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

Abstract

Cancer pain remains a significant problem worldwide. It is often undertreated and presents in about half of cancer patients. Although several guidelines and pharmacological interventions for cancer pain management (CPM) exist, inadequate assessment and undertreatment of cancer pain are well-documented globally, especially in developing countries, including Libya. Perceptions, cultural and religious beliefs of healthcare professionals (HCP), patients, and caregivers about cancer pain and opioids are reported as barriers to CPM globally. This qualitative descriptive study aimed to explore Libyan HCPs’, patients’, and caregivers’ views and religious beliefs about CPM and involved semi-structured interviews with 36 participants: 18 Libyan cancer patients, 6 caregivers, and 12 Libyan HCPs. Thematic analysis was used to analyse the data. Patients, caregivers, and newly qualified HCPs were concerned about poor tolerance and drug addiction. HCPs perceived a lack of policies and guidelines, pain rating scales, and professional education and training as CPM barriers. Some patients were unable to pay for medicines if they faced financial difficulties. Instead, patients and caregivers emphasised religious and cultural beliefs for managing cancer pain, including the use of the Qur’an and cautery. Our results suggest that religious and cultural beliefs, lack of knowledge and training in CPM among HCPs, and economic and Libyan healthcare system-related factors negatively affect CPM in Libya.

Healthcare Providers’ Perceptions of the Cancer Pain Management Barriers at a Hospital in Zambia: A Qualitative Study

“… Javier et al (2016) concurred that a lack of available guidelines was one of the institution-related barriers to cancer pain management. A study by Makhlouf et al (2023) also confirmed that healthcare providers perceived the absence of policies, guidelines, education and training in managing pain as a barrier to cancer pain management. This study confirmed that limited medications were available to manage cancer pain.…”

“…In this study, two beliefs affecting adherence to cancer pain management regimens and follow-up included the belief that witchcraft was responsible for their cancer, and male patients not reporting pain due to the belief that this reflects weakness. Makhlouf et al (2023) and Uysal (2018) also reported cultural beliefs as barriers to cancer pain management. In a study by Kwon (2014) , negative attitudes toward morphine was reported, due to the fear of addiction, religious concerns, and cultural prohibitions.…”

“…However, despite developments in cancer pain management and guidelines, the pain often remains undertreated ( Jara et al, 2018 ), with up to 31% of patients’ cancer pain not effectively controlled ( Breivik et al, 2009 ). Ineffective cancer pain management is worse in developing countries, where treatment coverage is limited, and many patients with cancer do not receive appropriate pain management ( Ahmedzai et al, 2019 ; Makhlouf et al, 2023 ; Nia & Epstein, 2019 ). In these resource-limited countries, up to 80% of patients dying from cancer experience moderate to severe pain lasting, on average, for up to 90 days ( Knaul et al, 2018 ).…”