Faculty of Health,University of Technology,Sydney,NSW,Australia.
Greenwich Palliative and Supportive Care Services,Greenwich,NSW,Australia.
Palliat Support Care. 2018 Dec;16(6):785-799. doi: 10.1017/S1478951517001171. Epub 2018 Jan 17.
More than half of all cancer patients experience unrelieved pain. Culture can significantly affect patients' cancer pain-related beliefs and behaviors. Little is known about cultural impact on Chinese cancer patients' pain management. The objective of this review was to describe pain management experiences of cancer patients from Chinese backgrounds and to identify barriers affecting their pain management.
A systematic review was conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they reported pain management experiences of adult cancer patients from Chinese backgrounds. Five databases were searched for peer-reviewed articles published in English or Chinese journals between1990 and 2015. The quality of included studies was assessed using Joanna Briggs Institution's appraisal tools.
Of 3,904 identified records, 23 articles met criteria and provided primary data from 6,110 patients. Suboptimal analgesic use, delays in receiving treatment, reluctance to report pain, and/or poor adherence to prescribed analgesics contributed to the patients' inadequate pain control. Patient-related barriers included fatalism, desire to be good, low pain control belief, pain endurance beliefs, and negative effect beliefs. Patients and family shared barriers about fear of addiction and concerns on analgesic side effects and disease progression. Health professional-related barriers were poor communication, ineffective management of pain, and analgesic side effects. Healthcare system-related barriers included limited access to analgesics and/or after hour pain services and lack of health insurance.Significance of resultsChinese cancer patients' misconceptions regarding pain and analgesics may present as the main barriers to optimal pain relief. Findings of this review may inform health interventions to improve cancer pain management outcomes for patients from Chinese backgrounds. Future studies on patients' nonpharmacology intervention-related experiences are required to inform multidisciplinary and biopsychosocial approaches for culturally appropriate pain management.
超过一半的癌症患者经历着无法缓解的疼痛。文化会显著影响患者的癌症疼痛相关信念和行为。对于文化对中国癌症患者疼痛管理的影响知之甚少。本综述的目的是描述中国背景癌症患者的疼痛管理体验，并确定影响其疼痛管理的障碍。
本研究遵循系统评价和荟萃分析的首选报告项目进行系统综述。如果研究报告了中国背景的成年癌症患者的疼痛管理体验，则将其纳入研究。在 1990 年至 2015 年期间，从英文或中文期刊中检索了五个数据库的同行评审文章。使用 Joanna Briggs 研究所的评估工具评估纳入研究的质量。
在 3904 条记录中，有 23 篇文章符合标准，并提供了 6110 名患者的主要数据。镇痛剂使用不当、治疗延迟、不愿报告疼痛和/或对规定镇痛剂的依从性差，导致患者的疼痛控制不足。患者相关的障碍包括宿命论、渴望成为好人、低疼痛控制信念、疼痛耐受信念和负面效果信念。患者和家属共同面临着对成瘾的恐惧以及对镇痛剂副作用和疾病进展的担忧。卫生专业人员相关的障碍包括沟通不畅、疼痛管理无效以及镇痛剂的副作用。医疗保健系统相关的障碍包括获得镇痛剂和/或夜间疼痛服务的机会有限以及缺乏健康保险。
中国癌症患者对疼痛和镇痛剂的误解可能是最佳缓解疼痛的主要障碍。本综述的结果可能为改善中国背景癌症患者的疼痛管理结果提供信息。需要对患者的非药物干预相关体验进行未来研究，以提供多学科和生物心理社会方法，实现文化上适当的疼痛管理。
