title: Connecting the Dots: A Comparative Global Multi-Institutional Study of Prohibitive Factors Affecting Cancer Pain Management.
abstract: The goal of this study was to elucidate the attitudes, beliefs, and barriers interfering with cancer pain management, the degree of barrier interference with trainees’ care of patients, and the relationships among prohibitive factors to pain management for physicians in a low–middle-income countries (LMICs) vs high-income countries (HICs).
  
  
  
  A multi-institutional cross-sectional survey of physicians in specialties with a focus in pain management training was performed. All surveys were completed anonymously from July 1, 2015, to November 30, 2015.
  
  
  
  One hundred and twenty physicians participated in the survey.
  
  
  
  Surveys were based on prior questionnaires published in the literature. Descriptive statistics were calculated, and chi-square (ℵ2) analysis, Fisher’s exact test, and Spearman rank correlation analyses were performed.
  
  
  
  Compared with their peers in HICs, physicians in LMICs reported less experience with cancer pain management despite seeing more cancer patients with advanced disease (41% vs 15.2%, p < 0.05). Some barriers were common to both environments, but a few were unique to each setting. Organized by percentage of severity of interference, cultural values/beliefs about pain (84% vs 76%) and lack of training and expertise (87% vs 78%) were significantly more prohibitive for physicians in LMICs than those in HICs; p < 0.05.
  
  
  
  There are significant differences in perceived barriers and degree of prohibitive factors to cancer pain management among trainee physicians in low- vs high-resource environments. Understanding these differences may spur further collaboration in the design of contextually relevant solutions, which could potentially help improve the adequacy of cancer pain management
authors.affiliation: Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Amoatey Odonkor
authors.affiliation: Department of Radiation Oncology, Radiotherapy & Nuclear Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: William
authors.initials: W
authors.lastname: Addison
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Smith
authors.affiliation: Department of Radiation Oncology, Radiotherapy & Nuclear Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Ernest
authors.initials: E
authors.lastname: Osei-Bonsu
authors.affiliation: Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Tang
authors.affiliation: Department of Anesthesiology & Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Erdek
mesh_terms: D000328:Adult; D000072716:Cancer Pain / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency; D008297:Male; D059408:Pain Management; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: Comparative Study; Pain Management; Attitudes; Oncology; Outcome Measures; Global Health; Cancer Pain