Barriers to successful treatment of cancer pain
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Objectives: 1. To discuss barriers that prevent effective treatment of cancer pain 2. To propose solutions to promote effective cancer pain management
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Barriers to successful treatment of cancer pain
- 1. Facilitated by Abdulqadir J. Nashwan, RN, BSN, MSN
- 3. Objectives • To discuss barriers that prevent effective treatment of cancer pain • To propose solutions to promote effective cancer pain management
- 5. Barriers to Successful Management of Cancer Pain Healthcare Professionals- related Patient- related System- related
- 8. Patient-related Reluctance to take pain medication
- 9. Patient-related High costs of medications and treatments
- 10. Patient-related Belief that pain is inevitable in cancer
- 11. Patient-related Fear of alienating care givers
- 12. Patient-related Fear of addiction, dependence, adverse effects of medications
- 13. System-related
- 14. System-related Low priority given to cancer pain treatment
- 16. System-related Failure to recognize pain as a major cause of disability
- 19. Healthcare Professionals-related “Unbelievably, American doctors regularly refuse to prescribe effective doses of narcotic pain killers to dying patients on the grounds that the patients might become addicted. The treatment of cancer pain, clearly, is still not based solely on scientific fact but draws on ignorance, fear, prejudice, and on an invisible, unacknowledged moral code expressing half- baked notions about evil of drugs and the duty to bear affliction.” - Dick Morris from The Culture of Pain
- 20. Healthcare Professionals-related Inadequate knowledge/training in pain management Inadequate pain assessment Concerns about regulation of controlled substances Fear of patient addiction Ethnic/racial/gender/age biases Negative feelings towards patients’ pain
- 22. Healthcare Professionals-related Inadequate pain assessment
- 23. Healthcare Professionals-related Concerns about regulation of controlled substances
- 24. Healthcare Professionals-related Fear of patient addiction
- 26. Healthcare Professionals-related Negative feelings towards patients’ pain
- 27. Barriers to Successful Management of Cancer Pain Healthcare Professionals- related Patient- related System- related
- 28. Strategies to overcome barriers
- 29. System- related • Individualized Treatment Plan • Reform regulations (balanced) • Monitoring programs Patient- related • Awareness, Education, Bill of Rights, patient engagement Healthcare Professiona ls-related • Education, Clear guidelines, Multidisciplinary approach, quality management
Notes de l'éditeur
- Suffering is experienced by persons, not merely by bodies, and has its source in challenges that threaten the intactness of the person as a complex social and psychological entity. Suffering can include physical pain but is by no means limited to it. Eric J Cassel The Nature of Suffering and the Goals of Medicine, N Engl J of Med 1982; 306:639-45.
- Reluctance to report pain- fear that pain means disease is worse, concern about not being a good patient, concern about distracting physician from treatment of cancer. Cost is also a factor in preventing patients taking medication Belief that pain is inevitable in cancer (due to religious/Spiritual believes)
- Reluctance to report pain- fear that pain means disease is worse, concern about not being a good patient, concern about distracting physician from treatment of cancer. Cost is also a factor in preventing patients taking medication Belief that pain is inevitable in cancer (due to religious/Spiritual believes)
- Reluctance to report pain- fear that pain means disease is worse, concern about not being a good patient, concern about distracting physician from treatment of cancer. Cost is also a factor in preventing patients taking medication Belief that pain is inevitable in cancer (due to religious/Spiritual believes)
- Reluctance to report pain- fear that pain means disease is worse, concern about not being a good patient, concern about distracting physician from treatment of cancer. Cost is also a factor in preventing patients taking medication Belief that pain is inevitable in cancer (due to religious/Spiritual believes)
- Pain is inevitable .. Suffering is optional
- Reluctance to report pain- fear that pain means disease is worse, concern about not being a good patient, concern about distracting physician from treatment of cancer. Cost is also a factor in preventing patients taking medication Belief that pain is inevitable in cancer (due to religious/Spiritual believes)
- Reluctance to report pain- fear that pain means disease is worse, concern about not being a good patient, concern about distracting physician from treatment of cancer. Cost is also a factor in preventing patients taking medication Belief that pain is inevitable in cancer (due to religious/Spiritual believes) Salat
- Low priority given to cancer pain treatment Priority on curing cancer
- Low priority given to cancer pain treatment Priority on curing cancer
- Underestimation of cancer pain management
- Availability and accessibility to healthcare facilities
- stereotype
- Major criticism of the “ barriers literature” is the failure to analyze these barriers from an ethical perspective Curative versus palliative models of medicine Disparity between current state of medical knowledge and prevailing practice of pain management Irrational beliefs about addiction, tolerance and adverse side effects
- Identifying the drug seeking patient
- unavoidable