Barriers to cancer pain management: home-health and hospice nurses and patients

Undertreatment of cancer pain remains a major health-care problem. We utilized focus groups of hospice and home-health nurses and patients to elucidate factors contributing to inadequate pain management and to generate solutions for closing the gap between the current reality and optimal pain management. Focus groups were conducted among hospice and home-health-care nurses (two groups; n=22) and patients (six groups; n=54) using a standardized question guide. Audiotapes were transcribed and analyzed using NUD*IST software. Themes discovered among patients and nurses were analyzed for similarities and differences. Of 22 participants in the two home-health and hospice nurses focus groups, all were white women, the average age was 43 (range 29–64) years, and the average number of years in nursing was 21 (range 8–47) years. Of 54 participants in the six cancer patient focus groups, 80% were women, the average age was 54 (range 25–76) years, and 76% were white. Fifty-four percent of patients reported a history of pain associated with their cancer, and almost 30% had pain that they rated as 8 or higher on the pain scale. Barriers to adequate pain management fell into four categories: fears; attitudes, beliefs, and values; patient and provider behaviors; and structural barriers. Patients and nurses reported similar barriers to pain management; however, patients identified more barriers related to provider behavior and structure of the health care system. This study identified several barriers to cancer pain control not previously identified in the literature. Strategies to improve cancer pain control are suggested.