The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Exploring interference from analgesia in patients with cancer pain: a longitudinal qualitative study
Article first published online: 20 DEC 2013
© 2013 John Wiley & Sons Ltd
Journal of Clinical Nursing
Volume 23, Issue 13-14, pages 1877–1888, July 2014
How to Cite
Manzano, A., Ziegler, L. and Bennett, M. (2014), Exploring interference from analgesia in patients with cancer pain: a longitudinal qualitative study. Journal of Clinical Nursing, 23: 1877–1888. doi: 10.1111/jocn.12447
- Issue published online: 19 JUN 2014
- Article first published online: 20 DEC 2013
- Manuscript Accepted: 27 JUN 2013
- National Institute for Health Research (NIHR)
- Programme Development Grants. Grant Number: RP-DG-1108-10010
Aims and objectives
To increase understanding of the impact of analgesic side effects in patients with cancer pain.
Studies in the area of cancer pain often refer to the need to find a satisfactory balance between analgesics and side effects as the key to cancer pain management. We explore how patients achieve this balance, its components and how it affects pain treatment adherence.
An exploratory longitudinal study using qualitative research methodology.
Twenty-five semi-structured face-to-face interviews with patients with advanced cancer and their caregivers. Longitudinal interviews were conducted with patients (n = 11) at six-week intervals over three months. Eleven first interviews, eight second interviews and six third interviews were completed with attrition due to death or ill health. Ten of the 25 interviews included caregivers.
How cancer pain analgesics interfere with patients' life determines their adherence to the prescribed treatment. Compromises were made to manage three elements: pain, cognitive adverse effects of analgesics and physical activity. Negotiations and choices within this triad fluctuated and were determined by multiple psychosocial circumstances affecting patients and their caregivers varying from simple to complex. Patients with cancer and their caregivers actively managed the interference of analgesic drugs in their cognitive abilities and displayed a variety of nonadherence behaviours.
Further understanding of the role of analgesic side effects in the success of cancer pain management in patients is needed. This would enable clinicians to frame an optimal pain management plan.
Relevance to clinical practice
Clinicians should advise their patients about side effects of analgesic drugs, specifically the impact that cognitive alterations might have on their lives and subsequent adherence behaviour. Helping patients to achieve a balance between pain, adverse effects and physical function should have a key place in pain management strategies with advanced cancer.