Healthcare Professionals’, Patients’, and Caregivers’ Views about Cancer Pain and its Management in Libya

Background: Cancer pain remains a significant problem worldwide. It presents in about 50% of cancer patients with advanced stages. Although several guidelines and pharmacological interventions for Cancer Pain Management (CPM) exist, inadequate assessment and undertreatment of cancer pain are well-documented globally, especially in developing countries, including Libya. Lack of knowledge and negative attitudes and perceptions towards cancer pain and opioids among Healthcare Professionals (HCPs), patients, and caregivers are reported as barriers to effective CPM in Libya and worldwide. Aim: This study aimed to explore Libyan HCPs’, patients’, and caregivers’ views about cancer pain and its management. Methods: The research design in this study is an exploratory sequential mixed-methods approach, which is more appropriate for this study based on the study's purpose to answer the research questions. This thesis consists of three studies: A systematic review, a qualitative descriptive study involving semi-structured interviews with 36 participants: 18 Libyan cancer patients, 6 caregivers, and 12 Libyan HCPs, and a cross-sectional survey involving a convenience sample of 152 oncology nurses and physicians working in six oncology settings in Libya. Results: Libyan patients, caregivers, and newly qualified HCPs were concerned about the social stigma of opioids and feared drug addiction. Some patients and caregivers relied on religious and cultural beliefs for managing cancer pain, including the use of the Qur'an and cautery as coping strategies for CPM. Libyan HCPs perceived a lack of policies and guidelines, pain rating scales, and professional education and training in CPM as barriers to effective CPM. Conclusion: Our results suggest that Libyan patients, caregivers, and oncology HCPs hold perceived barriers, lack of knowledge, and negative attitudes towards CPM. Professional education and training in CPM among HCPs, addressing phobia and myths on opioid usage, and the benefits and complications of using opioids will likely result in reduced barriers to CPM in Libya.