Received: 4 February 2022 | Accepted: 10 May 2022

DOI: 10.1111/nuf.12761

ORIGINAL ARTICLE

Cancer pain management program: Patients' experiences–A

qualitative study

Mahmoud Alsaraireh RN, PhD1 | Mohammed ALBashtawy RN, PhD2 |

Asem Abdalrahim RN, PhD3 | Abdullah Alkhawaldeh RN, PhD2 |
Moawiah Khatatbeh PhD4 | Jamal Qaddumi RN, PhD5 | Sa'd ALBashtawy MD6 |
4 7 8
Zaid ALBashtawy MD | Ali Ibnian MDs | Ahmad Ayed RN, PhD |
Mohammad Suliman RN, PhD3 | Nisser Alhroub RN, PhD9

1
Faculty of Nursing, Zarqa University, Zarqa,
Jordan Abstract
2
Princess Salma Faculty of Nursing, AL al‐Bayt Background: Cancer patients frequently experience unrelieved pain as a significant
University, Mafraq, Jordan
symptom. However, several studies have found that cancer‐related pain is
3
Community and Mental Health Department,
Princess Salma Faculty of Nursing, AL al‐Bayt frequently undertreated.
University, Mafraq, Jordan Purpose: This study aimed to understand the pain experiences of cancer patients
4
Faculty of Medicine, Yarmouk University, who were newly engaged in a multidisciplinary pain management program (PMP) at
Irbid, Jordan
5
King Hussein Cancer Centre and still receiving cancer treatments and cancer pain
Faculty of Medicine and Health Sciences,
An‐Najah National University, Nablus, management.
Palestine
Methods: A qualitative study design and semi‐structured interviews were used to
6
Ministry of Health, Irbid, Jordan
obtain data from 21 cancer patients who were purposefully selected. All patients had
7
Faculty of Medicine, JUST, Irbid, Jordan
advanced cancer, including skeleton metastases. All female participants had breast
8
Faculty of Nursing, Arab American
University, Jenin, Palestine cancer, and all male participants had prostate cancer.
9
Faculty of Nursing, Jerash University, Jerash, Results: It was found that the patient−healthcare professional relationship and
Jordan satisfaction with services emerged as two themes in healthcare professionals' pain

Correspondence
management.
Abdullah Alkhawaldeh, RN, PhD, Princess Conclusion: The results from this study can offer a new understanding of the knowledge
Salma Faculty of Nursing, AL al‐Bayt
related to satisfaction of patients with cancer in terms of the quality of pain management.
University, Mafraq, Jordan.
Email: dr-abd@[Link] Additional qualitative studies are required to replicate the findings in populations from
different backgrounds, ethnicities, and cultures experiencing cancer pain.

KEYWORDS
cancer, pain management, patients' experiences

1 | INTRODUCTION illness.1–3 Cancer‐related pain can be caused by the disease itself

(e.g., tumor pushing on bones, nerves, or organs), treatment and its
Cancer patients frequently experience unrelieved pain as a significant side effects (e.g., mouth sores, radiation mucositis, and peripheral
symptom. In recent population‐based studies of pain in cancer neuropathy), surgery, or other tests and procedures.3
patients, the prevalence of unrelieved pain was found to range from It is recognized that cancer pain is not just a sensory experience,
55% among inpatients of cancer patients experiencing pain while but also includes physiological, physical, social, and psychosocial
receiving treatment to 66% among cancer patients with advanced experiences.4 Physically, patients are more likely to have fatigue,

Nursing Forum. 2022;1–12. [Link]/journal/nuf © 2022 Wiley Periodicals LLC. | 1

2 | ALSARAIREH ET AL.

nausea, and vomiting.5–7 Socially, they are unable to interact with was deemed to be the most appropriate method for this
others as pain limits their social activities.4,8 Psychologically, cancer study because a straight description of participants' responses was
9,10
patients may experience anger, anxiety, and depression. desired for this exploration of patients' experiences and expectations
Patients with cancer have concerns about the appropriateness of in relation to nursing pain management.
palliative care planned for pain and symptom control at all phases of
therapy.11,12 Furthermore, cancer patients may be unaware of the
long‐term negative effects of cancer‐related pain following 2.2 | Participants
therapy.13
The incidence of cancer continues to increase globally, and it In this study, the participants were 21 patients with a diagnosis of
increases dramatically with age.14,15 Several studies, however, have cancer. These patients were convenience‐recruited from different
16–18
found that cancer‐related pain is frequently undertreated. wards at King Hussein Cancer Center (KHCC). The inclusion criteria
According to a cross‐sectional study conducted in Jordan, about were as follows: patients with pain and who required an analgesic
73.3% of cancer patients reported severe pain, and one‐third of the treatment and with a diagnosis of breast cancer, prostate cancer, and
19
patients with pain were undertreated. These cancer‐related pain advanced cancer, including skeleton metastases. Furthermore, the
studies were mostly quantitative and survey‐based.20–24 Based on medical charts of participants were reviewed to confirm the
this background, the aim of the present study was to understand the participants' adequacy of pain management.
experiences of a cohort of cancer patients who were newly engaged Many patients appeared to have built up a positive and trusting
in a multidisciplinary pain management program (PMP) in Jordan and relationship with the healthcare professionals they came into contact
still receiving cancer treatments and cancer pain management. with as they attended the regular pain clinic. Those patients who
described positive relationships appeared to value the opportunity to
communicate their concerns and worries, have their queries
2 | M E TH O D S answered, and discuss any questions that they had with healthcare
professionals on a regular basis. The theme “patients−healthcare
2.1 | Design professionals' relationship” is made up of three codes. The first of
these relates to the way in which interviewees described how they
The aim of this study was to derive low‐inference descriptions of the felt that they were the focus of healthcare professionals: “sense of
experiences of a cohort of cancer patients who were newly engaged being the focus.” The second code relates to how interviewees
in a multidisciplinary PMP, remaining as close to the data as possible described how they began to learn how to deal with pain: “gaining
and without deliberate attempts to impose the researcher's theoreti- knowledge.” The third code was identified as “trust” and was evident
cal position on the patient's expressed meaning. Therefore, the in the way in which interviewees noted in the interviews how they
chosen method for this study was qualitative description as outlined believed in the care provided. This combination of continuity of care,
by Sandelowski.25 According to Sandelowski, the outcome of being dealt with positively, building up a sense of trust, and gaining
qualitative description is to literally describe the phenomenon as a knowledge about how to deal with what was happening to them
starting point, and its methodological orientation can be drawn from meant that interviewees described how they were satisfied with the
a variety of theorists. The qualitative description design then goes care provided and engaged with the PMP. Each of these codes is
beyond the literal description of the data and attempts to interpret presented below and discussed in more detail, supported by evidence
the findings without straying too far from it. Qualitative description quoted from interviewees' responses (see Table 1).

TABLE 1 Themes, subthemes, and representative quotes from interviews

Themes Subthemes Quotes

Patient−healthcare professional The center of care The center of care: The doctor is listening to the patient and answer all their queries,
relationship advise them to take [medicine] or not, inform them if it is useful or not. (T/1‐ I)

Gaining knowledge Gaining knowledge: Today he [doctor] explained about each medicine what the effects of
the medicine are? What are their side‐effects? What should we [patients] do if the
pain gets increased? Some medication we can increase the dose but we can't increase
for other medications. (T/7‐I)

Trust Trust: Very often the doctor jokes with me and deals me as a friend but not as a patient.
These give me a feeling of brotherhood which enhances my trust to him. As a result, I
feel free to ask any question to him and I also gave the answers of his questions freely.
(T/1‐I)

Satisfaction about services Satisfaction about services: Yes, thanks to God, the program is very good… Services here
are quite enough. (T/18‐I)
ALSARAIREH ET AL. | 3

2.3 | Data collection TABLE 2 Samples of the questions used during the interview

# Sample questions
Data were collected by semi‐structured interviews conducted by a
I Patients' knowledge and pain experience
nurse at the pain clinic over a period of 1 year, starting in 2021. The
1 Could you please to tell me a bit about your self?
semi‐structured interview was used to collect data since it is a very
flexible approach designed to capture the phenomena under 2 Can you describe your pain? Where? When? How often?
investigation. 26
The semi‐structured interview was designed to What helps? What makes it worse?

capture participants' responses to their pain, the ways in which they 3 What will you do if you have pain?
deal with pain, knowledge, and their satisfaction with the PMP. 4 Do you think that your pain medication relieves your pain? If
The nurse was very familiar with the type of patient being not why?
interviewed. All patients who agreed to participate in the study were 5 Do your medications have side‐effects for you?
interviewed. The interview took between 40 and 60 min. Probing
6 How do you manage these?
questions were used for follow‐up and to dig deeper into the
interview responses, as well as to seek clarification and elaboration of 7 Do you always take your drugs? If not, why?

the answers provided, as participants are able to raise issues that are 8 What types of pain management do you know about ‐‐‐‐‐‐‐
important to them and not on the interview schedule. This also helps which ones have you tried?

the researchers gain a more in‐depth understanding of the interview 9 Do you prefer other alternatives to control your pain rather
26 than medications? If not, why?
experience and data richness.
To avoid missing any important information, a tape recorder was II Patients' questions about the program
utilized to record all interviewers' words and to listen to what
1 Could you please to tell me about the educational program
interviewees said while transcribing. In addition, field notes were undertaken in the pain clinic?
used to write what participants said before or after each interview so
2 Has it been hard for you?
that it could be incorporated into the analysis when needed.
3 Does it help you to manage your pain?
Patients were informed and gave permission for face‐to‐face
interviews after their third clinic visit. The interviewer was an oncology 4 How does the educational program help you to manage
your pain?
nurse who had worked with these patients previously and had been
trained to conduct the interviews. The use of a semi‐structured interview 5 What type of information do you prefer?
guide also helped to keep the interviews on track and focused on the 6 Do you think that current facilities help you to manage
topic at hand. The nurse was told to stop the interview if the patient felt your pain?
tired. The data were collected by preparing a set of questions to 7 What other facilities would you prefer to be added to the
understand the impact of the multidisciplinary pain management clinic on program?
patients' experiences of the pain management process in the center. The 8 What do you think of the current program?
interview questions are presented (see Table 2).
9 What do you like about it?

10 What would you like to be done differently?

2.4 | Data analysis 11 How can the pain management program be improved?

All interviews were audio‐recorded to ensure that no important

information was missed during transcription. The recorded interviews considered as keywords of the same response. The descriptive
were transcribed and checked for inaccuracies. Following that, the words and phrases found in the responses were assigned to similar
data were accurately transcribed and translated into English. To groups, and then the more often used words in each group were
verify the validity, three copies of translated transcripts were back‐ highlighted as positive and negative keywords using inductive
27
translated and compared to the original transcribed text. To ensure analysis and continual keyword refining before categorization.
confidentiality, all additional personal details were removed. The The keywords were classified under their defined category. For
transcribed data were manually coded and categorized using a example, the word “listening” from the quote “the doctor is listening to
constant comparative approach based on participant responses to the patients and answers all their queries” was classified under the
each question or the most salient themes emerging from the set of category of “the center of care”. Similarly, the words “quite enough” and
interviews.26 The findings of this analysis were organized into “very good” from the quote “the program is very good… Services here are
themes, patterns, and categories to develop theories or hypotheses quite enough” were classified under the category of “satisfaction.” Like-
about the phenomenon under investigation. 28
wise, the words “trust” or “do not trust” were classified under a category
The repetitive and more common words through different of “trust.” Through constant comparison and refinement for each set of
responses were considered as the keywords.29 In this situation, both categories, the categories that related to each other were grouped into
positive and negative responses to the same question were core categories that formed the major themes. For example, all previous
4 | ALSARAIREH ET AL.

TABLE 3 Process of qualitative data analysis

# Step Description

1 Keyword analysis Identify the descriptive words through responses and group these words according to their
relationship to each other.

2 Checks and balances for data dependability Examine and re‐examine a set of data to ensure a proper grouping for responses.

3 Defined categories The concepts that captured the ideas of keywords.

4 Core categories Categories that related to each other were grouped under core categories.

categories including trust, gaining knowledge, and being the focus descriptions and explanations of the themes and codes. The
of healthcare professionals formed the major theme for this study: participant's ID number is used to reference all quotes, which are
patient−healthcare professional relationship (Table 3). The coding process anonymized. A more detailed description of each of these topics is
and analyses of responses were carried out by two researchers who were presented, which is summarized in Table 1. As examples of participant
experts in implementing and analyzing qualitative research. answers, illustrative quotes are offered.

2.5 | Validity of responses 3.3 | Patient−healthcare professional relationship

Two different researchers analyzed the data independently, and the 3.3.1 | The center of care
similarities and differences were discussed until an agreement was
reached concerning the themes and subthemes. Additionally, all the This code emerged from what patients said about their feelings
researchers audited data to ensure the rigor of the interpretation and toward the care provided and the empathetic way in which
the description of the findings. healthcare professionals dealt with them. For the patients, this way
of care created a sense of being the focus and the center of care
provided by healthcare professionals. Some patients appreciated the
2.6 | Ethical considerations way in which healthcare professionals responded to their queries,
listened to them, and gave consideration to their personal autonomy
All of the participants received verbal and written information about the as well as to their psychological, biological, and social perspectives.
aim and design of the study. They were assured that they had the right to The overwhelming majority of those interviewed described how
discontinue their participation at any time and that the data would be they were generally happy with the way in which healthcare
handled in a confidential way to be used only for the declared purpose. professionals interacted with them. Interviewees described how the
The current study was approved by the ethics committees of the positive way in which they were dealt with, such as a good welcome
University. Study participants provided their formal consent to participate and a sense of being appreciated, gave them a feeling of being
in the study. They were informed that their participation is voluntary and supported and motivated them to talk, interact, and raise any queries
they have the choice to withdraw from the study at any stage. To protect they wanted to with the healthcare professionals. The examples from
the confidentiality, the data were stored in a safe computer. three interviewees demonstrate these feelings.
A 44‐year‐old male patient, who was diagnosed with Hodgkin
lymphoma, shared his positive feelings toward the care provided with
3 | RESULTS the following:

3.1 | Participants' characteristics The doctor is listening to the patient and answer all
their queries, advise them to take [medicine] or not,
The mean age of the participants was 59.8 years (SD = 5.8, range inform them if it is useful or not. (T/1‐ I)
50−70 years). Of the participants, 15 were married, 4 were single,
and 2 were divorced. Disease duration varied from newly diagnosed A 38‐year‐old female patient, who was diagnosed with face and neck
to 10 years (see Table 4). cancer, shared her comfortable feeling with the following quotation:

The style of conversation with doctor makes me to feel

3.2 | Patients' experiences about pain management comfortable, he [the doctor] was fun and laughs. (T/2‐I)

Four codes were applied to the data, resulting in two themes. The interactions between patients and healthcare professionals
Verbatim statements from interviewed participants complement the were supported via whatever mode of interaction patients favored,
TABLE 4 Interviewees' characteristics

Age Marital Income

Code (years) Gender status Job in JD Education Diagnosis Treatment
ALSARAIREH

T/1‐ I 44 Male Married Coiffure 450 Secondary education Hodgkin lymphoma Surgery and chemotherapy, and pain killers (adol, celebrex,
ET AL.

or morphine)

T/2‐I 38 Female Married Hairstylist 400 Elementary education Face and neck cancer Surgery and chemotherapy, and pain killers (morphine)

T/3‐I 60 Female Married Retired/Jordanian Army 300 Diploma Cervical cancer Hysterectomy

T/4‐I 28 Female Divorced Private work 400 Bachelor's degree Bone cancer Chemotherapy, radiotherapy, morphine

T/5‐I 57 Male Married Private work 500 Diploma Non‐Hodgkin Chemotherapy, radiotherapy, hormonal therapy, tramal,
lymphoma morphine

T/6‐I 34 Female Married Private work 650 Bachelor's degree Lymphocyte glands' Morphine
tumor

T/7‐I 21 Female Single Don't work — University student Leukemia Surgery, morphine as a pain killer

T/8‐I 56 Male Married Cashier 350 Diploma Colon cancer, bladder Surgery, radiotherapy, chemotherapy pain killers
cancer

T/9‐I 42 Male Married Carpenter 450 Elementary education Lip sarcoma Surgery and pain killers

T/10‐I 59 Male Married Private work 600 Bachelor's degree Colon cancer Surgery, radiotherapy, chemotherapy, and pain killers

T/11‐I 68 Male Married Private clinic 1500 Specialist in pediatric Lung cancer chemotherapy and radiation, tramal, lyrica, and panadol
medicine

T/12‐I 55 Male Divorced Private sector 500 Diploma Colon cancer Chemotherapy and radiotherapy

T/13‐I 34 Male Married Taxi driver 300 Secondary education Hujken lymphoma Chemotherapy and radiotherapy, and hormonal therapy

T/14‐I 54 Male Single Retired/health sector 450 Secondary education Metastasis liver cancer Chemotherapy, radiotherapy, and morphine as a pain killer

T/15‐I 60 Male Married Construction/stone 500 Elementary education Lymphoma Chemotherapy, radiotherapy and tramal, morphine as a pain
worker killer

T/16‐ I 45 Male Married Tailor 350 Diploma Leukemia Leukemic‐related treatment, celebrex

T/17‐I 22 Male Single Not working — University student/ Knee tumor/Left leg Surgery, radiotherapy, morphine, and tramal
Bachelor's degree

T/18‐I 67 Female Married House wife 300 Secondary education Colorectal cancer Chemotherapy, radiotherapy, celebrex, and sometimes
panadol as a pain killer

T/19‐I 44 Female Married English teacher 450 Diploma Breast cancer Surgery, chemotherapy, radiotherapy, tramal, morphine
for pain relief

T/20‐I 35 Female Single None — Elementary education Breast cancer Surgery, chemotherapy, radiotherapy, tramal, morphine
for pain relief

T/21‐I 30 Female Married Maths teacher 450 Bachelor's degree Leukemia Chemotherapy, tramal, morphine for pain relief
|
5

Abbreviation: JD, Jordanian Dinar.

6 | ALSARAIREH ET AL.

for example, discussions with doctors were available either by phone information they received enabled them to understand how to use
or by visiting the pain clinic. Interviewees reported how they their pain medication, when to use it, and its side effects.
appreciated the way that doctors responded to them and articulated A 56‐year‐old male patient with colon and bladder cancer shared
how they had a sense of being encouraged not to hesitate to contact the gaining knowledge experience, with the following quotation:
their doctors if they have any queries regarding pain medications. The
quotations below highlight these issues: Today he [doctor] explained about each medicine
A 28‐year‐old female patient, who was diagnosed with bone what the effects of the medicine are? What are their
cancer and is on chemotherapy, shared how she appreciated the way side‐effects? What should we [patients] do if the pain
that doctors responded to her with the quotation: gets increased? Some medication we can increase the
dose but we can't increase for other medications.
Yes, they [healthcare professionals] are cooperative (T/7‐I)
and looking after the patients as they call them
[patients] if they would like to change the appoint- The following quote of a 42‐year‐old male patient with lip
ment or remind them with it. (T/4‐I) sarcoma illustrates how this patient recognized the safe use of pain
medications recommended during the doctor's consultation and was
A 60‐year‐old female patient, with cervical cancer, and a 57‐year aware of how to avoid possible hazardous side effects or any other
old male patient with non‐Hodgkin lymphoma, shared their experi- complications. They perceived the risky habit of taking a high dose of
ence of positive impressions about the doctor's interactions with pain medications as well as the importance of contacting and seeking
their conditions. Another 34‐year‐old female patient with a tumor of advice from doctors about their pain management. They had faith
the lymphocyte glands mentioned the focus of the doctor's attention that doctors work on their behalf, and follwing the doctor's
on improving her physical condition, with the following quotations: instructions will help them avoid pain and live a pain free life:

I have visited the clinic, the physician told me to refer me The doctor told me it could be OK with this medicine,
to physical therapy and he used to move my hand. (T/3‐I) but the case might not the same with other medicine
as some medications have fatal side‐effects such as
The doctor has told me he will refer me to the dying or harmful to the body organs, so, you have to
physiotherapist but not yet, this will be at stage by consult your doctor before you decide anything
stage. (T/5‐I)I have told the doctor to refer me to the regarding medications and what you have done was
psychologist as I feel anxious and irritable is this wrong. (T/9‐I)
therapy is the half of treatment… the treatment is not
only a tablet of medicine but it is the need for Interviewees reported that they received information about
somebody listen to yours complains and discuss cancer pain and how it could be measured from the pain clinic. They
everything you feel… today I will see the psychologist developed skills in how to report their pain by using pain scales and
and I will explain to her everything. (T/6‐I) understood its usefulness in determining the right medicine and dose.
They became aware that pain has different intensities and that the
A 21‐year‐old female patient with leukemia commented that treatment can be adjusted according to these intensities:
pain mismanagement occurred because pain doctors ignored A 44‐year‐old female patient with breast cancer shared the
patients' viewpoints about pain management, as they did not include aspect of gaining information about her cancer pain experience, with
them in decision‐making. One participant commented: the following quotation:

I mean by word awareness that some patient does not It is good, they explain to me how to estimate my pain
know their rights and duties. on a scale from 0 to 10, and then they decide to increase
or decrease the amount of medication. (T/19‐I)
Different patients have different thoughts about their
treatments. One more thing, patient's record must be Respondents also showed their ability to evaluate their pain in
reviewed accurately by all specialists. (T/7‐I) detail using a numerical pain scale. They became experts in evaluating
and measuring pain intensities, which enabled them to compare
pain intensities before and after the program. A 35‐year‐old
3.3.2 | Gaining knowledge female patient, with breast cancer, showed her understanding as
follows:
The explanations offered by the doctor during the consultation
appeared to enable patients to feel empowered and experience a I learnt how to write down on a form when does the
sense of control over their pain. Most interviewees explained that the pain occur, its place and its degree from 0‐10, and also
ALSARAIREH ET AL. | 7

to write down how often, how long does it occur before Very often the doctor jokes with me and deals me as a
and after taking the medicine for example it reached 8 of friend but not as a patient. These give me a feeling of
10 with me when I first came here. (T/20‐I) brotherhood which enhances my trust to him. As a
result, I feel free to ask any question to him and I also
The vast majority of respondents believed that pain medications, gave the answers of his questions freely. (T/1‐I)
especially opioids, could cause addiction. As a result, gaining
knowledge appeared to shift patients' beliefs and attitudes about I am thankful to the doctors as they visited me in
pain medications, particularly opioids. Through the program, they hospital and assured me that I will be in a better
became aware that safe use of opioids will not lead to addiction. The situation very soon which makes me confident to trust
following quote of a 30‐year‐old female patient, with leukemia, them. (T/2‐I)
highlights this point:
In contrast, a small number of interviewees were wary about the
They [doctors] told me that I should regularly take this program, because they experienced adverse side effects after being
medicine… and when I told the physician that I am treated. As a result, they started to ask for alternative treatments
afraid of addiction and keep asking more and more for such as going to another doctor with whom they feel more confident
it, he assured me that appropriate use of opioids will and trusted. One female patient with cervical cancer stated:
not lead to addiction and the doses will be reduced
gradually from a high dose to the lowest one. (T/21‐I) To be honest, I haven't visited the pain clinic rather I
have visited my family doctor to whom I trust more
However, not all the respondents reported feeling satisfied with compare to them [the clinic doctor] where I explained
the level of information that they received. Some reported feeling my feelings.
anxious because of a perceived lack of information. This led to feeling
suspicious about their pain management, with patients reporting they I asked him whether I have done a mistake by stopping
felt that the doctors were responsible for any side effects or lack of the pain medication or not; but he [family doctor]
efficacy in the medication they were prescribed. A 21‐year‐old praised me as a brilliant and this assured me and made
female patient with leukemia reported: me very comfort. Then he prescribed a medicine for
my colon. (T/3‐I)
I don't know what happened [i.e. to cause the
experienced side‐effects related to pain medications] Moreover, some interviewees reported feeling distressed and
I would like to know what happened… May they want anxious because they had a sense of being ignored. They commented
us to be like a doctor, to know everything about the that doctors did not involve them in pain treatment or consider their
medicine. (T/7‐I) viewpoints and feelings about pain treatment:

Also they [doctors] should check whether the patient

3.3.3 | Trust is happy with them or not. (T/4‐I)

Trust is considered an important factor in health care as it contributes As a result, some patients reported that the lack of pain
to engagement with the health care provided and continuity of the management was linked to the knowledge deficit by pain doctors
patient−doctor relationship.30 In this study, trust in medications, the and that doctors must take their pain seriously and to pay attention
healthcare system, and interpersonal relationships were found to to the appropriate medications with concern in relation to their side‐
have an influence on adherence to cancer pain management. effects. One interviewee with lymphocyte glands tumor stated:
Interviewees presented different opinions regarding the services
provided in the PMP. In this study, some of the interviewees reported To control pain, doctor must deal with patients' pain
that they “trusted” the services provided through healthcare seriously; he must know the importance of the
professionals in PMP; as a result, they were engaged in these medicine along with its side‐effects. (F) (T/6‐I)
services and interactions with their doctors, conveying any matter
regarding pain management. This encouraged them to trust in the One of the causes of the lack of knowledge stated by one
services provided and the healthcare professionals. Others, who held respondent was the overestimation of pain, as she felt that prescribed
a negative attitude toward the PMP, were not convinced by the care medications were more than necessary and that the use of pain
provided and appeared to have a mistrust of the program. The medications should be based on a specific agenda. Moreover, she
following quotes show how respondents developed trust in their commented that the doctors must know alternative medicines, and not
doctors: stick to a specific medicine as the availability of all medications is the
8 | ALSARAIREH ET AL.

responsibility of the administrators of the program. One female things. This really improved my mood and made me to
interviewee aged 21 years old with leukemia said: feel stronger to manage my pain. (T/21‐I)

Yes, he [doctor] gave me high dose of morphine which Respondents also described the relationship between pain and
he should not in an initial stage; I don't know why he psychological distress. They stated that they get distressed and
did so… (T/7‐I) anxious when they are psychologically disturbed. Two interviewees
(one male and one female) expanded on this matter as follows:
A 22‐year‐old male patient with a knee tumor (T/17‐I) and a
3.4 | Satisfaction 67‐year‐old female patient with colorectal cancer (T/18‐I) shared
their experiences in terms of pain and psychological distress with the
Satisfaction is considered an important factor for continuity of care following quotes:
that contributes to the stability of the patient−healthcare profes-
sional relationship.31 The vast majority of respondents reported a If I have good psychology, the pain becomes moder-
feeling of comfort regarding the services provided in the PMP and its ate; but when I am distressed, it becomes worse…
crucial role in helping them to gain control over their pain. (T/17‐I) and the higher the stress the more the pain
Interviewees reported their satisfaction with the quality of care in experienced. (T/18‐I)
the PMP, the services provided, and the knowledge gained through
consultations with doctors. As a result, they stated their desire to have psychotherapist
Generally, most of the interviewees appeared to be satisfied with consultations, because they believed that negative thinking and poor
the services provided in the PMP, and its effect on health psychology necessitated consultations with a psychiatrist. One
improvement, describing it as a good program with adequate female patient aged 44 years old with breast cancer stated:
facilities. They appreciated the availability of services in the PMP,
which helped in alleviating their pain and meeting their requirements A person who has anxiety and deep thinking might
immediately. The statements of some interviewees were as follows: need a psychologist. (T/19‐I)

Yes, thanks to God, the program is very good… These thoughts helped them to perceive the effect of this
Services here are quite enough. (T/18‐I) therapy and appeared to motivate them to engage in psychological
treatment. They appreciated this type of therapy, because it helps
The availability of the program in particular regions was valued and gave them the opportunity to discuss their thoughts and worries
by respondents as it reduced the effort to access pain management with the specialist. They believed that this type of therapy was part
services. Interviewees were delighted and valued the existence of the of the cure. The statements of some respondents were as follows:
program. They considered the program as an important solution to
deal with their pain, and one that is not available in other regions of The psychiatrist encouraged me to discuss my emo-
Jordan. The quotes of some participants were as follows: tions as it would help in getting my pain relieved. The
psychotherapy is fantastic; the psychotherapists are
It is considered an important solution for patients' cooperative and offer excellent moral support. (T/21‐I)
pain. (T/17‐I) and Very much, I hope that there will be
a programme such as this in each hospital. (T/20‐I) In addition, interviewees valued the availability of physiotherapy
sessions as they helped them to feel better and be physically well. They
The availability of various services in the program, such as revealed that what they learnt from physiotherapy was helpful and
psychotherapy and physiotherapy, contributed to a decrease in motivated them to practice what they have learnt. One female stated:
tension caused by cancer and cancer‐related pain. Some respondents
felt worried and anxious as they believed that pain is an indicator of Yes, the doctor gave me this therapy for my neck and
the existence of a particular medical problem. However, they were my hand, and it is now much better. Before I could not
satisfied with the psychotherapy as it helped in relieving their fear move my hand or turn my back due to the inflamma-
and negative thoughts. tion in the joints, but now my condition is much better.
They also told me about exercises that need to be
I met her [psychiatrist] and she told me that my practice at home. (T/20‐I)
disease was not cancer but a psychological disease. She
[psychiatrist] advised me to visit her next week, and Although the vast majority of patients were satisfied with the
avoid any negative thoughts. For example, thinking of PMP, a small group revealed their desire to include some more
death or paralysis of my hand, but focus on the positive services to it. The statements of some participants were as follows:
ALSARAIREH ET AL. | 9

Honestly, there is no spiritual therapy available here knowledge. The importance of a constructive patient−healthcare
[pain clinic]. These ways are not available in our professional relationship appears to lie in its influence on patient
countries, but are rather available in other European behaviors, improvement of self‐efficacy, and self‐management of
countries. (T/1‐I) and I don't know about nutritional pain.32 The codes under the major theme “healthcare professionals'
therapy, just from Al‐Bashir Hospital. (T/2‐I) relationship” highlighted the importance of this relationship and its
role in motivating patients to maintain pain control and initiating a
However, they were happy with the medication and its efficacy sense of self‐management of their pain. For instance, gained
in pain reduction. They were satisfied with is because it allowed them knowledge helped patients to understand the importance of pain
to meet their daily needs. The statements of some patients were as management and its effect on their well‐being. Other factors such as
follows: a trusting relationship and satisfaction with care provided are
considered important elements for the continuity of care and
For a long period of time now, I have been feeling increased the depth of the relationship between patients and
much better and experienced quite an improvement. I healthcare professionals.33 Ridd et al. found that educational
don't feel a pain in my back anymore, and have started intervention, based on the self‐efficacy theory, had a statistically
to walk. (T/3‐I) significant effect on improving participants' health behaviors, self‐
efficacy, and self‐management.33 These findings support this study's
Respondents also highlighted the importance of the place and finding that participants felt more confident and able to manage pain
the large spaces available for cancer patients. One of the participants themselves once they were participating in the PMP.
valued the variety of rooms available, as he was happy with the place In this study, the majority of patients reported a positive trusting
arrangement, which contributes to patients' privacy and comfort. A relationship with healthcare professionals because the latter met
57‐year‐old male interviewee shared the following feeling: their needs and helped them to control their pain. However, two
patients did not trust their doctors, because they experienced side
Nothing and there are a lot of spaces here so the effects from using pain medication and the doctors did not listen to
patients feel comfortable. (T/5‐I) their complaints or offer any alternative treatment. It seems that
patients want physicians to pay more attention to them and listen to
One of the important policies of KHCC is the insurance policy, their needs. In addition, patients also desire to have more support to
particularly for those who have limited income and are not included compensate for threats associated with having cancer.34 Earlier
in governmental or military health insurance systems. This motivates studies suggested that patients with cancer need considerable
them to engage with the PMP. From their point of view, sharing in reassurance about their reactions and concerns.35 Therefore, physi-
simple costs, such as payment for transportation, was not a barrier to cians need to create a trusting atmosphere in which patients are
come to the pain management clinic compared to the costs of the treated as individuals and made to feel that the physician shows
services offered in the PMP. Therefore, they expressed their interest in, and is sensitive to, their problems and feelings.35
happiness with the health insurance system in the program. A The findings of this study suggest that patients wanted to share
54‐year‐old male patient with metastasis liver cancer shared his decision‐making about appropriate treatment with their doctors. The
experiences in terms of the health insurance system in the findings of this study are in line with those of van den Brink‐Muinen
program with the following quotes: et al.,3 who found that chronically ill patients had high levels of trust
in their regular healthcare professionals, whereas a few trusted other
Alhamdulillah [all praise is due to God], this center doctors outside the healthcare system.3 Therefore, physicians should
offers all services free, such as X‐rays, blood investi- encourage their patients to share decision‐making and responsibility
gations and other investigations, which cost the center for care provided by offering different options and preferences of
many millions of JD [Jordanian Dinar] compared with alternative treatments, and should not ignore patients' views about
what we pay for transportation. (T/14‐I) their preferences for care provided. The reduction in pain was
reflected in participants' views regarding pain management in this
study. The majority of patients interviewed reported experiencing
4 | DISC US SION considerable pain relief after initial engagement in the PMP. This
result is consistent with the findings of previous studies that found a
The findings in this study may help to identify the factors that beneficial effect of a multidisciplinary approach in cancer pain
contribute to improving pain outcomes in the PMP. One important management.36–38
finding was the patient−healthcare professional relationship, which Knowledge improvement is important for cancer patients
explained how a PMP enabled patients to manage their pain. The because of its influence on their ability to make decisions regarding
main elements that contributed to the strong relationship between their pain treatment. This was supported by Leighl et al.,39 who found
patients and their healthcare professionals were the patients' feeling that gaining knowledge is an important element for empowerment
that they were the center of care, trust, satisfaction, and gaining and self‐awareness, which helps patients make better decisions and
10 | ALSARAIREH ET AL.

improves their quality of life. As a result, information can be limitation may be the impact of recent surgery or other treatments
recognized as a crucial necessity for patients, as it helps them to on the outcome.
participate in the treatment process, especially for those with chronic
diseases. Tran et al. found that cancer patients always need to know
about their illness and hope for a cure.40 Some patients in this study 5 | CONCLUSION
expressed a desire for additional information regarding their
condition and what treatments are effective for their pain. For The present study described the subjective experiences of patients
instance, one female revealed her desire to know the source of her with cancer and newly engaged in a multidisciplinary PMP. The
pain (e.g., from the disease or from drug side effects). Wilson themes identified in the present study offer a new understanding
et al.41 identified that healthcare providers can help patients to of the knowledge related to satisfaction of patients with cancer in
recognize the side effects of drugs from the disease itself, which terms of the quality of pain management. Additional qualitative
helps in understanding how patients adhere to their choice of studies are required to replicate the present study in different
medication regimens. populations and investigate how people from different backgrounds,
The knowledge improvement was correlated with self‐efficacy ethnicities, and cultures experience pain associated with cancer.
and this can affect health outcomes. According to Hogenmiller The findings of the current study can increase awareness among
et al.,42 low levels of knowledge were associated with low self‐ nurses regarding their role in pain management as a step toward
efficacy for patients to participate in cervical cancer screening. Simi- enhancing the quality of health services for patients since cancer
larly, cancer education was found to be efficacious in improving self‐ treatment and pain management require unique skills. The findings
efficacy in patient−physician interaction.43 In the current study, highlight some of the scientific implications for pain management in
findings suggested that patients became capable of controlling their cancer care. The discovery of current research that cancer patients
pain themselves, evidenced by pain scores through different time with pain view nurses as important but have difficulty in describing
points as well as through interviews. This explains why patients did the skills of a nurse raises questions about how the pain management
not adhere to the prescribed dose and preferred to take the dose that practices of nurses are invisible and limited in their scope. By
they felt to be appropriate. Also, patients learned how to deal with expanding the scope of nursing pain management, the role of the
pain medications and how to use other alternatives such as nurse in pain management can become clearer and more effective.
physiotherapy besides traditional treatment to manage their pain. Hospitals' cancer management system, nurses of oncology
Having different behaviors toward pain management (among non- wards, and researchers need to pay more attention to pain
cancer patients) were found to be more effective than dependence management as a priority in the care plan. Also, there is a need for
solely on pain medication.44 continuous efforts including comprehensive pain assessments,
The limitations of this study were as follows: interviews in this patient education, and evidence‐based treatments to deliver satis-
study were performed by a hospital nurse, which may have been one factory pain relief and end‐of‐life care. Also, listening to cancer
of the reasons why patients did not want to complain about the care patients' experiences of pain and appreciation of the individuality of
and pain management they received. Its also difficult to ask patients the lived experience of cancer will improve our understanding of pain
because some of them want to share thoughts that match to social and its management.
norms and aviod seeming bad. Another potential limitation is that the
quality of data collection and outcomes is heavily dependent on the A UT H O R C O N T R I B U TI O NS
interviewer's abilities and the analyses' rigor. Another potential flaw Mahmoud Alsaraireh, Mohammed ALBashtawy, and Asem
is that while analyzing the data, it is justified to wonder if the Abdalrahim: Conceptualization; methodology; formal analysis; inves-
interviews ended too soon. Patients did not report that they tigation; data curation; visualization; writing—original draft. Abdullah
expected any care from nurses other than medication management, Alkhawaldeh, Moawiah Khatatbeh, Jamal Qaddumi, Sa'd
but they did identify a variety of elements that helped ease pain and ALBashtawy, and Zaid ALBashtawy: Conceptualization; methodol-
the anxiety caused when nurses asked too many questions, implying ogy; formal analysis; writing—review and editing; supervision. Ali
that data processing was completed prematurely. Ibnian and Ahmad Ayed: Conceptualization; formal analysis; writing—
Another potential drawback is the validity of data from review and editing; supervision. Mohammad Suliman and Nisser
interviews with the three patients who currently had a pain score Alhroub: Conceptualization; methodology; formal analysis; writing—
of more than 3, because more severe pain, than mild pain, can review and editing; supervision; project administration.
influence cognition. All of these patients, however, were deemed
capable of being questioned by the research nurse. This nurse has a CONFLIC T OF INTEREST
lot of experience dealing with cancer patients who are in a lot of The authors declare no conflict of interest.
pain. Patients with a high pain score were also counseled by the
nurse conducting the interviews to get care for their pain as soon as DATA AVAILABILITY STATEMENT
possible after the interview was concluded. If they required The data that support the findings of this study are available from the
assistance, the nurse contacted the ward's nurses. The last possible corresponding author upon reasonable request.
ALSARAIREH ET AL. | 11

ORCID 19. Qadire MA, Tubaishat A, Aljezawi MEM. Cancer pain in Jordan:
Abdullah Alkhawaldeh [Link] prevalence and adequacy of treatment. Int J Palliat Nurs. 2013;19:
125‐130.
Mohammad Suliman [Link]
20. Albashtawy M, Gharaibeh H, Alhalaiqa F, et al. The health belief
model's impacts on the use of complementary and alternative
REFERENCES medicine by parents or guardians of children with cancer. Iran J Publ
1. Holtan A, Aass N, Nordøy T, et al. Prevalence of pain in Health. 2016;45:708‐709.
hospitalized cancer patients in Norway: a national survey. Palliat Med. 21. Al Qadire M, Alkhalaileh M, ALBashtawy M. Lifestyle and dietary
2007;21:7‐13. factors and prostate cancer risk: a multicentre case−control study.
2. Religioni U, Czerw A, Sygit K, et al. Pain management strategies Clin Nurs Res. 2019;28:992‐1008.
among cancer patients. Normalization of the CSQ (The Pain Coping 22. Freij M, Al Qadire M, Khadra M, et al. Awareness and knowledge of
Strategies Questionnaire) Form. Int J Environ Res Public Health. 2022;19: ovarian cancer symptoms and risk factors: a survey of Jordanian
1013. women. Clin Nurs Res. 2018;27:826‐840.
3. Van den Brink‐Muinen A, Rijken PM. Does trust in health care 23. Howeri NM, AlBashtawy M, Ozayb N, et al. The role of ketogenic
influence the use of complementary and alternative medicine by diet in the treatment of cancer: a review paper. EC Psychol Psychiatr.
chronically ill people? BMC Public Health. 2006;6:1‐9. 2020;9:30‐33.
4. Lin CC, Lai YL, Ward SE. Effect of cancer pain on performance 24. Khatatbeh MM, Jadallah KA, AL Bashtawy M, et al. Factors
status, mood states, and level of hope among Taiwanese cancer associated with colorectal cancer among Jordanians: a case−control
patients. J Pain Symptom Manage. 2003;25:29‐37. study. Asian Pac J Cancer Prev. 2018;19:577‐581.
5. Batiha AM, Obead KA, Alhalaiqa FN, et al. Quality of life and fatigue 25. Sandelowski M. Whatever happened to qualitative description? Res
among Jordanian cancer patients. Iran J Publ Health. 2015;44: Nurs Health. 2000;23(4):334‐340.
1704‐1705. 26. Maykut P, Morehouse R. Beginning Qualitative Research: A Philo-
6. Obead KA, Batiha AM, Al‐Jauissy MS, et al. Impact of radiotherapy sophical and Practical Guide. Routledge; 2002.
treatment on Jordanian cancer patients' quality of life and fatigue. 27. Pearson M. Handling qualitative data: a practical guide.
Int J Adv Nurs Stud. 2014;3:6. Sociol Res Online. 2005;10:73.
7. Olimat F, ALBashtawy M, Alkhawaldeh A, et al. Effectiveness of 28. Parahoo K. Nursing Research. Nursing Research: Principles, Process
exercise to reduce cancer related fatigue: a literature review. EC and Issues. Macmillan International Higher Education; 2014.
Emerg Med Crit Care. 2021;5(5):29‐35. 29. Jahangiri L, Mucciolo TW. Characteristics of effective classroom
8. Al Qadire M, Aldiabat KM, Alsrayheen E, et al. Public attitudes teachers as identified by students and professionals: a qualitative
toward cancer and cancer patients: a Jordanian national online study. AADS Proc. 2008;72:484‐493.
survey. Middle East J Cancer. 2022;13:352‐362. 30. Andreassen HK, Trondsen M, Kummervold PE, Gammon D,
9. Beatty L, Oxlad M, Koczwara B, Wade TD. The psychosocial Hjortdahl P. Patients who use e‐mediated communication with their
concerns and needs of women recently diagnosed with breast doctor: new constructions of trust in the patient−doctor relation-
cancer: a qualitative study of patient, nurse and volunteer perspec- ship. Qual Health Res. 2006;16:238‐248.
tives. Health Expect. 2008;11:331‐342. 31. Vigier M, Thorson KR, Andritsch ER. Physiological linkage during
10. Goblan M, ALBashtawy M, Al Omari O, et al. Patient‐related barriers interactions between doctors and cancer patients. Soc Sci Med.
to pain management among cancer patients. Medico Legal Update. 2021;284:114220.
2021;21:256‐259. 32. Fracso D, Bourrel G, Jorgensen C, et al. The chronic disease self‐
11. Centers for Disease Control and Prevention. A National Action Plan management programme: a phenomenological study for em-
for Cancer Survivorship: Advancing Public Health Strategies. US powering vulnerable patients with chronic diseases included in
Department of Health and Human Services; 2004. the EFFICHRONIC project. Health Expect. 2022;25(3):947‐958.
12. Ghanem R, AlBashtawy M, Alkhawaldeh A, et al. The impact of early 33. Ridd M, Shaw A, Lewis G, Salisbury C. The patient–doctor
palliative care for cancer patients: a literature review. EC relationship: a synthesis of the qualitative literature on patients'
Psychol Psychiatr. 2021;10:1‐6. perspectives. Br J Gen Pract. 2009;59:e116‐e133.
13. Chang KL, Fillingim R, Hurley RW, Schmidt S. Chronic pain 34. Takayama T, Yamazaki Y, Katsumata N. Relationship between
management: non‐pharmacological therapies for chronic pain. FP outpatients' perceptions of physicians' communication styles and
Essent. 2015;432:21‐26. patients' anxiety levels in a Japanese oncology setting. Soc Sci Med.
14. Ferlay J, Steliarova‐Foucher E, Lortet‐Tieulent J, et al. Cancer 2001;53:1335‐1350.
incidence and mortality patterns in Europe: estimates for 40 35. Arora NK. Interacting with cancer patients: the significance of physicians'
countries in 2012. Eur J Cancer 2013;49:1374‐1403. communication behavior. Soc Sci Med. 2003;57:791‐806.
15. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer 36. Hardavella G, Frille A, Theochari CI. Multidisciplinary care models for
J Clin. 2015;65:5‐29. patients with lung cancer. Breathe. 2020;16:200076.
16. Shen WC, Chen JS, Shao YY, et al. Impact of under treatment of 37. Follwell M, Burman D, Le LW, et al. Phase II study of an outpatient
cancer pain with analgesic drugs on patient outcomes: a nationwide palliative care intervention in patients with metastatic cancer. [see
survey of outpatient cancer patient care in Taiwan. J Pain Symptom comment]. J Clin Oncol. 2009;27:206‐213.
Manage. 2017;54:55‐65. 38. Peng WL, Wu GJ, Sun WZ, Chen JC, Huang AT. Multidisciplinary
17. Forgeron PA, Finley GA, Arnaout M. Pediatric pain prevalence and management of cancer pain: a longitudinal retrospective study on a
parents' attitudes at a cancer hospital in Jordan. J Pain Symptom cohort of end‐stage cancer patients. J Pain Symptom Manage. 2006;32:
Manage. 2006;31:440‐448. 444‐452.
18. Mitera G, Zeiadin N, Kirou‐Mauro A, et al. Retrospective assessment 39. Leighl NB, Shepherd HL, Butow PN, et al. Supporting treatment
of cancer pain management in an outpatient palliative radiotherapy decision making in advanced cancer: a randomized trial of a
clinic using the pain management index. J Pain Symptom Manage. decision aid for patients with advanced colorectal cancer
2010;39:259‐267. considering chemotherapy. J Clin Oncol. 2011;29:2077‐2084.
12 | ALSARAIREH ET AL.

40. Tran Y, Lamprell K, Nic Giolla Easpaig B, et al. What information do 44. Bennett MI, Bagnall AM, Closs SJ. How effective are patient‐based
patients want across their cancer journeys? A network analysis of cancer educational interventions in the management of cancer pain?
patients' information needs. Cancer Med. 2019;8:155‐164. Systematic review and meta‐analysis. PAIN®. 2009;143:192‐199.
41. Wilson HS, Hutchinson SA, Holzemer WL. Reconciling incompatibil-
ities: a grounded theory of HIV medication adherence and symptom
management. Qual Health Res. 2002;12:1309‐1322.
42. Hogenmiller JR, Atwood JR, Lindsey AM, Johnson DR, Hertzog M, How to cite this article: Alsaraireh M, ALBashtawy M,
Scott JC Jr. Self‐efficacy scale for Pap smear screening participation Abdalrahim A, et al. Cancer pain management program:
in sheltered women. Nurs Res. 2007;56:369‐377.
Patients' experiences–A qualitative study. Nurs Forum.
43. Ford ME, Wahlquist AE, Ridgeway C, et al. Evaluating an interven-
tion to increase cancer knowledge in racially diverse communities in 2022;1‐12. doi:10.1111/nuf.12761
South Carolina. Patient Educ Couns. 2011;83:256‐260.