Attitudinal Barriers to Pain Management and Associated Factors Among Cancer Patients in Mainland China: Implications for Cancer Education.

Attitudinal barriers to pain management are supposed to contribute to the uncontrolled cancer pain in mainland China. The purpose of this study was (1) to investigate the attitudinal barriers to pain management among cancer patients in mainland China, (2) to examine relationships between the attitudinal barriers and patients' pain management conditions in the light of medication adherence and adequacy of analgesic use, and (3) to identify factors associated with the attitudinal barriers. A cross-sectional questionnaire survey, including the Barriers Questionnaire-Chinese (BQ-C) and two scales that measure the medication adherence and the adequacy of analgesic use, was carried out among patients with a variety of cancers. The questionnaires were completed by 246 cancer patients (response rate 94.6%); their mean age was 51.5 years (SD = 11.7). Almost all the patients had various attitudinal barriers to pain management. The mean scores for the total scale and several subscales of the BQ-C were significantly different by the patients' characteristics, the medication adherence, and the adequacy of analgesic use. The associations with these variables for a given subscale, e.g., the subscale regarding concerns about side effects, were different from those for other subscales, e.g., the subscale regarding fatalism that cancer pain is uncontrollable. The findings suggest that a nurse-led educational program in the light of patients' characteristics is required for overcoming the attitudinal barriers to pain management among cancer patients in mainland China.