title: Assessment and management of adult cancer pain: a systematic review and synthesis of recent qualitative studies aimed at developing insights for managing barriers and optimizing facilitators within a comprehensive framework of patient care.
abstract: BACKGROUND
  Cancer pain is a common, burdensome problem, which is not well managed despite evidence-based guidelines.
  
  
  OBJECTIVE
  To develop insights for managing barriers and optimizing facilitators to adult cancer pain assessment and management within a comprehensive framework of patient care.
  
  
  METHODS
  We undertook a systematic review and synthesis of qualitative studies. Medline, PsycINFO, Embase, AMED, CINAHL, and Sociological Abstracts were searched from May 20 to 26, 2011. To be included, the articles had to be published in a peer-reviewed journal since 2000; written in English; and report original qualitative studies on the perspectives of patients, their significant others, or health care providers. Article quality was rated using the checklist of Kitto et al. Thematic synthesis followed a three-stage approach using Evidence for Policy and Practice Information and Co-ordinating Centre-Reviewer 4 software: 1) free line-by-line coding of "Results," 2) organization into "descriptive" themes, and 3) development of "analytical" themes informative to our objective. At Stage 3, a conceptual framework was selected from the peer-reviewed literature according to prima facie "fit" for descriptive themes.
  
  
  RESULTS
  Of 659 articles screened, 70 met the criteria, reporting 65 studies with 48 patient, 19 caregiver, and 21 health care provider samples. Authors rarely reported reflexivity or negative cases. Mead and Bower's model of patient-centered care accommodated 85% of the descriptive themes; 12% more related to the caregiver and service/system factors. Three themes could not be accommodated.
  
  
  CONCLUSIONS
  Findings highlight the need to integrate patient/family education within improved communication, individualize care, use more nonpharmacological strategies, empower patients/families to self-manage pain, and reorganize multidisciplinary roles around patient-centered care and outcomes. These conclusions require validation via consensus and intervention trials.
authors.affiliation: Improving Palliative Care through Clinical Trials, New South Wales Palliative Care Clinical Trials Collaborative, Sydney, NSW 2007, Australia. t.luckett@unsw.edu.au
authors.forename: Tim
authors.initials: T
authors.lastname: Luckett
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
authors.forename: Anna
authors.initials: A
authors.lastname: Green
authors.forename: Frances
authors.initials: F
authors.lastname: Boyle
authors.forename: John
authors.initials: J
authors.lastname: Stubbs
authors.forename: Melanie
authors.initials: M
authors.lastname: Lovell
mesh_terms: D000328:Adult; D015984:Causality; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000451:nursing*; D010146:Pain / Q000175:diagnosis* / Q000453:epidemiology; D059408:Pain Management / Q000706:statistics & numerical data*; D010147:Pain Measurement / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome