Do patients' beliefs act as barriers to effective pain management behaviors and outcomes in patients with cancer-related or noncancer-related pain?
OBJECTIVE
To understand the role of patients' beliefs in pain management in a cancer population treated in a primary care setting.


METHODS
Secondary analyses of data from the baseline phase of a randomized study.


METHODS
Eight of the largest primary care clinics in a managed care system.


METHODS
342 patients with cancer who reported pain that would not dissipate on its own or when treated by over-the-counter medication; approximately half had pain that was not cancer related.


METHODS
Telephone interviews.


METHODS
Patients' demographic characteristics, self-reported history and beliefs about pain and pain treatment, willingness to report pain and take pain medication, recent pain intensity, and administrative data on opioid prescriptions.


RESULTS
Patients' beliefs were not associated strongly with reporting pain or taking medication. Regression analyses revealed that patients' beliefs played a limited role in predicting recent pain intensity, whereas the providers' pain management practices seemed to have a far greater predictive role. Additionally, among patients with recent moderate to severe pain, the relationship between patients' beliefs and their history of pain and pain treatment further suggests that beliefs are likely to be formed, in part, as a consequence of the care they receive. Results did not depend on whether the cause of pain was related to cancer.


CONCLUSIONS
Patients' beliefs were important barriers to effective pain management, either as direct or indirect determinants of pain. Providers' pain management practices were more likely to determine the level of pain relief achieved and the beliefs their patients came to hold based on their personal experiences.


CONCLUSIONS
Nursing interventions should examine the impact of evaluating patients' beliefs in conjunction with pain assessment on pain-related behaviors and pain relief, as well as the ability of patient educational efforts to strengthen accurate beliefs and enable patients to assert themselves when interacting with less knowledgeable providers.
Dawson
Ree
R
Frontier Science and Technology Research Foundation, Boston, MA, USA. dsellers@edc.org
Sellers
Deborah E
DE
Spross
Judith A
JA
Jablonski
Erica S
ES
Hoyer
Doris R
DR
Solomon
Mildred Z
MZ
D000367:Age Factors; D000368:Aged; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use; D001294:Attitude to Health; D004522:Educational Status; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000451:nursing*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology* / Q000451:nursing; D010147:Pain Measurement; D011320:Primary Health Care; D016896:Treatment Outcome
D000700:Analgesics