Running head: INTEGRATIVE REVIEW

Integrative Review
Jessica Organt
Bon Secours Memorial College of Nursing
Nursing Research
NUR 4222
Dr. Christine Turner
December 1, 2015

I pledge

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Integrative Review
Abstract

Objective: Almost half of cancer patients state that they experience some type of pain
going untreated, or being treated ineffectively while hospitalized. There are currently no
standards for goals in the treatment of cancer pain set in place. This review examines how pain
control and pain management in oncology patients have been described, and any deficits found.
Methods: An integrative review was conducted using the databases PubMed, CINAHL
and Ovid Online. The writer evaluated papers that discussed studies conducted on pain
management in patients with cancer.
Results: Using the search terms pain management in oncology patients and pain control
in cancer, a total of 6,924 papers were identified, only a few of those being studies conducted on
the subject; five were chosen for analysis for this paper. In each of the studies, pain control was
reported as inadequate for many of the patients.
Conclusion: Approximately half of oncology patients report uncontrolled pain during
their treatment course. There are many reported causes for the under-treatment of pain in
oncology patients including the lack of knowledge and understanding from health care staff and
patients alike, as well as patients not feeling empowered in their decision making abilities.

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Introduction

As a nurse in the oncology field, the writer has found a common problem in her field of
work; uncontrolled pain. The fact is, a large population of oncology patients has reported
ineffective pain management during their treatment course. Because there is no standard or goal
for pain management in the treatment of oncology patients, there remains a lack of knowledge
and understanding on what is considered effective pain management. With millions of people
being treated for pain each year, how is it that there remains a large population of oncology
patients still going with untreated pain? The purpose of this study is to research the different
aims and goals for pain management in oncology patients, and how to better treat it. The writer
created a PICOT question at the beginning of this study: in patients aged 55 and older with an
active diagnosis of cancer, how does medicating the patients pain at a lower pain level influence
their overall pain control and satisfaction with their pain management? The goal was to research
studies that have examined pain management in oncology patients to better understand the
problems identified in overall pain control, and possible ways to improve upon it.
Design/Search Methods
The writer performed an integrated review of literature that was found on the topic of
pain control in oncology patients. An integrated review is defined as a specific review method
that summarizes past empirical or theoretical literature to provide a more comprehensive
understanding of a particular phenomenon or healthcare problem (Boveldt et al., 2014, p. 1204).
The writer used the databases PubMed, CINAHL and Ovid Online to search for the literature
needed. The writer used the following search terms, pain management in oncology patients and
pain control in cancer. There were no limits applied for language, and the search yielded results
ranging from journals from the last forty years up until the current year. Once the search results

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were found, the writer searched through the abstracts looking for criteria that fit her subject
including qualitative, quantitative and literature review studies. Other criteria the writer searched
for were empowerment with pain control, and knowledge/education in pain control for oncology
patients. There appeared to be no studies that directly fit the writers PICOT question in regards
to medicating for pain at a certain pain level, however there were plenty of studies completed on
pain management in oncology patients. Five results fit the criteria necessary, and have been
included in this review. Four of the five articles were published in the years 2008 and 2014,
while one was published in 1998. The writer believed using the study from 1998 would lend a
perspective on how things have changed over the last 18 years.
Findings/Results
Initially the search results yielded 6,924 articles related to the topics. After the abstracts
were reviewed by the writer and read for the necessary criteria, five articles were selected for
review for this discussion. Three of the five articles found focus more on pain control and
management from the healthcare perspective. These articles focus on the knowledge and
education deficits of the healthcare staff, as well as the perspective goals in pain management
from healthcare members. One article focused solely on the prevalence of the under-treatment of
pain in oncology patients, while the last article focused on integrating patient empowerment in
patients pain management. All five articles noted the prevalence of untreated and under-treated
pain in oncology patients; essentially half, 43 percent, of oncology patients state their pain was
ineffectively treated during the course of their treatment (Deandrea, Montanari, Moja, &
Apolone, 2008). All five of the articles reviewed were valid studies; all of the researchers were
qualified in the area in which the study was conducted, adherence to ethical standards were
maintained, and all of the studies referenced literature that was relevant to the study and helped

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support their findings. Three of the five articles focused on either qualitative or quantitative
studies, while the other two were literature reviews on the same subject. Of the studies
conducted, two of them used interviews of the healthcare professionals, i.e., nurses and
oncologists. The third study interviewed the oncology patients themselves. Two of the studies
found that patients who dont appear as ill as other patients were shown to have pain that was
not treated effectively, showing a deficit in knowledge of healthcare staff of what pain might
look like for different patients. Two studies noted that nearly a quarter of patients who reported
daily pain received no medication whatsoever. These two studies also noted that patients who
were older in age, aged 85 and up, were also more likely to never receive any pain medication.
All five articles noted the significance of under-treated pain and its effects on patients daily
lives such as depression, sleep, mood and overall function.
Discussion/Implications
The writers review of relevant studies has shown a reported 46-54 percent of oncology
patients with unrelieved pain. The writer found that not only is this an epidemic in American
medicine, but the same issues seem to have evolved in Europe and Eastern medicine as well. In
the research conducted, it was found that American healthcare seems to have better standards for
pain control, and better reported overall pain control than in other areas of the world. Age seems
to play a large part of pain control in that advanced age shows a reported decrease in pain
management. There appears to be a deficit in knowledge for both healthcare workers and patients
in what a realistic pain level should be, and because of this, many times pain may go untreated
altogether. There is more of a prevalence of untreated pain in patients aged 65 and older, and it
has also been found that patients aged 85 and older are more likely to never receive pain
medication at all, as opposed to a younger patient.

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Based on the studies reviewed for this paper, it is clear that there still remains a need for
education in pain management. Patients need education in learning realistic pain goals for their
pain management, as well as understanding their options for pain control. Non-pharmacological
pain interventions need to be used when available to allow better pain control. Nurses and
physicians need more education on what pain control looks like; what has been found to control
pain for one patient may not do anything for a second patient. Because each patient and
diagnosis needs to be treated differently, healthcare workers need to be open to trying multiple
options for pain control, including trying different medications, different modalities such as
acupuncture and meditation, and any other non-pharmacological pain interventions. These other
modalities can be used both alone, as well as in conjunction with pain medications, and may be
different for each patient. It is critical for the healthcare worker to listen to the patient and look
for non-verbal cues to evaluate a patients pain level.
Limitation/Conclusion
In the three studies found, two of the studies only questioned healthcare professionals in
the field of oncology, i.e. nurses and physicians. The last study only questioned oncology
patients, and did not interview any medical professionals. The writer believes the first two
studies were limited by not including the opinions of oncology patients, and the last study is
limited by not having any medical professionals included in the study interviews. Another
limitation noted was that the studies did not note the stage of the cancer being treated. Perhaps
pain management would differ for a Stage 2 cancer versus Stage 4.
The findings of this integrative review support the initial reasoning behind the PICOT
question; that pain management in oncology patients remains difficult to manage, and patients
report having untreated pain. It is clear the takeaway message from these studies is that pain

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management is vast and differs greatly from patient to patient and population to population. Pain
remains under-treated and uncontrolled in oncology patients, and healthcare workers need to
explore all options for pain control. Because of this, the writer believes that research on this topic
will never be complete.

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References

Alqahtani, M., & Jones, L. K. (2014). Quantitative study of oncology nurses knowledge and
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Bernabei, R., Gambassi, G., Lapane, K., Landi, F., Gastonis, C., Dunlop, R., ... Mor

, V.

(1998). Management of pain in elderly patients with cancer. Journal of the American
Medical Association, 279(23), 1877-1882. [Link]
Bhatia, R., Gibbins, J., Forbes, K., & Reid, C. (2014). We all talk about it as though were
thinking about the same thing. Healthcare professionals goals in the management of
pain due to advanced cancer: a qualitative study. Supportive Care in Cancer, 22(), 20672073. [Link]
Boveldt, N. T., Vernooji-Dassen, M., Leppink, I., Samwel, H., Vissers, K., & Engels, Y. (2014).
Patient empowerment in cancer pain management: an integrative literature review.
Psycho-Oncology, 23(), 1203-1211. [Link]
Deandrea, S., Montanari, M., Moja, L., & Apolone, G. (2008). Prevalence of undertreatment in
cancer pain. A review of published literature. Annals of Oncology , 1-7.
[Link]