Barriers to Pain Management among Adolescents with Cancer

摘要

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 and use analgesics, and adequacy of analgesics), which in turn affects outcomes (pain severity and quality of life). Sixty adolescent patients with cancer aged 12 to 17 years completed the ABQ; twenty-two 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 use analgesics). However, coping did not mediate the relationship between barriers and outcomes. All 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.