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Dr Ibraheem Bashayreh, RN, PhD Nursing School, Philadelphia University

Dr Ibraheem Bashayreh, RN, PhD Nursing School, Philadelphia University. Cancer Pain Management: A Jordanian Perspective. Background. By 2020, WHO estimated that there will be 20 million new cancer cases in the globe 70% of them in developing countries (WHO, 1998).

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Dr Ibraheem Bashayreh, RN, PhD Nursing School, Philadelphia University

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  1. Dr Ibraheem Bashayreh, RN, PhD Nursing School, Philadelphia University Cancer Pain Management: A Jordanian Perspective

  2. Background • By 2020, WHO estimated that there will be 20 million new cancer cases in the globe 70% of them in developing countries (WHO, 1998). • By 2015, 9 million cancer deaths in the world, 50% of them in developing countries (Melvin and Liter, 2002)

  3. Background • Cancer pain prevalence: • 15% in non-metastatic stage (Cleeland, 1982) • 65-90% in metstatic stage (Cleeland, 1982; Sterman, 2003) • 90% of cancer patients in hospitals (Sterman, 2003)

  4. *Reluctance to report pain *Incompliance with RX regimens *Inadequate knowledge *Improper communication patterns *Poor assessment skills *Bureaucratic regulation *Low priority to CPM *Lack of funds *Lack of expertise staff

  5. Cancer in Jordan Causes of Mortality in Jordan • Circulatory diseases 38.2%. (2482 deaths). • Neoplasm 14.3%. (928 deaths) • External causes like car accidents 11.5% (745 deaths) (JMOH, 2003). • 3478 New cancer cases/ year (JNCR, 2003)

  6. Aim To explore the barriers of the patients, family caregivers, and clinicians that impede attaining effective cancer pain management in Jordan.

  7. Study Objectives • To evaluate health care providers’ knowledge regarding CPM. • To evaluate the role of organizational system in CPM and to determine the impacts of this system on patients and clinicians. • To determine the prevalence, severity, and proportion of under-treatment of cancer pain in Jordan.

  8. Objectives • To identify the attitudinal barriers to effective CPM among HCP, Pts & their FCs • To compare the attitudinal barriers between Pts, FCs and HCPs

  9. Settings Irbid Amman

  10. Sample • Convenience sample of • 300 Patients • 246 Family caregivers • 473 Clinicians (Nurses (200), Pharmacists (113), Doctors (160) ). • Qualitative study (purposive sample), Interview of • 2 Patients • 2 Family caregivers • 6 Clinicians

  11. Instruments • Health care professionals • Nurse Knowledge and Attitude Survey (NKAS). • Barrier Questionnaire II Patients & Family caregivers • Barrier Questionnaire II: Arabic version (ABQII) • Brief Pain Inventory Questionnaire: Arabic version (ABPI).

  12. Prevalence of painin Jordanian cancer patients • 179 (71%) cancer patients reported that their worst pain was between 7-10 on pain scale in last 24 hrs. • 48 (19 %) cancer patients rated their worst pain as moderate , 5 or 6 . • The average of pain in last 24 hrs as reported by 208 (81.7%) pts was between 5 & 10

  13. Prevalence of painin Jordanian cancer patients • 157 (62%) cancer patients were having pain (=>5) at the time of the study. • 171 (68%) of cancer patients reported that pain killers relieved their pain by 50% at least. • 117 (83%) of Mets pts their average pain was above or =7 in the last 24 hrs. • 51 (36%) of Mets pts their pain was below or =4 as a result of using pain killers

  14. Results • Conducting factor analysis identifies four major barriers: • Fears related to analgesic use • Fears related to side effects • Concern related to communication • Cultural beliefs

  15. Fears related to analgesic use

  16. Fears related to side effects

  17. Communication concerns

  18. Cultural beliefs

  19. Organizational Barriers • The interviews showed some barriers • Access Barriers * Health Insurance * Geographic location • Low priority to CPM • Opioid prescription • Lack of expertise staff & work overload.

  20. Conclusion • Baseline information to design a national cancer plan • Identify the gap of knowledge among various health professionals

  21. Thank you all • Any Questions?

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