Flemming, K. (2010). The use of morphine to treat cancer-related pain: A synthesis of quantitative and qualitative research. Journal of Pain and Symptom Management, 39(1), 139–154.
Electronic searches retrieved a total of 2,886 records. After screening by title, 255 abstracts were retrieved for initial review. Of these the author obtained 30 articles for full review. Reference chaining yielded another 10 articles. A final sample of 19 resources met criteria and were analyzed. The author used a quality-appraisal checklist. Findings from each qualitative report were identified and compared with recommendations regarding effectiveness. Two resources provided the framework of comparison: Cochrane Systematic Review of Oral Morphine for Cancer Pain and the European Association for Palliative Care recommendations regarding use of opioids for cancer pain.
The study resulted in the synthesis of four arguments.
Patients were selective about their disclosure of pain severity. The degree of confidence and trust in providers influenced reporting about pain, treatment choices, and use of opioids. Negative feeling toward providers led to reluctance to report pain.
This review provides a wealth of powerful and meaningful information that healthcare professionals can use to improve how they work with patients and caregivers in the management of cancer-related pain. Findings suggest that many professionals still have concerns about addiction with the use of opioids in the treatment of chronic cancer pain and that these professionals intentionally or unintentionally communicate these concerns, adversely influencing patients' and caregivers' experiences. Findings point to the importance of aggressive management and prevention of adverse side effects from opioids, to have a positive effect on the patient’s sense of the trade-offs involved with opioids. Findings support the concept that a team approach involving providers, caregivers, and patients and trust among team members are crucial to effective pain management.
Nurses can use the themes to guide open discussion and to anticipate potential issues regarding the use of opioids for pain management.