Elsevier

Pain Management Nursing

Volume 11, Issue 4, December 2010, Pages 224-233
Pain Management Nursing

Original Article
Barriers to Pain Management among Adolescents with Cancer

https://doi.org/10.1016/j.pmn.2009.05.006Get rights and content

Abstract

Patient-related barriers to reporting pain and using analgesics (e.g., fear of addiction) can detrimentally affect pain management for adolescents with cancer. However, adolescent barriers have not been systematically investigated; furthermore, no instrument exists to measure these barriers. The purposes of this study were to examine the psychometric properties of the newly developed Adolescent Barriers Questionnaire (ABQ) and to describe adolescent barriers to pain management. The study was guided by a barriers model which suggests that barriers (beliefs) influence coping (hesitation to report pain, use of analgesics, and adequacy of analgesics), which in turn affects outcomes (pain severity and quality of life). Sixty adolescent patients with cancer aged 12-17 years completed the ABQ; 22 of which reported pain and also completed measures of hesitation, analgesic use, pain severity, and physical and psychosocial function. Initial testing provided evidence that the ABQ is reliable and valid. Internal consistency estimates for the total scale ranged from 0.91 to 0.94 and for the subscales ranged from 0.54 to 0.96. Test-retest reliability over a 2-week period was r = 0.82. Construct validity was supported by a significant positive relationship between barriers scores and coping (hesitation to report pain and to use analgesics). However, coping did not mediate the relationship between barriers and outcomes. All of the adolescents reported some barriers. Barriers scores did not vary by age or gender. The leading barrier was concern that social activities would be restricted if pain was reported. Clearly, adolescents have barriers that can interfere with pain management. Interventions are needed to identify and help adolescents overcome these barriers.

Section snippets

Participants

Participants were adolescents recruited through a cancer survey center and from a pediatric oncology clinic, both located in the State of Wisconsin. Inclusion criteria were ages 12-17 years and diagnosed with cancer for at least 1 month. Exclusion criteria were known cognitive disabilities that would interfere with completing the surveys, as well as the participant's or the parent's inability to read and write in English. Among the 174 adolescents who were eligible, 47 were unable to be located

Sample

The mean age of the adolescents was 14.77 years (SD 1.86, range 12-17 years). See Table 1 for sample characteristics. The majority of the adolescents were caucasian (90%) and female (53.3%). The mean length of time diagnosed with cancer was 30.52 months (SD 14.91, range 2-60 months). Leukemia was the most common cancer diagnosis (35%), followed by lymphoma (21.7%) and bone tumors (13.3%). The majority (70%) reported that they had finished treatment for their cancer. Most of the participants

Discussion

The ABQ appears to be a reliable measure of adolescent barriers. The alphas for the total scale were adequate at both time 1 and time 2. Six of the subscales had somewhat low alphas at time 1, but all of these subscales except one had acceptable alphas at time 2. Regarding the stability of the ABQ, the correlation between time 1 and time 2 ABQ total scores was high and, other than the fatalism subscale, the correlations between the subscales at time 1 and time 2 were substantial. These findings

Acknowledgments

The author thanks Sandra Ward, Ronald Serlin, and Sue Hughes for their excellent guidance. She is deeply grateful to the adolescents who participated in the study and to the University of Wisconsin Pediatric Hematology/Oncology Clinic staff for their strong support.

References (53)

  • S.E. Ward et al.

    Patient-related barriers to management of cancer pain in Puerto Rico

    Pain

    (1994)
  • L.N.L. Zonneveld et al.

    Accuracy of children's pain memories

    Pain

    (1997)
  • S. Ameringer et al.

    Concerns about pain management among adolescents with cancer: Developing the Adolescent Barriers Questionnaire

    Journal of Pediatric Oncology Nursing

    (2006)
  • K.J. Anand et al.

    Halothane-morphine compared with high-dose sufentanil for anesthesia and postoperative analgesia in neonatal cardiac surgery

    New England Journal of Medicine

    (1992)
  • R.W. Blum et al.

    Family and peer issues among adolescents with spina bifida and cerebral palsy

    Pediatrics

    (1991)
  • C.T. Chambers et al.

    A randomized trial of a pain education booklet: Effects on parents' attitudes and postoperative pain management

    Child Health Care

    (1997)
  • C.J. Claflin et al.

    Does “telling” less protect more? Relationships among age, information disclosure, and what children with cancer see and feel

    Journal of Pediatric Psychology

    (1991)
  • C. Cleeland

    Documenting barriers to cancer pain management

  • C.S. Cleeland et al.

    How to assess cancer pain

  • J. Cohen et al.

    Applied multiple regression/correlation analysis for the behavioral sciences

    (1983)
  • J. Dunsmore et al.

    Information, support, and decision-making needs and preferences of adolescents with cancer: Implications for health professionals

    Journal of Psychosocial Oncology

    (1995)
  • G.W. Einhorn

    Total quality pain management: a computerized quality assessment tool for postoperative pain management

    Analgesia

    (1994)
  • K. Enskar et al.

    Symptom distress and life situation in adolescents with cancer

    Cancer Nursing

    (1997)
  • J. Garber et al.

    Concordance between mothers' and children's reports of somatic and emotional symptoms in patients with recurrent abdominal pain or emotional disorders

    Journal of Abnormal Child Psychology

    (1998)
  • Gordon, D., Pellino, T., Schroeder, S., McConley, R., & Whitman, H. (1998). How much pain is too much? Examining pain...
  • R.S. Greenberg et al.

    Videotape increases parental knowledge about pediatric pain management

    Anesthesia & Analgesia

    (1999)
  • Cited by (39)

    • Normalization of Symptoms in Advanced Child Cancer: The PediQUEST-Response Case Study

      2022, Journal of Pain and Symptom Management
      Citation Excerpt :

      Attending to symptom related suffering is a moral imperative. Barriers to symptom management in children with cancer have frequently been described from the perspective of parents and/or professionals, with only a few studies incorporating the perspective of children and teens.16–18 These studies have identified, for example, that patients and parents are reluctant to report symptoms, do not want to “bother” doctors or worry family members, have misconceptions and fears about using pharmacological treatments, or tend to have negative expectations or fatalistic beliefs about cancer (and symptom) treatments.16,18,19

    • Validation of the Adolescent Barriers Questionnaire for use in Brazilian adolescents with cancer

      2021, Jornal de Pediatria
      Citation Excerpt :

      Evaluation instruments are useful in clinical practice and can be complementary measures or even contribute to the outcome of the care plan used by professionals.21 Thus, using the appropriate methodology for the validation process is of fundamental importance.13 The ABQ validation process for the Brazilian Portuguese language followed the methodology proposed to ensure adequate interpretation by adolescents and, consequently, identification of barriers.

    • Pain and its Impact on the Functional Ability in Children Treated at the Children's Cancer Center of Lebanon

      2018, Journal of Pediatric Nursing
      Citation Excerpt :

      The FDI was chosen for its sensitivity to change, its well-established reliability and validity across a broad range of painful pediatric conditions and its ease of administration, scoring, and interpretation. The efficiency of the FDI has been demonstrated in pediatric pain research (Eccleston et al. 2006; Palermo et al. 2008) and in cancer pain research (Ameringer 2010). The psychometric properties of the FDI have been well-established in different populations (Claar & Walker 2006; Lynch-Jordan et al. 2010; Palermo et al. 2008; Reid, Lang, & McGrath 1997; Vervoort, Goubert, Eccleston, Bijttebier, & Crombez 2006).

    View all citing articles on Scopus

    Supported by Beta-Eta-at-Large Sigma Theta Tau International Chapter (NINR F31NR009324), and the Eckberg Fund Research Award, University of Wisconsin–Madison School of Nursing.

    View full text