Patient-perceived barriers for cancer pain management between Western and Asian cultures-a systematic review by meta-analysis

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1 Patient-perceived barriers for cancer pain management between and cultures-a systematic review by meta-analysis, RN, MSN,1, 2 Siew-Tzuh Tang, RN, DNSc1 1Chang Gung University, Graduate School of Nursing, Tao-Yuan, Taiwan, R.O.C. 2Kang-Ning Junior College of Medical Care and Management, Taipei, Taiwan, R.O.C. Introduction Patient barriers for cancer pain management were found to contribute to cancer patients reluctance to report pain and to use prescribed analgesics, which in turn resulted in inadequate cancer pain control. Different cultures may influence patients perceived barriers to cancer pain management. The purposes of this study was to compare patient-perceived pain barriers in cancer patients between and cultures. Materials and methods: A systematic review of the literature was conducted to compare studies that used Ward s barriers questionnaire (BQ) to measure pain barriers in cancer patients from and cultures. Meta-regression analysis was used to compare differences in weighted barrier scores between and cultures. Results: Twenty-four studies using the BQ were included. The most common patientperceived pain barriers included disease progression (weighted mean ± SD; 2.3±1.64), addiction (2.64±1.53), tolerance to pain medicine (2.40±1.52). Except for barriers of be good and side effects, barrier scores reported from cancer patients were significantly higher than those from cultures. Metaregression analysis indicated that patientperceived pain barriers differed significantly between and cultures for disease progression (beta= ; 5% CI -1.67, - 0.6), fatalism (beta= ; 5% CI -1.6, ), tolerance (beta= -0.56; 5% CI -1.76, ), and total BQ (beta= ; 5% CI , ). Table 1. The comparison of patient-perceived barriers for cancer pain management between and countries Type of pain barriers addiction Fatalism tolerance be good side-effects Fear of injections distract physician disease progression Total BQ score Culture No of studies Sample size Weight mean (SD) 2.5 (1.66) 2.52 (1.45) 2.13 (1.33) 1.37 (1.25) 3.01 (1.67) 2.05 (1.44) 1.4 (1.37) 1.46 (1.3) 2.26 (1.37) 2.26 (1.34) 2.5 (1.67) 1.0 (1.41) 1.3 (1.42) 1.53 (1.36) 3.57 (1.67) 2.42 (1.61) 2.45 (0.2) 1. (0.7) Effect size a a Effect size: ES = (M M ) SD pooled b Meta-regression used, with inverse variance weight Metaregression Beta (5% CI) b (-0.3, 0.5) (-1.6, -0.54) (-1.76, ) (-1.02, 0.366) -0.1 (-0.52, 0.241) (-2.45, 0.112) (-1.52, 0.044) (-1.67, -0.6) (-1.04, ) Conclusion: Patient-perceived pain barriers from cancer patients were significantly higher than those reported from countries (especially for concerns for disease progression, fatalism, and tolerance). These findings suggest that cancer patients from countries need to be assessed carefully for perceived pain barriers to optimize cancer pain management. Sources of funding: National Health Research Institute (NHRI-EX-06PI) and Ministry of Education. p 0.1 <

2 Patient-perceived barriers for cancer pain management between and cultures- a systematic review by meta-analysis Chen Hsiu Chen, MSN, RN Siew Tzuh Tang, DNSc 1

3 Background Patient barriers for cancer pain management were found to contribute to cancer patients reluctance to report pain and to use prescribed analgesics, which in turn resulted in inadequate cancer pain control. Patients perceived barriers to managing cancer pain may be influenced by culture. 2

4 Purpose This meta-analysis was conducted to compare differences in and patientperceived barriers to managing cancer pain. 3

5 Materials and methods The relevant literature in English was searched on PubMed, PsychInfo, and Google Scholar using the terms cancer, pain, barriers, and patients as keywords to identify relevant titles and abstracts. The literature was systematically reviewed to compare pain barriers in and cancer patients that used Ward s Barrier Questionnaire. Differences in weighted barrier scores were compared by meta-regression analysis. 4

6 Results The selected 24 studies explored patients barriers to cancer pain management in six countries: the United States, Australia, Puerto Rico, Taiwan, Hong Kong, and Korea. cancer patients had higher barrier scores than patients, except for barriers of good patient, side effects.. 5

7 Results Meta-regression analysis indicated that patients perceived pain barriers differed significantly from those of patients for disease progression (beta= ; 5% CI ~ -0.6), fatalism (beta= ; 5% CI -1.6~ -0.54), tolerance (beta= -0.56; 5% CI -1.76~ ), and total BQ (beta= ; 5% CI -1.04~ ). 6

8 Table 1. The comparison of patient-perceived barriers for cancer pain management between and cultures Type of pain barriers Culture No of studies Sample size Weight mean (SD) Effect size a. Meta-regression Beta (5% CI) b p Fatalism (1.33) 1.37 (1.25) (-1.6~ -0.54) P<0.001 tolerance (1.67) 2.05 (1.44) (-1.76~ ) P=0.014 Disease progression (1.67) 2.42 (1.61) (-1.67~ -0.6) P=0.001 Fear of injections (1.67) 1.0 (1.41) (-2.45~ 0.112) P= Distract physician (1.42) 1.53 (1.36) (-1.52~ 0.044) P= a Effect size: ES = (M M ) SD pooled b Meta-regression used, with inverse variance weight a 7

9 Table 1. The comparison of patient-perceived barriers for cancer pain management between and cultures Type of pain barriers Culture No of studies Sample size Weight mean (SD) Effect size a. Meta-regression Beta (5% CI) b p addiction (1.66) 2.52 (1.45) (-0.3~ 0.5) P= 0.1 good patient (1.37) 1.46 (1.3) (-1.02~ 0.366) P= side-effects (1.37) 2.26 (1.34) (-0.52~ 0.241) P= Total BQ score (0.2) 1. (0.7) (-1.04~ ) P=0.004 a Effect size: ES = (M M ) SD pooled b Meta-regression used, with inverse variance weight

10 Conclusion patients perceived barriers to managing cancer pain were significantly higher than those for patients (especially for concerns about disease progression, tolerance, and fatalism). These findings suggest that cancer patients from countries need to be assessed and treated carefully for perceived barriers to optimize cancer-pain management.

11 The End!! Thank you