Cancer Pain Management Among Oncology Nurses: Knowledge, Attitude, Related Factors, and Clinical Recommendations: a Systematic Review

  • Salehoddin Bouya
  • Abbas Balouchi
  • Abdulbaset MaleknejadEmail author
  • Maryam Koochakzai
  • Esra AlKhasawneh
  • Abdolghani Abdollahimohammad


The current study evaluated the oncology nurse’s knowledge, attitude, related factors of cancer-related pain management (CPM), and clinical recommendations for improving knowledge and attitude. In this systematic review, international databases (PubMed, EMBASE, Web of science (WOS), Science Direct, and Scopus) were searched for relevant studies published in English language from March 30, 2000 to March 30, 2018. The quality of the studies was evaluated using the Hoy instrument. Out of 888 initial studies, 12 studies performed on 3574 participants were included in the final stage of the review. Based on the results, most studies indicated that nurses had a poor (n = 4) or moderate (n = 4) knowledge of CPM. The lowest and the highest knowledge levels were 28.5% and 75%, respectively. According to most studies, nurses had a fair (average) (n = 4) or negative (n = 3) attitude toward CPM. The important factors related to the nurses’ knowledge of CPM included previous pain-related education programs (n = 7) and having work experience with cancer patients (n = 4). The most important barrier was the deficit in staff’s knowledge of pain (n = 2). The important clinical recommendations for improving nurses’ levels of knowledge included the implementation of educational programs (n = 9), training programs (n = 3) on CPM and including CPM topics in nursing curricula (n = 5). This systematic review showed that most nurses had poor knowledge of CPM and a fair attitude toward CPM, indicating the importance of considering the barriers to knowledge, strengthening the positive relevant factors, and using clinical recommendations based on clinical guidelines such as including CPM topics in nursing curricula and implementing educational programs on CPM to improve the knowledge, attitude, and skills of oncology nurses. The results of the present study could be used by policymakers to provide care for cancer patients and manage their pain.


Cancer pain management Nurses Knowledge Attitude Systematic review 


Compliance with Ethical Standards

This manuscript does not contain clinical studies or patient data.

Conflict of Interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Bouya S, Rafiemanesh H, Balouchi A, Taheri S, Badakhsh M, Didehvar M (2018) Health-related quality of life of Iranian breast cancer patients: a meta-analysis and systematic review. Breast Cancer Res Treat 1–8Google Scholar
  2. 2.
    Ham O-K, Chee W, Im E-O (2017) The influence of social structure on cancer pain and quality of life. West J Nurs Res 39(12):1547–1566CrossRefGoogle Scholar
  3. 3.
    Zylla D, Larson A, Chuy G, Illig L, Peck A, Van Peursem S, Fulbright JW, Pawloski PA, Richter S, Mettner J (2017) Establishment of personalized pain goals in oncology patients to improve care and decrease costs. J Oncol Pract 13(3):e266–e272CrossRefGoogle Scholar
  4. 4.
    Haumann J, Joosten EBA, van den Beuken-van MHJ (2017) Pain prevalence in cancer patients: status quo or opportunities for improvement? Curr Opin Support Palliat Care 11(2):99–104CrossRefGoogle Scholar
  5. 5.
    van den Beuken-van MHJ, Hochstenbach LMJ, Joosten EAJ, Tjan-Heijnen VCG, Janssen DJA (2016) Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manage 51(6):1070–1090. e1079CrossRefGoogle Scholar
  6. 6.
    Oldenmenger WH, Geerling JI, Mostovaya I, Vissers KCP, de Graeff A, Reyners AKL, van der Linden YM (2018) A systematic review of the effectiveness of patient-based educational interventions to improve cancer-related pain. Cancer Treat Rev 63:96–103CrossRefGoogle Scholar
  7. 7.
    Bouya S, Balouchi A, Ahmadidarehsima S, Badakhsh M (2018) Knowledge and source of information about early detection techniques of breast Cancer among women in Iran: a systematic review. J Cancer Prev 23(1):51–60CrossRefGoogle Scholar
  8. 8.
    Alnajar MK, Darawad MW, Alshahwan SS, Samarkandi OA (2017) Knowledge and attitudes toward cancer pain management among nurses at oncology units. J Cancer Educ 1–8Google Scholar
  9. 9.
    Purkayastha A, Sarin A, Sharma N, Singh S, Bisht N (2018) Knowledge, attitude and practice of paramedical staff and nursing assistants towards Cancer Pain Management in a Tertiary Cancer Care Centre. Clin Oncol 3:1439Google Scholar
  10. 10.
    Jun M-H, Gong S-H, Lee S-H, Kim Y-H, Choi J-S, Park K-S (2006) Knowledge and attitude toward cancer pain management: clinical nurses versus doctors. J Korean Acad Soc Nursi Educ 12(1):115–123Google Scholar
  11. 11.
    Kim HJ, Park IS, Kang KJ (2012) Knowledge and awareness of nurses and doctors regarding cancer pain management in a tertiary hospital. Asian Oncol Nurs 12(2):147–155CrossRefGoogle Scholar
  12. 12.
    Kim M-h, Park HG, Park EC, Park K (2011) Attitude and knowledge of physicians about cancer pain management: young doctors of South Korea in their early career. Jpn J Clin Oncol 41(6):783–791CrossRefGoogle Scholar
  13. 13.
    Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097CrossRefGoogle Scholar
  14. 14.
    McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C (2016) PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol 75:40–46CrossRefGoogle Scholar
  15. 15.
    Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, Baker P, Smith E, Buchbinder R (2012) Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol 65(9):934–939CrossRefGoogle Scholar
  16. 16.
    Darawad M, Alnajar MK, Abdalrahim MS, El-Aqoul AM (2017) Cancer pain Management at Oncology Units: comparing knowledge, attitudes and perceived barriers between physicians and nurses. J Cancer Educ 1–9. doi:
  17. 17.
    Alqahtani M, Jones LK (2015) Quantitative study of oncology nurses' knowledge and attitudes towards pain management in Saudi Arabian hospitals. Eur J Oncol Nurs 19(1):44–49. CrossRefPubMedGoogle Scholar
  18. 18.
    Bernardi M, Catania G, Lambert A, Tridello G, Luzzani M (2007) Knowledge and attitudes about cancer pain management: a national survey of Italian oncology nurses. Eur J Oncol Nurs 11(3):272–279. CrossRefPubMedGoogle Scholar
  19. 19.
    Ferreira FS, Santos J, Meira KC (2016) Knowledge of resident nurses on the management of cancer pain: a crosssectional study. Online Braz J Nurs 15(4):694–703CrossRefGoogle Scholar
  20. 20.
    Jho HJ, Kim Y, Kong KA, Kim DH, Choi JY, Nam EJ, Choi JY, Koh S, Hwang KO, Baek SK, Park EJ (2014) Knowledge, practices, and perceived barriers regarding cancer pain management among physicians and nurses in Korea: a nationwide multicenter survey. PLoS One 9(8):e105900. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Lai YH, Chen ML, Tsai LY, Lo LH, Wei LL, Hong MY, Hsiu LN, Hsiao-Sheen ST, Chen SC, Kao CC, Huang TW, Chang SC, Chen L, Guo SL (2003) Are nurses prepared to manage cancer pain? A national survey of nurses' knowledge about pain control in Taiwan. J Pain Symptom Manag 26(5):1016–1025. CrossRefGoogle Scholar
  22. 22.
    Shahriary S, Shiryazdi SM, Shiryazdi SA, Arjomandi A, Haghighi F, Vakili FM, Mostafaie N (2015) Oncology nurses knowledge and attitudes regarding Cancer pain management. Asian Pac J Cancer Prev 16(17):7501–7506CrossRefGoogle Scholar
  23. 23.
    Utne I, Smastuen MC, Nyblin U (2018) Pain knowledge and attitudes among nurses in Cancer Care in Norway. J Cancer Educ.
  24. 24.
    Xue Y, Schulman-Green D, Czaplinski C, Harris D, McCorkle R (2007) Pain attitudes and knowledge among RNs, pharmacists, and physicians on an inpatient oncology service. Clin J Oncol Nurs 11(5):687–695CrossRefGoogle Scholar
  25. 25.
    Yildirim YK, Cicek F, Uyar M (2008) Knowledge and attitudes of Turkish oncology nurses about cancer pain management. Pain Manag Nurs 9(1):17–25. CrossRefPubMedGoogle Scholar
  26. 26.
    Enskär K, Ljusegren G, Berglund G, Eaton N, Harding R, Mokoena J, Chauke M, Moleki M (2007) Attitudes to and knowledge about pain and pain management, of nurses working with children with cancer: a comparative study between UK, South Africa and Sweden. J Res Nurs 12(5):501–515. CrossRefGoogle Scholar
  27. 27.
    Zhang Q, Yu C, Feng S, Yao W, Shi H, Zhao Y, Wang Y (2015) Physicians' practice, attitudes toward, and knowledge of Cancer pain Management in China. Pain Med (United States) 16(11):2195–2203. CrossRefGoogle Scholar
  28. 28.
    Peker L, Celebi N, Canbay Ö, Sahin A, Cakir B, Uzun S, Aypar U (2008) Doctors' opinions, knowledge and attitudes towards cancer pain management in a university hospital. Agri 20(2):20–30PubMedGoogle Scholar
  29. 29.
    Lou F, Shang S (2017) Attitudes towards pain management in hospitalized cancer patients and their influencing factors. Chin J Cancer Res 29(1):75–85CrossRefGoogle Scholar
  30. 30.
    Lin C-C (2000) Barriers to the analgesic management of cancer pain: a comparison of attitudes of Taiwanese patients and their family caregivers. Pain 88(1):7–14CrossRefGoogle Scholar
  31. 31.
    Hochberg U, Perez J, Borod M (2018) New frontier: cancer pain management clinical fellowship. Support Care Cancer 1–5Google Scholar
  32. 32.
    Kwon JH (2014) Overcoming barriers in cancer pain management. J Clin Oncol 32(16):1727–1733CrossRefGoogle Scholar
  33. 33.
    Mann E, Carr E (2018) Pain management. Foundation Studies for Caring: Using Student-Centred Learning 259Google Scholar
  34. 34.
    Manchikanti L, Kaye AM, Knezevic NN, McAnally H, Slavin K, Trescot AM, Hirsch J (2017) Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician 20(2S):S3–S92PubMedGoogle Scholar
  35. 35.
    Syrjala KL, Jensen MP, Elena Mendoza M, Yi JC, Fisher HM, Keefe FJ (2014) Psychological and behavioral approaches to cancer pain management. J Clin Oncol 32(16):1703–1711CrossRefGoogle Scholar
  36. 36.
    Xu X, Luckett T, Wang AY, Lovell M, Phillips JL (2018) Cancer pain management needs and perspectives of patients from Chinese backgrounds: a systematic review of the Chinese and English literature. Palliat Support Care 1–15Google Scholar
  37. 37.
    Alqahtani M, Jones LK (2015) Quantitative study of oncology nurses' knowledge and attitudes towards pain management in Saudi Arabian hospitals. Eur J Oncol Nurs 19(1):44–49CrossRefGoogle Scholar
  38. 38.
    Elumelu TN, Adenipekun AA, Eriba LO, Akinlade BI (2014) Knowledge of cancer pain management among nurses in a Nigerian tertiary health institution. J Nurs Educ Pract 4(4):74Google Scholar
  39. 39.
    Samarkandi OA (2018) Knowledge and attitudes of nurses toward pain management. Saudi J Anaesth 12(2):220CrossRefGoogle Scholar

Copyright information

© American Association for Cancer Education 2018

Authors and Affiliations

  • Salehoddin Bouya
    • 1
  • Abbas Balouchi
    • 2
    • 3
  • Abdulbaset Maleknejad
    • 4
    Email author
  • Maryam Koochakzai
    • 5
  • Esra AlKhasawneh
    • 6
  • Abdolghani Abdollahimohammad
    • 3
  1. 1.Internal Medicine and Nephrology, Clinical Immunology Research Center, Ali-Ebne Abitaleb HospitalZahedan University of Medical SciencesZahedanIran
  2. 2.Student Research Committee, Nursing and Midwifery School, Iran University of Medical SciencesTehranIran
  3. 3.Zabol University of Medical SciencesZabolIran
  4. 4.Clinical Immunology Research Center, Ali-Ebne Abitaleb HospitalZahedan University of Medical SciencesZahedanIran
  5. 5.Department of MidwiferyZabol University of Medical ScienceZabolIran
  6. 6.Department of Maternal & Child Health Nursing, College of NursingSultan Qaboos UniversityMuscatOman

Personalised recommendations