Research Article| Volume 22, ISSUE 1, P33-41, March 2015

Australian survey of current practice and guideline use in adult cancer pain assessment and management: The community nurse perspective

Published:December 23, 2013DOI:



      Cancer pain remains a major public health concern. Despite effective treatments being available to manage the majority of cancer pain, this debilitating symptom is frequently under treated. As cancer has becomes a chronic disease a range of health professionals, including community nurses in Australia are increasingly caring for people living with cancer related pain. Yet, little is known about community nurses capacity to assess and manage cancer pain in accordance with best available evidence.


      This study aimed to: identify the barriers and facilitators to adult cancer pain assessment and management as perceived by Australian health professionals; identify if cancer pain guidelines are currently used; identify barriers and facilitators to guideline use; and establish the need for Australian cancer pain guidelines. This article reports on community nurses’ perceptions of managing cancer pain in the community setting.


      A cross-sectional survey was administered online. Invitations were circulated via peak bodies and clinical leaders seeking the views and experiences of health professionals involved in caring for people living with cancer pain. Descriptive statistics were used to summarise the quantitative data, and thematic content analysis were used to describe the qualitative data.


      Sixty-two community nurses responded to the survey, representing 29% of the total sample. These participants reported high levels of adherence to accepted cancer pain management practices in their workplace, with 71% nominating the Palliative Care Therapeutic Guideline V.3 as being most frequently used to manage community patients’ cancer related pain. Key barriers to effective cancer pain management in the community were: difficulties accessing non-pharmacological interventions (89%), lack of coordination by multiple providers (89%), and impact of distance on ability to access pain-related services for patients (86%).


      A range of system, health professional and consumer barriers limit access to best available treatment in the community setting for people with cancer pain. A clinical pathway that gives step-by-step guidance on evidence-based practice along with an evaluation framework may be the best way of enabling community nurses to ensure their patients with cancer related pain have access to best available care.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Collegian
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Aranda S.
        • Yates P.
        • Edwards H.
        • Nash R.
        • Skerman H.
        • McCarthy A.
        Barriers to effective cancer pain management: A survey of Australian family caregivers.
        European Journal of Cancer Care (England). 2004; 13: 336-343
        • Bender J.L.
        • Hohenadel J.
        • Wong J.
        • Katz J.
        • Ferris L.E.
        • Shobbrook C.
        • Warr D.
        • Jadad A.R.
        What patients with cancer want to know about pain: A qualitative study.
        Journal of Pain and Symptom Management. 2008; 35: 177-187
        • Bennett M.I.
        • Closs S.J.
        • Chatwin J.
        Cancer pain management at home: Do older patients experience less effective management than younger patients?.
        Support Care Cancer. 2009; 17: 787-792
        • Benson M.
        NICS-VQC Fellow 2006–2008, Project: Improving the management of cancer pain.
        • Brando A.
        Transforming literature findings to practical indicators – An effort to incorporate best practice pain management for palliative care patients. abs#418.
        in: Paper presented at: annual scientific meeting of the Clinical Oncological Society of Australia (COSA), Perth. 2011
        • Breuer B.
        • Fleishman S.B.
        • Cruciani R.A.
        • Potrtenoy R.K.
        Medical oncologists’ attitudes and practice in cancer pain management: A national survey.
        Journal of Clinical Oncology. 2011; 29: 4769-4775
        • Brink-Huis A.
        • van Achterberg T.
        • Schoonhoven L.
        • Brink-Huis A.
        • van Achterberg T.
        • Schoonhoven L.
        Pain management: A review of organisation models with integrated processes for the management of pain in adult cancer patients.
        Journal of Clinical Nursing. 2008; 17: 1986-2000
        • Dalal S.
        • Bruera E.
        Access to opioid analgesics and pain relief for patients with cancer.
        Nature Reviews Clinical Oncology. 2013; 10: 108-116
        • Deandrea S.
        • Montanari M.
        • Moja L.
        • Apolone G.
        Prevalence of undertreatment in cancer pain. A review of published literature.
        Annals of Oncology. 2008; 19: 1985-1991
        • Dy S.M.
        • Asch S.M.
        • Naeim A.
        • Homayoon S.
        • Anne W.
        • Karl A L.
        Evidence-based recommendations for cancer pain management.
        Journal of Clinical Oncology. 2008; 26: 3879-3885
        • Eysenbach G.
        • Wyatt J.
        Using the Internet for surveys and health research.
        Journal of Medical Internet Research. 2002; 4: E13
        • Falvo D.R.
        Effective patient education: A guide to increased adherence.
        4th ed. Jones & Bartlett Learning, Sudbury, MA2011
        • Fisch M.J.
        • Lee J.-W.
        • Weiss M.
        • Wagner L.I.
        • Chang V.T.
        • Cella D.
        • Manola J.B.
        • Minasian L.M.
        • McCaskill-Stevens W.
        • Mendoza T.R.
        • Cleeland C.S.
        Prospective, observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung, or prostate cancer.
        Journal of Clinical Oncology. 2012; 30: 1980-1988
        • Foley K.M.
        How well is cancer pain treated?.
        Palliative Medicine. 2011; 25: 398-401
        • Guthaus M.A.
        • White D.
        Blending the roles of home care nursing and cardiovascular specialties: A model for nursing practice in the community.
        Home Health Care Management & Practice. 2002; 14: 255-261
        • Heading G.
        • Mallock N.
        • Sinclair S.
        • Bishop J.
        New South Wales cancer patient satisfaction survey. Interim report.
        Cancer Institute, NSW, Sydney2008
        • Hutton N.
        • McGee A.
        • Dunbar C.
        A guide to cancer pain management.
        British Journal of Community Nursing. 2008; 13: 464-470
        • Jannings W.
        • Underwood E.
        • Almer M.
        • Luxford B.
        How useful is the expert practitioner role of the clinical nurse consultant to the generalist community nurse?.
        The Australian Journal of Advanced Nursing. 2010; 28: 33-40
        • Kemp L.A.
        • Harris E.
        • Comino E.J.
        Changes in community nursing in Australia: 1995–2000.
        Journal of Advanced Nursing. 2005; 49: 307-314
        • Koller A.
        • Miaskowski C.
        • De Geest S.
        • Opitz O.
        • Spichiger E.
        A systematic evaluation of content, structure, and efficacy of interventions to improve patients’ self-management of cancer pain.
        Journal of Pain and Symptom Management. 2012; 44: 264-284
        • Kraut R.
        • Olson J.
        • Banaji M.
        • Bruckman A.
        • Cohen J.
        • Couper M.
        Psychological research online.
        American Psychologist. 2004; 59: 105-117
        • Loftus L.A.
        • McIntosh J.
        • Peace E.
        • Tolson D.
        Implementation of Sign 44 guidelines for managing cancer pain in a community setting.
        International Journal of Palliative Nursing. 2007; 13: 315-324
        • Lovell M.
        • Forder P.
        • Stockler M.
        • Butow P.
        • Briganti E.M.
        • Chye R.
        • Goldstein D.
        • Boyle F.M.
        A randomized controlled trial of a standardized educational intervention for patients with cancer pain.
        Journal of Pain and Symptom Management. 2010; 40: 49-59
        • Luckett T.
        • Davidson P.M.
        • Boyle F.
        • Liauw W.
        • Agar M.
        • Green A.
        • Lovell M.R.
        • et al.
        Australian survey of current practice and guideline use in adult cancer pain assessment and management: Perspectives of oncologists.
        Asian-Pacific Journal of Clinical Oncology. 2013; (in press-a, Article first published online: 17 December 2012)
        • Luckett T.
        • Davidson P.M.
        • Green A.
        • Boyle F.
        • Stubbs J.
        • Lovell M.
        Assessment and management of adult cancer pain: a systematic review and synthesis of recent qualitative studies aimed at developing insights for managing barriers and optimizing facilitators within a comprehensive framework of patient care.
        Journal of Pain and Symptom Management. 2013; 46: 229-253
        • Martin M.
        • Pisu M.
        • Kvale E.
        • Johns S.
        Developing effective cancer pain education programs.
        Current Pain and Headache Reports. 2012; 16: 332-342
        • McKenzie H.
        • Boughton M.
        • Hayes L.
        • Forsyth S.
        • Davies M.
        • Underwood E.
        • McVey P.
        A sense of security for cancer patients at home: The role of community nurses.
        Health & Social Care in the Community. 2007; 15: 352-359
        • Mildon B.
        • Underwood J.
        Competencies for home health nursing: A literature review.
        Community Health Nurses of Canada, 2010
        • Momen N.
        • Hadfield P.
        • Harrison K.
        • Barclay S.
        Managing pain in advanced cancer: A survey of United Kingdom general practitioners and community nurses.
        Journal of Pain and Symptom Management. 2013 Sep; 46: 345-354
        • National Comprehensive Cancer Network (NCCN)
        NCCN clinical practice guidelines in oncology: Adult cancer pain. Version 2.2011.
        NCCN, New York2011
        • National Institute of Clinical Studies
        Evidence-practice gaps report: Vol. 1. A review of developments 2004–2007.
        National Health and Medical Research Council, Canberra2008
        • National Pain Summit Initiative
        National pain strategy.
        Faculty of Pain Medicine, Melbourne2010
        • Oldenmenger W.H.
        • Sillevis Smitt P.A.E.
        • van Dooren S.
        • Stoter G.
        • van der Rijt C.C.D.
        A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: A critical appraisal.
        European Journal of Cancer. 2009; 45: 1370-1380
        • Pigni A.
        • Brunelli C.
        • Gibbins J.
        • Hanks G.
        • Deconno F.
        • Kaasa S.
        • Caraceni A.
        Content development for European guidelines on the use of opioids for cancer pain: a systematic review and Expert Consensus Study.
        Minerva Anestesiologica. 2010; 76: 833-843
        • Potter V.
        • Wiseman C.
        • Dunn S.
        • Boyle F.
        Patient barriers to optimal cancer pain control.
        Psycho-Oncology. 2003; 12: 153-160
      1. Scottish Intercollegiate Network (SIGN). 2008. Control of pain in patients with cancer: A national clinical guideline. Edinburgh. 106.

        • Stockler M.R.
        • Wilcken N.R.C.
        Why is management of cancer pain still a problem?.
        Journal of Clinical Oncology. 2012; 30: 1907-1908
        • Therapeutic Guidelines
        Palliative care.
        Therapeutic Guidelines Limited, Melbourne2010
        • Vallerand A.H.
        • Musto S.
        • Polomano R.C.
        Nursing's role in cancer pain management.
        Current Pain and Headache Reports. 2011; 15: 250-262
        • Yates P.
        • Aranda S.
        • Edwards H.
        • Nash R.
        • Skerman H.
        • McCarthy A.
        Family caregivers’ experiences and involvement with cancer pain management.
        Journal of Palliative Care. 2004; 20: 287-296
        • Yates P.M.
        • Edwards H.E.
        • Nash R.E.
        • Walsh A.M.
        • Fentiman B.J.
        • Skerman H.M.
        • Najman J.M.
        Barriers to effective cancer pain management: A survey of hospitalized cancer patients in Australia.
        Journal of Pain and Symptom Management. 2002; 23: 393-405