Attitudes, Knowledge, and Perceived Barriers Towards Cancer Pain Management Among Healthcare Professionals in Libya: a National Multicenter Survey

Abstract

Cancer pain presents in approximately 66% of patients in advanced stages. Although several guidelines and pharmacological options are available for cancer pain management (CPM), assessment and treatment of cancer pain remain inadequate globally, particularly in developing countries. Lack of knowledge and negative attitudes towards CPM among healthcare professionals (HCPs) are important barriers to CPM. This survey aimed to evaluate nurses’ and physicians’ knowledge, attitudes, and potential barriers regarding CPM in Libya. This cross-sectional survey involved a convenience sample of 152 oncology nurses and physicians working in six oncology settings in Libya. The response rate was 76%. The Barriers Questionnaire II (BQ-II) was used for data collection (higher scores signify greater attitudinal barriers and poorer knowledge). Data analysis was carried out using Statistical Package for Social Sciences (SPSS), version 26 software. An independent t-test (unadjusted estimate) indicated that Libyan nurses showed higher mean barrier scores (mean = 3.8, SD = 0.7) to CPM than physicians (mean = 2.9, SD = 0.8), p < 0.001. The six most common differences in attitudinal barriers between nurses and physicians were “opioid side effects,” “poor tolerance,” “strong patient endures pain,” “distract the physician,” “drug addiction,” and “opioids impair immune function,” p < 0.001. Multiple regression results (adjusted estimate) indicated that nurses had more barrier scores to CPM than physicians (B = − 0.530, p < 0.05), and participants with higher educational levels were associated with lower barrier scores to CPM (B = − 0.641, p < 0.05). Our results suggest that Libyan oncology HCPs hold perceived barriers, lack of knowledge, and negative attitudes towards CPM. Professional education and training in CPM, addressing phobia and myths on opioid usage, and the benefits and complications of using opioids are likely to result in reduced barriers to CPM in Libya.

Libyan Healthcare Professionals’, Patients’ and Caregivers’ Perceptions and Religious Beliefs about Cancer Pain and its Management: A Descriptive Qualitative Study

“…Many barriers to effective CPM exist, including HCPs, patients, caregivers, and healthcare system-related factors. For example, negative attitudes and lack of knowledge towards CPM among HCPs, patients, and caregivers, and a lack of policies and CPM guidelines in health systems were reported as barriers to adequate CPM (Kwon, 2014 ; Makhlouf et al, 2020 , 2022 ; Oldenmenger et al, 2009 ; Potter et al, 2003 ). Furthermore, religious and cultural beliefs could be barriers to effective CPM.…”

“…Understanding patients’ religious and cultural beliefs can enable HCPs to improve CPM, as such beliefs should guide HCPs in how and when patients’ pain should be treated (Silbermann & Hassan, 2011 ). A recent survey showed that Libyan HCPs are concerned about the social stigma of opioids due to a fear of poor tolerance and drug addiction, which could be related to their religious and cultural beliefs, resulting in barriers to effective CPM (Makhlouf et al, 2022 ). Similar findings also were found in other countries (Kagawa-Singer, 2011 ; Nasser et al, 2016 ; Rajeh Saifan et al, 2019 ).…”

“…Furthermore, Libya lacks healthcare services, such as pain management (Elzahaf et al, 2016 ; Petropoulos et al, 2016 ) and palliative care (El Ansary et al, 2014 ). A recent survey reported that Libyan HCPs had poor attitudes towards opioids and lacked knowledge about CPM (Makhlouf et al, 2022 ). Many studies indicated that HCPs, who have experience in pain clinics and palliative care settings, showed better attitudes towards opioids and knowledge about CPM than those who did not (Darawad et al, 2019 ; McCaffery & Ferrell, 1995 ; Rurup et al, 2010 ).…”