Patient-perceived barriers for cancer pain management between
Western and Asian cultures－A systematic review by meta-analysis
Chen-Hsiu Chen, RN, MSN,1, 2 Siew-Tzuh Tang, RN, DNSc1
1Chang Gung University, Graduate School of Nursing, Tao-Yuan, Taiwan, R.O.C.
2Kang-Ning Junior College of Medical Care and Management, Taipei, Taiwan, R.O.C.
Introduction
Patient barriers for cancer pain
management were found to contribute to cancer
patients’ reluctance to report pain and to use
prescribed analgesics, which in turn resulted in
inadequate cancer pain control. Different
cultures may influence patients’ perceived
barriers to cancer pain management.
The purposes of this study was to
compare patient-perceived pain barriers in
cancer patients between Western and Asian
cultures.
Materials and methods: A systematic
review of the literature was conducted to
compare studies that used Ward’s barriers
questionnaire (BQ) to measure pain barriers in
cancer patients from Western and Asian cultures.
Meta-regression analysis was used to compare
differences in weighted barrier scores between
Western and Asian cultures.
Table 1. The comparison of patient-perceived barriers for cancer
pain management between Western and Asian countries
Type of
Culture No of Sample
pain barriers
studies size
Twenty-four studies using the BQ
were included. The most common patientperceived pain barriers included disease
progression (weighted mean ± SD; 2.93±1.64),
addiction (2.64±1.53), tolerance to pain
medicine (2.40±1.52). Except for barriers of “be
good” and “side effects”, barrier scores reported
from Asian cancer patients were significantly
higher than those from Western cultures. Metaregression analysis indicated that patientperceived pain barriers differed significantly
between Western and Asian cultures for disease
progression (beta= -0.763; 95% CI -1.867, 0.610), fatalism (beta= -0.725; 95% CI -1.688, 0.584), tolerance (beta= -0.568; 95% CI -1.796,
-0.235), and total BQ (beta= -0.603; 95% CI 1.049, -1.234).
MetaEffect
sizea. regression
Beta
(95% CI) b
p
addiction
Asian
Western
9
11
1077
1920
2.85 (1.66)
0.22
2.52 (1.45)
-0.368
(-0.938,
0.105)
0.110
Fatalism
Asian
Western
9
10
1077
1806
2.13 (1.33)
0.59
1.37 (1.25)
-0.725
(-1.688,
-0.584)
<0.001
tolerance
Asian
Western
8
10
1029
1806
3.01 (1.67)
0.63
2.05 (1.44)
-0.568
(-1.796,
-0.235)
0.014
be good
Asian
Western
9
10
1077
1806
1.4 (1.37)
0.04
1.46 (1.38)
-0.236
(-1.029,
0.366)
0.330
side-effects
Asian
Western
8
11
1014
1920
2.26 (1.37)
0.00
2.26 (1.34)
-0.188
(-0.529,
0.241)
0.441
Fear of
injections
Asian
Western
3
5
230
714
2.95 (1.67)
0.71
1.90 (1.41)
-0.674
(-2.458,
0.112)
0.067
distract
physician
Asian
Western
8
10
1029
1806
1.93 (1.42)
0.29
1.53 (1.36)
-0.447
(-1.529,
0.044)
0.063
disease
Asian
progression Western
8
7
1029
1273
3.57 (1.67)
0.70
2.42 (1.61)
-0.763
(-1.867,
-0.610)
0.001
8
13
1029
2021
2.45 (0.82)
0.54
1.99 (0.87)
-0.603
(-1.049,
-1.234)
0.004
Total BQ
score
a Effect
Results:
Weight
mean
(SD)
Asian
Western
size: ES = (M Asian − M Western) ÷ SD pooled
used, with inverse variance weight
b Meta-regression
Conclusion:
Patient-perceived pain barriers
from Asian cancer patients were significantly higher
than those reported from Western countries
(especially for concerns for disease progression,
fatalism, and tolerance). These findings suggest that
cancer patients from Asian countries need to be
assessed carefully for perceived pain barriers to
optimize cancer pain management.
Sources of funding: National Health Research
Institute (NHRI-EX99-9906PI) and Ministry of
Education.
Patient-perceived barriers for cancer
pain management between Western
and Asian cultures－ a systematic
review by meta-analysis
Chen Hsiu Chen, MSN, RN
Siew Tzuh Tang, DNSc
Chen-Hsiu Chen
1
Background
• Patient barriers for cancer pain management
were found to contribute to cancer patients’
reluctance to report pain and to use prescribed
analgesics, which in turn resulted in inadequate
cancer pain control.
• Patients’ perceived barriers to managing cancer
pain may be influenced by culture.
Chen-Hsiu Chen
2
Purpose
• This meta-analysis was conducted to compare
differences in Western and Asian patientperceived barriers to managing cancer pain.
Chen-Hsiu Chen
3
Materials and methods
• The relevant literature in English was searched on
PubMed, PsychInfo, and Google Scholar using the
terms “cancer,” “pain,” “barriers,” and “patients” as
keywords to identify relevant titles and abstracts.
• The literature was systematically reviewed to compare
pain barriers in Western and Asian cancer patients that
used Ward’s Barrier Questionnaire.
• Differences in weighted barrier scores were compared
by meta-regression analysis.
Chen-Hsiu Chen
4
Results
• The selected 24 studies explored patients’
barriers to cancer pain management in six
countries: the United States, Australia,
Puerto Rico, Taiwan, Hong Kong, and
Korea.
• Asian cancer patients had higher barrier
scores than Western patients, except for
barriers of “good patient,” “side effects.” .
Chen-Hsiu Chen
5
Results
• Meta-regression analysis indicated that Asian
patients’ perceived pain barriers differed
significantly from those of Western patients for
disease progression (beta= -0.763; 95% CI 1.867~ -0.610), fatalism (beta= -0.725; 95% CI
-1.688~ -0.584), tolerance (beta= -0.568; 95%
CI -1.796~ -0.235), and total BQ (beta= -0.603;
95% CI -1.049~ -1.234).
Chen-Hsiu Chen
6
Table 1. The comparison of patient-perceived barriers for cancer pain management
between Western and Asian cultures
Type of pain
barriers
Culture
No of
studies
Sample
size
Weight mean
(SD)
Fatalism
Asian
Western
9
10
1077
1806
2.13 (1.33)
1.37 (1.25)
tolerance
Asian
Western
8
10
1029
1806
3.01 (1.67)
2.05 (1.44)
Asian
Western
8
7
1029
1273
3.57 (1.67)
2.42 (1.61)
Asian
Western
3
5
230
714
2.95 (1.67)
1.90 (1.41)
Asian
Western
8
10
1029
1806
1.93 (1.42)
1.53 (1.36)
Disease
progression
Fear of
injections
Distract
physician
Effect
sizea.
Meta-regression
Beta (95% CI)b
p
P<0.001
0.59
-0.725
(-1.688~ -0.584)
P=0.014
0.63
-0.568
(-1.796~ -0.235)
P=0.001
0.70
-0.763
(-1.867~ -0.610)
P= 0.067
0.71
-0.674
(-2.458~ 0.112)
-0.447
(-1.529~ 0.044)
P= 0.063
0.29
a Effect size: ES = (M Asian − M Western) ÷ SD pooled
ba Meta-regression used, with inverse variance weight
Chen-Hsiu Chen
7
Table 1. The comparison of patient-perceived barriers for cancer pain management
between Western and Asian cultures
Type of pain
barriers
Culture
No of
studies
Sample
size
Weight mean
(SD)
addiction
Asian
Western
9
11
1077
1920
2.85 (1.66)
2.52 (1.45)
good patient
Asian
Western
9
10
1077
1806
1.4 (1.37)
1.46 (1.38)
side-effects
Asian
Western
8
11
1014
1920
2.26 (1.37)
2.26 (1.34)
Total BQ
score
Asian
Western
8
13
1029
2021
2.45 (0.82)
1.99 (0.87)
Effect
sizea.
Meta-regression
Beta (95% CI)b
p
P= 0.110
0.22
-0.368
(-0.938~ 0.105)
P= 0.330
0.04
-0.236
(-1.029~ 0.366)
P= 0.441
0.00
-0.188
(-0.529~ 0.241)
-0.603
(-1.049~ -1.234)
P=0.004
0.54
a Effect size: ES = (M Asian − M Western) ÷ SD pooled
b Meta-regression used, with inverse variance weight
Chen-Hsiu Chen
8
Conclusion
• Asian patients’ perceived barriers to managing
cancer pain were significantly higher than those
for Western patients (especially for concerns
about disease progression, tolerance, and
fatalism).
• These findings suggest that cancer patients
from Asian countries need to be assessed and
treated carefully for perceived barriers to
optimize cancer-pain management.
Chen-Hsiu Chen
9
The End !!
Thank you
Chen-Hsiu Chen
10