The Kingdom of Saudi Arabia is among the nations affected by cancer cases. Although some reports have suggested that cancer cases have been low in the past, there were risks that would lead to an increase in the disease rates (Ibrahim, Zeeneldin, El-Khodary, Al-Gahmi, & Sadiq, 2008 a, b). Cancer Incidence Report 2013 by Saudi Health Council (2016) showed a total of 15,653 of cancer incidents that were reported that year. Women were more affected by 53% while men stood at 47%. The areas reported having a high number of cases are the Eastern region, Riyadh, Tabuk, Makkah, and the Northern region in that order. The common cancers in order of most infections to the least include breast cancer, colorectal, thyroid, Non-Hodgkin Lymphoma (NHL), leukemia, liver, lung, stomach, and kidney cancer (El Saghir, Khalil, Eid, El Kinge, Charafeddine, Geara, & Shamseddine, 2007). Little is known about cancer pain prevalence in Saudi Arabia. Pain is considered to be a significant challenge for cancer patients given the suboptimal cancer prevention programs (Al-Zahrani, Eldali, & Al-Shahri, 2014) and the late presentation of most patients. According to Seya, Gelders, Achara, Milani, & Scholten, 2011, approximately 9% of cancer patients reported in a pain clinic in a teaching hospital were diagnosed with cancer-related pain. The per-capita consumption of morphine in Saudi Arabia is alarmingly low at 0.35mg compared with the global mean of approximately 5.6mg (Seya et al, 2011). The main obstacle believed to be the cause for the inadequate use of opioids is the stringency of national and international regulations. However, hospitals are granted legal access to morphine and other opioids through the Ministry of Health (Almalki, FitzGerald, & Clark, 2011), therefore, there got to be other hindrances to this low intake. The aim of this literature review is to analyze the possible general barriers that cancer patients face in pain management clinic in Saudi Arabia as discussed by researchers.
The barriers to cancer pain management will be grouped into three major categories namely patient and family related barriers, healthcare professional barriers, and organization and system barriers.
Patient and Family Related Barriers
Information from cancer patients and their families is integral to service delivery for pain management. As cited by Abulkhair, Al Tahan, Young, Musaad, & Jazieh, (2010), patients family contribute to the failure being evidenced in Saudi Arabia in pain management. Several barriers have been observed that are patient and family related and they are considered to cause significant effects in the way that they are attended to in the hospitals. One of the barriers is the late presentation of patients (Amin, Suleman, Al Taissan, Al Joher, Al Mulhim, & Al Yousef, 2012). This means that they report their health cases in hospitals when the cancer condition has extended into the body. The level of medical administration depends on the level of cancer in the patients body. If the patient visits the hospital when the condition has intensified, the pain medications might not be as effective as when it had been earlier communicated. Secondly, some patients have been found to communicate their health problem with the hospital erroneously (Amin et al, 2012). This could happen when the patient is describing his or her condition to the doctor. The wrong description would lead to wrong diagnosis and prescription of drugs. This means that the patient will continue experiencing pain even after medication.
Other patients and their families are reluctant about seeking medical care (Williams & McCorkle, 2011). Saudi Arabia has its tertiary health care facilities located in their major cities. This means that the facilities are not within proximity for the patients who could be living in rural areas. The long-distance travels for these patients, and their families could contribute to their reluctance in seeking medical care to ease their pain. Additionally, since these hospitals are not adequate (Alsirafy, Hassan, & Al-Shahri, 2009), patients could be discouraged that their visits would not prove fruitful. If such patients do not have the support and encouragement from their families, their cases will fall among the many that do not benefit from the pain management programs. Another barrier is cultural beliefs and interpretations related to the causal and management of cancer. One of the causes of cancer is genetic heredity (Alsbeih, Ahmed, Al-Harbi, Venturina, Tulbah, & Balaraj, 2011). Some of the people interpret such acquired cancer with a wrong attitude which leads to less concern being allocated to such patients. Some will want to be left to die arguing that the pain medication would not heal the disease. Others, according to Al-Rowais, Al-Faris, Mohammad, Al-Rukban, & Abdulghani (2010) seek other alternatives of relieving pain such as traditional options.
For the children with cancer, it is the mandate of the family members to acquire medical care for them by either taking them to pain clinics or purchase the pain drugs. If the family does not show the required concern and care, the child will suffer pain helplessly. Another barrier could be financial limitations. Some patients and their families may not be financially capable of catering for the pain management services which may include hospital accommodation and medicine bills. This leaves them with the option of managing the pain in their way (Jazieh, Al Sudairy, Abulkhair, Alaskar, Al Safi, Sheblaq, & Tamim, 2012), or leave the patient to persevere the pain till he or she dies. Breast cancer patients also exhibit limited knowledge as revealed in a certain research during a screening session (Dandash, & Al-Mohaimeed, 2007). These are some of the patients and family-related barriers that impede effective management of pain for cancer patients.
Healthcare Professional Barriers
Healthcare professionals have a vital role to play in the management of pain for the cancer patients. Given the effects that cancer pain has on patients such as physical, psycho-social, behavioral, emotional, and spiritual problems that impact adversely on their lives, professional ought to be on standpoint to help minimize these effects on patients (Omar, Alieldin, & Khatib, 2007). Healthcare professionals include the nurses and doctors, but nurses have a bigger mandate since they interact more with the patients. As such, nurses ought to be well prepared with knowledge of pain assessment and management techniques due to their critical role in the process of making decisions on pain management (Khatib, & Aljurf, 2008). However, the delivery of effective pain management services by these professionals has been limited in Saudi as noted by Al-Mahmoud, Mullen, & Spurgeon, 2012. One of the barriers is poor knowledge and negative attitudes towards pain management among nurses (Kaki, 2011). Considerable personal and cultural beliefs about causes of cancer and meaning predominate the nurses interpretation of pain, resulting in inappropriate and inadequate practices in pain management. Second, organization and system-related barriers under which pain management occurs may unintentionally impede the effective performance of the nurse. These constraints include unavailability of opioid drugs, lack of national policy and hospital regulations.
Nurses heavy workload is another barrier to effective service delivery. According to a research study conducted on nurses in the oncology section, nurses reported that heavy workload affected their high-quality care for their patients (Alqahtani, Jones, & Holroyd, 2015). The heavy workload prevented the nurses from providing the pain medication to the patient either at the scheduled time or immediately after a request by the patient. The workload also meant that there was no time to provide health education as well as comprehensively document reports on pain assessment and management. The heavy workload also affected the attitudes of the nurses making them feel negative about the reality of the pain that the patients underwent thus giving sub-optimal pain management services. The absence of health team collaboration in matters relating to cancer pain management also impedes the nurses ability to perform effectively. Although hospitals policies for pain management, there are considerable barriers to collaboration between the interdisciplinary healthcare professionals involved in caring for cancer patients (Alqahtani et al, 2015). The gap is identified between the nurses and the physicians in the application of the provided guidelines. According to the research study, the physicians were reported to be rarely present to prescribe the pain medication, and their absence resulted in delays in drug administration to the cancer patients. In Saudi Arabia, nurses are not allowed to administer a pain medication without a drug prescription from the physician (Ravichandran, Al-Hamdan, & Mohamed, 2011). The inadequate accessibility of these physicians was as a result of being concurrently involved in servicing other hospital departments. This delay in administering medication means that patients suffer more pain and this influence the quality of nursing care that they receive.
Another healthcare barrier in cancer pain management is the idea of the Saudi Arabian physicians treating pain management medication as a by need prescription, rather than as a regular medication (Alqahtani et al, 2015). American Pain Society guidelines for treating acute and chronic cancer pain dictate that pain medications should be provided on a scheduled basis rather than on patients request. The rationale behind the regular administration is to maintain therapeutic levels of the drug in the bloodstream which promote a pain-free state with minimal side effects. Lengthy protocols in the administration of a new prescription in Saudi Arabia for patients to receive medication from pharmacists is another barrier. This is because these pharmacists are located outside the pain clinic area. The barriers discussed above are related to healthcare professionals, and they contribute to the low levels of pain management for cancer patients in Saudi Arabia.
Organization System Barriers
The healthcare sector is the organization that is responsible for making the process of pain management for cancer patients smooth and functional. The Ministry of Health is at the topmost rank in providing policies and programs that ensure the availability of programs and the pain drugs for the cancer patients. Hospitals can afterward access these drugs to administer to their patients in their clinics. In Saudi Arabia, several organizational barriers exist that contribute to the reduced levels of pain management for cancer patients. One of the barriers is the limited progress in the Saudi pain management care programs as cited by Al-Shahri, 2009. The tertiary cancer care facilities are localized in a few major cities, yet the population of Saudi is large. This means that the facilities are not enough to cater for all the cancer patients who would be seeking pain relief services. Additionally, the availability of these pain relief medication is limited despite the Ministry of Health granting free access to adequate quantities of pain medication (Cleary, Silbermann, Scholten, Radbruch, Torode, & Cherny, 2013). This explains the low consumption of morphine and other opioids in Saudi Arabia. Shortage of healthcare professionals is another failure of the system. A 2011 report by the Ministry of Health indicated that the yearly number of Saudi nursing graduates was insufficient to meet healthcare demands (Alamri, 2011). This res...
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