Affiliation

Department of Public Health, Health Service Executive West, Merlin Park Hospital, Galway, Republic of Ireland

Corresponding Author

Dr. Geraldine McDarby, Department of Public Health, HSE West, Galway, Ireland, E-mail: Geraldine.mcdarby@hse.ie

Citation

McDarby, G., et al. Patient Barriers to Adequate Analgesia among Irish Palliative Care Patients. (2017) J Palliat Care Pediatr 2(1): 40- 45.

Copy rights

© 2017 McDarby, G. This is an Open access article distributed under the terms of Creative Commons Attribution 4.0 International License.

Keywords

Abstract

Background: Cancer pain is associated with significant costs. Uncontrolled cancer pain impairs physical and psychological functioning while also being associated with increased resource utilization and healthcare costs. Patients continue to report high levels of cancer pain despite the presence of effective guidelines, shown to produce highly significant and sustained reductions. These guidelines are based on the WHO analgesic ladder with opiate analgesics as the mainstay of treatment for moderate to severe pain regardless of its etiology. This study aimed to examine patient barriers to cancer pain control among Irish palliative care patients by examining patient reported pain, prescribed analgesics and patient concerns about reporting pain and using analgesics using internationally validated tools.
Methods: A cross sectional survey was undertaken of all eligible patients attending a regional specialist palliative care centre over a four month period. Patients completed the Barriers Questionnaire II (BQII) to assess pain barriers to reporting pain and using analgesics. Patient records were examined to determine the adequacy of prescribed analgesics as define by the WHOs Pain Management Index PMI where adequacy of analgesia relates to the congruence between the level of analgesic prescribed according to the WHO ladder and patients reported pain intensity. Ethical approval was granted by the NUIG Research in Ethics Committee and the Research Ethics Committee of the Royal College of Physicians, Ireland. Anonymised data was analyzed using SPSS.
Results: The majority (76.6%) of patients surveyed reported some level of pain in the preceeding week, with the majority (91.5%) being prescribed the appropriate level of analgesic for their pain level. Moderate to high levels of concern were reported for three of the four BQII factors with fatalism, concern with addiction and the masking effects of analgesics given the highest subscale ratings.
Conclusions: Despite being prescribed adequate analgesics, three quarters of cancer patients reported pain. High levels of misconceptions and fears are present which have the potential to interfere with appropriate cancer pain management. Patient concerns represent areas for treating physicians to target when assessing cancer pain and control.