AN EVALUATION OF NURSES' KNOWLEDGE AND PRACTICES IN MANAGING CANCER PAIN AMONG ELDERLY PATIENTS IN A HOSPITAL IN OYO STATE

AN EVALUATION OF NURSES' KNOWLEDGE AND PRACTICES IN MANAGING CANCER PAIN AMONG ELDERLY PATIENTS IN A HOSPITAL IN OYO STATE CHAPTER ONE: INTRODUCTION 1.1 Background of the Study Nurses play a crucial role as members of an interdisciplinary team in managing cancer-related pain. They must be well-versed in pharmaceutical treatments, including their indications, contraindications, and possible side effects (Oliveira, Sobrinho, & Cunha, 2016). Beyond pharmacological interventions, nurses actively engage in nonpharmacological methods to effectively manage and alleviate pain. However, research by Manwere, Chipfuwa, and Chironda (2015) indicates that nurses generally have limited knowledge about pain management, particularly regarding pharmacology and pain assessment, where the highest rates of incorrect responses were recorded. One notable obstacle is the fear of opioid use, which some nurses harbor, thus impeding proper pain management (Henry, 2020). Nurses encounter multiple challenges in assessing and managing cancer pain, especially among elderly patients, encompassing both the evaluation of pain and the impact of subsequent treatments. Several studies have highlighted a gap in healthcare professionals’ understanding of cancer pain management. These studies attribute barriers to effective pain treatment to factors such as resistance to adopting new practices, negative attitudes towards cancer pain and its treatment, and poor coordination within the healthcare system (Prandi, Garino, Mastromarino, Torino, Vellone, & Carlo, 2015). Clinical experience, according to Manwere, Chipfuwa, and Chironda (2015), significantly enhances nurses' knowledge and confidence in managing patients' pain; registered nurses with longer practice durations tend to apply their pain management knowledge more effectively in daily care. Cancer, as defined by the National Cancer Institute (2015), refers to a group of diseases characterized by uncontrolled growth and spread of abnormal cells. One hallmark of cancer is the rapid multiplication of these abnormal cells, which can invade adjacent tissues and metastasize to distant organs. The World Health Organization (2017) identifies metastases as a leading cause of death among cancer patients. Globally, cancer was responsible for approximately 8.8 million deaths in 2015, making it the second leading cause of mortality worldwide. WHO (2017) further states that cancer accounts for roughly one in every six deaths around the globe. Ageing is identified as a significant risk factor for developing cancer, with incidence rates increasing markedly as people grow older, likely due to accumulated risk factors for certain malignancies over time. Marosi and Koller (2016) note that cancer diagnosis rates in individuals aged 65 and above are eleven times higher than those in younger populations. Similarly, Palli, Fortpied, and Wedding (2020) report that nearly 80% of all cancers are diagnosed in people aged 55 years or older. Arnold, Karim-Kos, and Coebergh (2015) state that the median age for tumor diagnosis exceeds 60 years, a trend observed in multiple cancer types such as hormone-sensitive breast cancer, multiple myeloma, renal cancer, prostate cancer, and colon cancer. According to Oliveira, Sobrinho, and Cunha (2016), cancer pain prevalence varies from 25 to 50% in newly diagnosed patients, rises to 33 to 80% during treatment, and reaches approximately 75 to 100% in patients with advanced or terminal disease. Kapoor, Kalwar, Singhal, Nirban, and Kumar (2015) found that 70 to 90% of patients with advanced cancer report persistent pain. Additional data suggest that patients older than 60 years tend to have hospital stays related to chronic pain twice as long as those under 59 years old. Despite significant advancements in pain management in recent decades, older adults are still less likely to receive adequate pain control compared to younger patients. McLachlan, Bath, Naganathan, and Hilmer (2021) found that older women are particularly prone to undertreatment compared to older men. As the population aged 65 and above increases, the prevalence of frailty and chronic pain-related illnesses is also expected to rise. The International Association for the Study of Pain (2019) reported that about 50% of patients experience pain at cancer diagnosis or early in their illness, increasing to 75% in advanced stages. Persistent pain in cancer patients may be directly caused by the tumor itself, treatments administered to control the disease, or unrelated medical conditions. Both acute and chronic pain syndromes are experienced by cancer patients, meaning pain may be tumor-related, treatment-related, both, or neither (Kapoor et al., 2015). These findings align with Oliveira, Sobrinho, and Cunha (2016), who state that cancer pain is linked to the presence of tumors and metastases and may also result from painful diagnostic or therapeutic procedures, or from the disease itself. The National Comprehensive Cancer Network (2021) describes nociceptive and neuropathic pathways as the main mechanisms causing pain. Most acute pain issues in cancer patients stem from diagnostic or therapeutic interventions (Henry, 2020). Therefore, pain management in older adults deserves special attention because neglecting pain, whether cancer-related or otherwise, can lead to increased chronic pain and complications later on (McCleane, 2017). Untreated or inadequately treated cancer pain severely impacts patients, disrupting their physical, psychological, and spiritual well-being, and drastically diminishing their quality of life (Swan & Hamilton, 2016). Treatment options for cancer-related pain include both pharmacological and non-pharmacological approaches. Delgado and Bruera (2018) emphasize that managing pain in elderly cancer patients requires a multidisciplinary approach that incorporates both types of treatments. A multidisciplinary team allows healthcare providers to better understand and respond to the experiences of patients and their families. Within such teams, specialists collaborate with the shared goal of alleviating suffering for patients and their relatives by contributing diverse perspectives and management strategies to improve patient quality of life (Delgado & Bruera, 2018). Consequently, this study aims to focus on the nursing team’s role within the multidisciplinary framework involved in managing cancer-related pain in elderly patients. It will specifically examine nurses' knowledge and approaches toward cancer pain management in elderly patients at a hospital located in Benin City. 1.2 Statement of the Problem Manwere, Chipfuwa, and Chironda (2015) highlight that despite pain being the most distressing and troublesome symptom experienced by cancer patients, it remains inadequately managed. Everdingen, Rijke, and Kessels (2017) report that, despite significant medical, pharmacological, and technological advances in cancer pain assessment and treatment, up to 90% of patients with advanced cancer continue to experience severe pain necessitating further intervention. A major barrier to effective pain management in Nigerian nurses is a lack of adequate knowledge (Elumelu, Adenipekun, Eriba, & Akinlade, 2014). While cancer patients, especially older adults, require comprehensive support beyond nursing care, Manwere, Chipfuwa, and Chironda (2015) found that nurses’ knowledge of pain management is weak, with the greatest deficiencies observed in pharmacology and pain assessment. Marosi and Koller (2016) project that, despite an overall decline in cancer incidence, the number of elderly patients diagnosed with cancer will rise substantially. Oyebola (2015) states that in Nigeria, 60–70% of cancer cases are diagnosed at an advanced stage, and at least 30% of these patients experience one or more types of pain that are almost pathognomonic of cancer. Elima, Paula, Olufemi, and Emmanuel (2019) report that the average age at cancer diagnosis in Nigeria is 51.1 years for men and 49.15 years for women, supporting WHO’s (2018) projections that by 2020 cancer incidence rates would be 90.7/100,000 for men and 100.9/100,000 for women, with mortality rates at 72.7/100,000 and 76/100,000 respectively. Adewuyi et al. (2016) found that cancer patients at ABUTH ranged in age from 18 to 82, with a median age of 49; the male-to-female ratio was 1:1.4. Cervical, breast, and prostate cancers were the most common types, with elderly individuals being most affected. Metastases, especially to the bones, frequently occur in breast and prostate cancer patients and contribute significantly to pain and reduced quality of life among older patients. The researcher’s practicum observations at Ahmadu Bello University Teaching Hospital in Zaria corroborated that elderly patients constitute the majority of cancer cases, mainly with cervical, breast, prostate, and colorectal cancers. However, despite the existence of oncology centers, no prior studies have focused on nurses' perspectives regarding care for cancer patients experiencing pain. Hence, investigating nursing strategies for managing cancer-related pain in elderly patients is vital to improving care standards. The University of Benin Teaching Hospital has been selected as the site for this study to assess nurses’ knowledge and approaches toward cancer pain management in elderly patients. 1.3 Objectives of the Study The general objective is to assess the knowledge and approaches of nurses towards cancer pain management in elderly patients at a hospital in Benin City. The specific objectives are: i. To determine the level of nurses’ knowledge regarding cancer pain management in elderly patients in the hospital. ii. To investigate the approaches nurses use for pain management among elderly patients in the hospital. iii. To explore nurses’ practices related to cancer pain management in the hospital. iv. To identify the challenges nurses face during cancer pain assessment in elderly patients at the hospital. 1.4 Research Questions The study aims to answer the following questions: i. What is the level of nurses’ knowledge on cancer pain management in elderly patients at the hospital? ii. What approaches do nurses take toward pain management among elderly patients in the hospital? iii. What are the nursing practices regarding cancer pain management at the hospital? iv. What challenges do nurses encounter during cancer pain assessment in elderly patients at the hospital? 1.5 Research Hypotheses This study will test the following hypotheses at a 0.05 significance level: H01: There is no significant relationship between nurses’ knowledge and cancer pain management in elderly patients at the hospital. H02: There is no significant relationship between nurses’ approaches and cancer pain management in elderly patients at the hospital. 1.6 Significance of the Study This research will provide valuable insight into nurses’ knowledge and practices related to cancer pain management in elderly patients, an area with limited existing data in Nigeria. The findings could guide healthcare educators in developing targeted training to improve pain management skills among nurses. Furthermore, it may inform hospital administrators and policymakers to enhance protocols and resource allocation to better support elderly cancer patients. By understanding challenges faced by nurses, this study could contribute to improving patient care quality, reducing pain-related suffering, and enhancing the overall quality of life for elderly cancer patients. 1.7 Scope of the Study This research aims to assess the extent of nurses’ knowledge regarding cancer pain management specifically in elderly patients at a hospital situated in Benin City. Additionally, the study will examine the various approaches employed by nurses in managing pain among elderly patients within the same hospital setting. The investigation will further delve into the actual nursing practices related to cancer pain management carried out at the hospital in Benin City. Lastly, the research seeks to identify and understand the difficulties and obstacles nurses face during the assessment of cancer-related pain in elderly patients within this hospital environment. Consequently, the scope of this study is confined and limited to the University of Benin Teaching Hospital. 1.8 Limitations of the Study As is common in all research endeavors, the researcher encountered certain minor challenges while conducting this study. One of the main limitations was the lack of sufficient funding, which hindered the researcher’s ability to efficiently procure relevant materials, access comprehensive literature, or gather necessary information through methods such as internet research, questionnaires, and interviews. Due to this financial constraint, the researcher opted to select a moderately sized sample to balance feasibility with research requirements. Furthermore, the researcher was simultaneously involved in other academic responsibilities, which inevitably reduced the amount of time available to devote exclusively to this research project, thereby impacting the overall time allocation for data collection and analysis. 1.9 Definition of Terms Knowledge: This refers to the collection of facts, information, and skills that are gained through experience or formal education. It encompasses both theoretical and practical understanding of a particular subject or field. Approaches: This term describes the specific methods or strategies utilized to address or handle a particular situation or problem. Cancer: Cancer is defined as a medical condition characterized by the uncontrolled growth and division of abnormal cells within a specific part of the body. Pain Management: Pain management refers to the strategies and plans developed by healthcare professionals to assist individuals in coping with various types of pain effectively, aiming to alleviate suffering and improve quality of life.