Patient Preference and Adherence (Aug 2020)

Relationship Between Adherence to Opioid Analgesics and Pain Beliefs Among Patients with Cancer Pain at Tertiary Care Hospitals in Malaysia

  • Kan E,
  • Mustafa S,
  • Chong WW,
  • Premakumar CM,
  • Mohamed Shah N

Journal volume & issue
Vol. Volume 14
pp. 1411 – 1419


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Elaine Kan,1,2 Suzana Mustafa,1 Wei Wen Chong,2 Chandini Menon Premakumar,2 Noraida Mohamed Shah2 1Pharmacy Department, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia; 2Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, MalaysiaCorrespondence: Noraida Mohamed ShahCentre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, MalaysiaTel +60 3 9289 8038Email [email protected]: Pain is a common and distressing symptom among cancer patients. Opioid analgesics are the mainstay of cancer pain management, and adequate adherence plays an important role in achieving good pain control.Purpose: To determine the level of adherence to opioid analgesics in patients with cancer pain and to identify factors that may influence the adherence.Patient and Methods: This was a cross-sectional study conducted from March to June 2018 at two tertiary care hospitals in Malaysia. Study instruments consisted of a set of validated questionnaires; the Medication Compliance Questionnaire, Brief Pain Inventory and Pain Opioid Analgesic Beliefs─Cancer scale.Results: A total of 134 patients participated in this study. The patients’ adherence scores ranged from 52– 100%. Factors with a moderate, statistically significant negative correlation with adherence were negative effect beliefs (rs= − 0.53, p< 0.001), pain endurance beliefs (rs = − 0.49, p< 0.001) and the use of aqueous morphine (rs = − 0.26, p=0.002). A multiple linear regression model on these predictors resulted in a final model which accounted for 47.0% of the total variance in adherence (R2 = 0.47, F (7, 126) = 15.75, p< 0.001). After controlling for other variables, negative effect beliefs were the strongest contributor to the model (β = − 0.39, p< 0.001) and uniquely explained 12.3% of the total variance.Conclusion: The overall adherence to opioid analgesics among Malaysian patients with cancer pain was good. Negative effects beliefs regarding cancer pain and opioids strongly predicted adherence.Keywords: beliefs, cancer pain, compliance, opioid analgesic