pain management, many patients with cancer are still undertreated. Therefore, this study aimed to assess factors associated with adherence to guidelines in cancer pain management among adult patients evaluated at the oncology unit, in the University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia.

Methods

An institution-based cross-sectional study was conducted from January to March 2021. All patients who were in cancer treatment were our population of interest. A systematic random sampling technique was used to select a total of 384 participants. The dependent variable of the study was adherence to guidelines in cancer pain management. It was determined using the pain management index (PMI) which was calculated by subtracting the pain level from the analgesics level. A negative range was considered an indicator of poor adherence to guidelines in cancer pain management. Bivariable and multivariable binary logistic regression analyses were performed. Adjusted odds ratio (AOR) with a 95% CI was used as a measure of association. Variables having P < 0.05 from the multivariable analysis were considered to have a significant association with the outcome.

Results

The prevalence of poor adherence to guidelines in cancer pain management among 384 adult patients in this study was 21.35% (95%CI: 17.53, 25.76). Patients who were not married [AOR = 2.2; 95%CI: 1.15, 4.19], who know their diagnosis before 4 months ago [AOR = 0.53; 95%CI: 0.26, 0.96], who have metastasis cancer [AOR = 3.76; 95%CI: 1.83, 7.72], and being stage III patients [AOR = 3.21; 95%CI: 1.64, 7.93] and stage IV patients [AOR = 1.63; 95%CI: 1.09, 5.81], respectively, had a significant association with poor adherence to guidelines in cancer pain management.

Conclusion

The prevalence of poor adherence to guidelines in cancer pain management among adult patients with cancer in UoGCSH Northwest Ethiopia is relatively low as compared with other studies. Factors such as patients who were not married and who have metastasis cancer, and being patients with stage III and stage IV cancer had a significant positive association with poor adherence to guidelines in cancer pain management, on the other hand, patients who know their diagnosis 4 months ago had a positive association with having adherence to guidelines in cancer pain management. Patients with high stage and metastasis need care from pain specialists early on in the diagnosis of pain. The hospital should reassure the diagnosis of cancer for the patient before they started the treatment.

Cultural factors affecting Chinese migrants' perceptions and responses to cancer pain and its pharmacological management: A convergent mixed-method study

INTRODUCTION

Studies identified barriers of pain reporting and use of analgesics impeding Chinese cancer patients to achieve optimal pain relief. No research has yet explored these issues in Chinese migrants, where cultural differences may exacerbate the barriers.

OBJECTIVES

To explore cultural factors influencing Chinese migrants' perspectives to cancer pain and its pharmacological management.

METHOD

Informed by Leininger's Cultural Care Theory, focus groups and a short version of Barrier Questionnaire-Taiwan (S-BQT) were conducted in Mandarin or Cantonese, with 24 Chinese migrants receiving ambulatory cancer and/or palliative care services in Sydney, Australia. Integrated thematic analysis, descriptive statistics, and meta-inference were adopted for data analysis and integration.

RESULTS

Participants suffered uncontrolled cancer pain negatively affecting their physical and psychosocial well-being. Most experienced moderate to severe pain, but only a third used opioids. Most adopted non-pharmacological approaches and half used Traditional Chinese Medicine. Participants scored a mean S-BQT of 3.28 (standard deviation ± 0.89). Three themes and seven sub-themes contributed to higher barriers of pharmacological pain management: (1) Philosophical health beliefs (cancer pain are self-provoked and body can self-heal); (2) Cultural values and beliefs (cancer pain is inevitable, and Chinese people express pain differently to local people); and (3) Conflicting views on the use of opioids (culture-related negative medication beliefs, Western biomedical model-related opioid fears, and opioids extend life for people with terminal cancer pain).

CONCLUSIONS

Chinese migrants' responses to cancer pain and attitudes towards opioids are complex. Culturally congruent strategies are needed to overcome culture-related barriers and improve quality of cancer pain care in this population.

Evaluation of a whole process management model based on an information system for cancer patients with pain: A prospective nonrandomized controlled study

Objective

The aim of this study was to evaluate the effects of whole process management model interventions based on information system benefits reported by patients with cancer pain.

Methods

We performed a quantitative, prospective nonrandomized controlled design from June to October 2020. A total of 124 cancer patients with pain were enrolled. Patients in the experimental group received a whole process management model intervention based on an information system compared to the control group who received routine cancer pain management. Data were collected at baseline and after a four-week follow-up, acting as a test-retest control. The primary outcome was pain management quality, which was measured using the American Pain Society Patient Outcome Questionnaire-Chinese version (APS-POQ-C). Secondary outcomes were patient-related attitudinal barriers and analgesic adherence. The Barrier Questionnaire (BQ) and a single-item questionnaire were used. Chi-square tests were used to compare the pain intensity and analgesic adherence, independent sample t-test and Mann-Whitney U test were performed to test the differences in the pain management quality and patient-related attitudinal barriers between control and experimental groups.

Results

Baseline characteristics and outcomes of the participants did not differ significantly (P ​> ​0.05). Primary outcomes were changes in four aspect of the quality of pain management (APS-POQ-C) between the two groups (P ​< ​0.05). Patients in the whole process management group reported significantly better pain control and perception of care than the control group. With respect to secondary endpoints, a significant difference in favor of the experimental group was found for barriers (P ​< ​0.05) and medication adherence (60.0% vs. 40.0%; P ​< ​0.05) after the interventions.

Conclusions

The whole process management of patients with cancer pain effectively improves patient-reported quality of pain management, reduces patient-perceived barriers, enhances patient adherence to analgesic drugs and is worthy of clinical application.

Cancer Pain: An Evolutionary Concept Analysis

BACKGROUND

Cancer pain is among the most severe types of pain and is among the most common types of cancer-related problems. Yet, many ambiguities surround the concept of cancer pain and its attributes.

OBJECTIVE

This study aimed to analyze the concept of cancer pain.

METHODS

This concept analysis was conducted using the Rodgers' evolutionary method. Nursing, psychology, social sciences, and medicine literature were reviewed through searching online databases. In total, 52 articles were included and analyzed through thematic analysis.

RESULTS/CONCLUSION

The attributes of cancer pain are known origin, sharp, burning, piercing, or throbbing quality, varying duration (acute, chronic, or breakthrough), intolerability, and moderate to severe intensity. Its antecedents are cognitive system, pain-related beliefs, coping strategies, family and social support, financial status, and cultural, ethnic, racial, and religious values. Its consequences include physical, psychological, existential and spiritual, and social consequences, and reduced quality of life. This concept analysis concludes that cancer pain is different from other types of acute and chronic pain. Thus, specific interventions are needed for its assessment and management.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

The results of this concept analysis can broaden the case manager/health care team and other health care providers' knowledge about cancer pain and help them make better decisions and take more effective interventions for its management. The information in the article can be used to inform the case manager/health care team when it may be time to consider palliative care or even hospice care. Also, the information, itself, is crucial for case managers to understand when a patient has cancer pain.

Exploration of Patient-Related Barriers to Effective Cancer Pain Management in a Diverse Multicultural Developing Country

CONTEXT

Cancer pain prevalence is high despite well-established international guidelines on pain management and improved accessibility to treatment. Inadequate cancer pain management can be attributed to barriers related to patients, health care professionals, and health care system.

OBJECTIVES

To identify patient-related barriers to effective cancer pain management in a diverse multicultural developing country.

DESIGN

A cross-sectional survey study was carried out using Brief Pain Inventory-Short Form to measure effectiveness of pain management and Barriers Questionnaire II to explore patient-related barriers to effective pain management.

SETTING/PARTICIPANTS

Patients on strong opioids treated in a comprehensive cancer unit of a public hospital in Sarawak, Malaysia.

RESULTS

Among 133 subjects surveyed, 66% reported no pain or mild pain, 34% moderate pain, and 10% severe pain. Despite good pain control, 71% of patients still reported moderate-to-severe interference with daily activities. Fatalism scored the highest median Barriers Questionnaire II score among the four domains of patient-related barriers followed by harmful effects, physiological effects, and communication factor.

CONCLUSION

Cancer pain is generally well controlled with more than half of patients reporting mild pain. However, degree of interference with daily activities is still high despite good cancer pain control. Fatalistic mentality need to be addressed for effective cancer pain management. Further studies on health care professional-related barriers and health system-related barriers are urgently needed to provide a comprehensive approach of holistic pain management.

Global Perspectives on Palliative Care for Cancer Patients: Not All Countries Are the Same

PURPOSE OF THE REVIEW

The integration of cancer-related palliative care is essential to holistic, quality cancer care. While some similarities exist between countries, this manuscript will focus on five differences that impact palliative care for cancer patients including the epidemiology of cancer and related symptoms, cancer-specific integration into care, palliative care education, economic development of the country, and cultural and religious differences.

RECENT FINDINGS

The epidemiology of cancer varies around the world resulting in variable symptoms and the need for individualized approaches to palliative care. While palliative care is integrated in some countries, it is lacking in over half of the world, and specific integration into cancer care is virtually absent. Education and training are the key to expansion, and yet oncology-focused palliative care education is lacking or is not well-reported in the literature. To complicate this global lens even further are the economic disparities that exist. Low-to-middle-income countries (LMICs) are resource poor and have the fewest resources and least amount of integration, and yet patients with advanced cancer are over-represented in these countries. Essential to cancer-related palliative care is a tailored approach that addresses cultural and religious differences around the globe. Palliative care is developing around the globe and yet palliative care specific for cancer patients is in its infancy. Cancer care professionals should (1) understand the epidemiologic differences that exist globally and the impact this has on palliative care, (2) integrate palliative care into the cancer care arena, (3) provide cancer-specific palliative education focused on the cancer trajectory from diagnosis through survivorship and end of life, (4) advocate for LMICs, which suffer from a lack of resources and services, and (5) understand cultural and religious differences that exist to provide holistic and sensitive cancer-related palliative care.

Stress and Perception of Procedural Pain Management in Chinese Parents of Children With Cancer

OBJECTIVES

Children with cancer are exposed to repeated painful and invasive procedures. This study examines Chinese parents' stress and perception toward their children's procedural pain control.

METHODS

We recruited 265 parents of children (aged <18 years) diagnosed with hematological cancer (74.7%) and solid tumors (25.3%) from two major public hospitals. Parents used a scale (0-10) to rate perceived pain experienced by their child when undergoing lumbar puncture (LP), bone marrow aspirate, or/and biopsy. They reported their stress level and attitudes toward analgesics using the adapted Pain Flexibility Scale for Parents and Parental Medication Attitude Questionnaire. General linear modeling was used to identify factors associated with perception outcomes.

RESULTS

Parents (72.8% mothers, age 36.5 [6.8] years) expressed that they were worried (31.7%) and had difficulty with concentration (57.7%) when the child was in pain. Among parents whose children had undergone LP (n = 207), 39.1% perceived that their child still experienced severe pain (pain score >7) even with existing pain control measures. Parents reported concerns over side effects of analgesics (69.4%) and addiction (35.1%). Half of the parents (47.2%) perceived that analgesics should only be reserved for severe pain. Parents who were older (estimate = 2.07, SE = 0.87; P = 0.0054) and had lower education attainment (estimate = -3.38, SE = 1.09; P = 0.0021) had a more negative attitude toward analgesics use. Higher parental distress was associated with avoidance of analgesics use (r_s = 0.17, P = 0.0052).

CONCLUSION

Our findings suggested that subgroups of Chinese parents demonstrated distress with their child's pain and harbored misconceptions over analgesics use. Future work includes devising targeted psychoeducation interventions for these parents.

Adequacy of Cancer-Related Pain Treatments and Factors Affecting Proper Management in Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia

Background

Cancer-related pain (CRP) is a major problem with a potential negative impact on quality of life of the patients and their caregivers.

Purpose

To assess the adequacy of cancer-related pain management in Ayder Comprehensive Specialized Hospital (ACSH). Methodology. A facility-based cross-sectional study design was conducted in ACSH from January to March 2019. A well-structured professional-assisted questionnaire using Brief Pain Inventory-Short Form (BPI-SF) was used to collect data concerning the severity of pain, functioning interference, and adequacy of pain management in cancer patients. Data were analyzed using SPSS v.21.

Result

Out of 91 participants, 47 (51.6%) were male and 52 (57.1%) were between the age group of 18–45, with the mean age of 44.8 ± 13.6 years. According to the pain assessment tool (BPI), 85 (93.4%) patients experienced pain and 90 (98.9%) patients had activity interference; negative pain management index (PMI) was observed in 40 (43.95%) patients, showing that 43.95% were receiving inadequate pain management. Out of 38 patients who received no analgesics, 35.2% were found to have inadequate pain management, whereas those who took strong opioids had 100% effective pain management and the majority of the patients were in stage III. Among 38 (41.76%) only 20 (52.63%) received adequate pain management, based on patients' self-report in which 18.7% of the participants stated that they got 30% pain relief and only 1.1% got 90% relief. The predictors of undertreatment were presence of severe pain, metastasis, comorbidity, and stage of the cancer and could also be due to the educational level and monthly income, as evidenced by significant association.

Conclusion

This study suggests that cancer pain management in ACSH was sufficient for only 56%. However, large numbers of individuals are suffering from a manageable pain. Hence, remedial action should be taken, including increasing awareness of symptom management in medical staff and incorporating existing knowledge into routine clinical practice.

An evaluation of cancer patients' opinions about use of opioid analgesics and the role of clinical pharmacist in patient education in Turkey

Background Patients' potential misconceptions and concerns about using opioids are among the primary causes of patient-related barriers that may lead to failure in pain management. These barriers can be eliminated through educational interventions, thus achieving better pain management. Objective The aim of this study was to assess patients' beliefs about opioids, reduce the impact of patient-related barriers through educational intervention by a clinical pharmacist, and improve patients' adherence to opioid analgesic treatment. Setting The study was conducted in the Hacettepe University Training and Research Oncology Hospital, Department of Algology in Ankara, Turkey. Method A prospective study conducted between September, 2018 and May, 2019. Patients were included who had been diagnosed with cancer, had been prescribed opioid analgesics, and who attended the pain unit during the period this study was conducted. Patients' beliefs about opioids were assessed using the Beliefs about Medicine Questionnaire (BMQ) right before and 1 month after an educational intervention was provided by a clinical pharmacist. Also, patients' adherence to the opioid regimen was assessed using a validated Self-Report Measure of Adherence questions in Turkish. Main outcome measure The mean scores of the BMQ Necessity Subscale and Concern Subscale, and a level of adherence to opioid treatment. Results Sixty patients who met the inclusion criteria were included and follow-up was completed with 38 patients. Although an increase was detected in the total score of the Necessity subscale after provision of education (p = 0.398), a statistically significant (p < 0.001) decrease was found in the total score of the 'Concern' subscale, which suggests that patients believe the benefits of opioids outweigh the risks. The patients' pain scores were decreased (p = 0.004); furthermore a significant increase was found in the adherence scores (3.16-3.55) (p = 0.027), and a high level of adherence was observed among the patients in the post-education assessment (p = 0.021). Conclusion The integration of a clinical pharmacist into the pain management team may have a positive impact on the patients' knowledge, concerns and misconceptions about opioids, which may improve adherence and effective pain management in cancer treatment.

Cross-Cultural Translation of the nChinese Version of Pain Care Quality Surveys (C-PainCQ)

Health disparities in pain care continue to exist among non-English-speaking Chinese-Americans. The Pain Care Quality?© (PainCQ) surveys, a valid instrument measuring the quality of pain care from the patient’s perspective, is available only in English currently. This study generated a Chinese version of the PainCQ (C-PainCQ) following a cross-cultural translation approach to address health equity in pain care. A multicultural, bilingual expert team produced a good quality, prefinal version of C-PainCQ. Chinese-speaking patients (n = 55) evaluated conceptual and content equivalence while bilingual participants (n = 13) reviewed semantic equivalence of C-PainCQ items. Feedback from participants, including adding a new item related to education on medication compliance, was used to revise the tool. This C-PainCQ is ready for future research to examine the reliability and construct validity with a large sample of Chinese-speaking patients.

Cancer Pain Management Among Oncology Nurses: Knowledge, Attitude, Related Factors, and Clinical Recommendations: a Systematic Review

The current study evaluated the oncology nurse's knowledge, attitude, related factors of cancer-related pain management (CPM), and clinical recommendations for improving knowledge and attitude. In this systematic review, international databases (PubMed, EMBASE, Web of science (WOS), Science Direct, and Scopus) were searched for relevant studies published in English language from March 30, 2000 to March 30, 2018. The quality of the studies was evaluated using the Hoy instrument. Out of 888 initial studies, 12 studies performed on 3574 participants were included in the final stage of the review. Based on the results, most studies indicated that nurses had a poor (n = 4) or moderate (n = 4) knowledge of CPM. The lowest and the highest knowledge levels were 28.5% and 75%, respectively. According to most studies, nurses had a fair (average) (n = 4) or negative (n = 3) attitude toward CPM. The important factors related to the nurses' knowledge of CPM included previous pain-related education programs (n = 7) and having work experience with cancer patients (n = 4). The most important barrier was the deficit in staff's knowledge of pain (n = 2). The important clinical recommendations for improving nurses' levels of knowledge included the implementation of educational programs (n = 9), training programs (n = 3) on CPM and including CPM topics in nursing curricula (n = 5). This systematic review showed that most nurses had poor knowledge of CPM and a fair attitude toward CPM, indicating the importance of considering the barriers to knowledge, strengthening the positive relevant factors, and using clinical recommendations based on clinical guidelines such as including CPM topics in nursing curricula and implementing educational programs on CPM to improve the knowledge, attitude, and skills of oncology nurses. The results of the present study could be used by policymakers to provide care for cancer patients and manage their pain.

The Global Burden of Cancer Pain

OBJECTIVES

To provide an overview of the global disparities in cancer pain management. To discuss cultural, religious, and spiritual considerations in cancer pain assessment and management.

DATA SOURCES

Peer-reviewed articles, book chapters, Internet.

CONCLUSION

Significant disparities in pain management exist globally, especially in developing countries. Cultural and religious differences influence pain care and opioid availability is lacking in many countries. Significant barriers impede good pain management; however, some countries have made positive strides in improving pain management for their population.

IMPLICATIONS FOR NURSING PRACTICE

Globally, nurses have a vital role in recognizing and addressing barriers to good pain management and can be ambassadors to advocate for improved pain assessment and management globally.

A Systematic Review: Mindfulness Intervention for Cancer-Related Pain

Moderate-to-severe pain is a common problem experienced by patients with cancer. Although analgesic drugs are effective, adverse side effects are common and some analgesic drugs are addictive. Nonpharmacological treatment may be a way to treat cancer pain without causing negative side effects. Mindfulness is used as an effective nonpharmacological treatment to improve quality of life (QoL) and to address psychological problems including distress, anxiety, stress, and depression. However, the effect of mindfulness on pain severity has not been sufficiently investigated. Therefore, a systematic review was undertaken to describe the effectiveness of mindfulness interventions for pain and its underlying pathophysiologic mechanisms. The search was conducted in PubMed, Ovid MEDLINE, and CINAHL and included only empirical studies published from 2008 to 2017. Search terms included mindfulness, mindfulness-based intervention, meditation, cancer, pain, and cancer-related pain. Six studies met the search criteria. These studies tested several types of intervention including mindfulness-based stress reduction, mindfulness-based cognitive therapy, meditation with massage, and mindful awareness practices. Study outcomes include improved pain severity, anxiety, stress, depression, and QoL. However, most studies reviewed were conducted in the United States and Denmark. Further research is needed to test culturally appropriate mindfulness interventions to reduce pain.

'Death is difficult in any language': A qualitative study of palliative care professionals' experiences when providing end-of-life care to patients from culturally and linguistically diverse backgrounds

BACKGROUND

Ethnic minority patients have unique challenges in accessing health services. These include language difficulties, unfamiliarity with the health system, lower rates of cancer screening and survival, higher rates of reported side effects from cancer treatment and poorer quality of life. Little is known about this patient group when transitioning to palliative care.

AIM

To elicit the experiences of palliative care health professionals when providing care for patients from culturally and linguistically diverse backgrounds which differ from mainstream Australian language and culture.

DESIGN

An emergent qualitative design, informed by theoretical and procedural direction from grounded theory research.

SETTING/PARTICIPANTS

Four focus groups held with palliative care staff ( n = 28) in a single specialist palliative care service in Australia.

RESULTS

The following themes emerged: (1) determining the rules of engagement around discussion of diagnosis and prognosis, (2) navigating the challenge of language to patient understanding, (3) understanding migration experiences to establish trust, (4) maintaining the balance between patient safety and comfort care, (5) providing a good death experience through accommodation of beliefs, and (6) navigating the important role of family members while privileging patient preferences.

CONCLUSION

Underlying provider perceptions of caring for patients was that death is difficult in any language. Care was conceptualised as considering cultural and linguistic backgrounds within individualistic care. Understanding the migration experience and building trust were key elements of this individualised approach. Acknowledgement of the key role played by families in patient care and safety are strategies to minimise barriers and understand the concerns of this patient group.