Experience of Barriers to Pain Management in Patients Receiving Outpatient Palliative Care

Background: Patient-reported barriers are an important obstacle to cancer pain management. For effective pain management, exploring patient-reported barriers and related factors is important. Objectives: The study's objective is to determine factors associated with patient-reported barriers to cancer pain management. Method: We conducted a secondary analysis of data from a prospective observational study examining opioid adherence in palliative care outpatients. We evaluated the association between high score on patient-reported barriers to cancer pain management, on the Barriers Questionnaire II (BQ-II), and patients' race, sex, smoking history, pain intensity, opioid dose, and depression. Results: Of 196 patients evaluated (median age 55 years), 147 (75%) were white, 41 (21%) had gastrointestinal cancer, and 121 (62%) were receiving anticancer treatment when data were collected. The median pain score was 4 (interquartile range [IQR] 3-7); 98% were receiving strong opioids; and 63% were satisfied with their pain medication. The median Edmonton symptom assessment scale (ESAS) depression score was 1 (IQR 0-3). Mean (SD) BQ-II scores were 1.8 (0.9) for physiologic effects, 1.6 (0.9) for fatalism, 0.9 (0.9) for communication, 2.3 (1.1) for harmful effects, and 1.7 (0.8) in total. Only racial differences were associated with high total BQ-II score in multivariable analysis (R2 = 0.05, overall F test significance = 0.02). Pain related factors including opioids dose, pain intensity, and satisfaction were not associated with high BQ-II score. Conclusion: Patients receiving palliative care expressed low barriers to pain control. There were minimal associations of BQ-II score with demographics and clinical factors.