Bad attitudes add to the suffering of patients in cancer wards, study

Thousands of cancer patients in Kenya are dying in pain, with most being denied medication by health workers, shows a new study. The World Health Organisation estimates 80 per cent of Kenyans dying from cancer suffer from untreated moderate to severe pain.

This roughly means 26,400 Kenyans who died from cancer last year suffered pain that could have been treated.

The cause for untreated pain, the study at Kenyatta National Hospital (KNH), indicates to be mainly negative attitude by nurses towards cancer patients.

The study published September 24, 2019 in the journal Pain Management Nursing blames negative attitude, poor training and fear of using opioids among nurses as well as interference by relatives of some patients.

The study carried out by Dr Lister Nyasero Onsongo, a lecturer at the School of Nursing Kenyatta University, also blames poor cooperation between nurses and doctors especially at the KNH private wing.

“When doctors come to review patients, most of the time they go alone. There is a negative attitude nurses have that when you accompany a doctor into the patient’s room you are like a maid,” said a study participant. Nurses at the hospital, handling the highest number of cancer patients in Kenya, view a transfer to the Oncology Unit as a punishment or demotion, reported the study.

One of the reasons for the negative view of the oncology wards, the study suggests are the high rates of deaths compared to other wards.

“The negative attitude toward working in the Oncology Unit played a negative role in pain management,” says the study.

The issue of money and payments also featured prominently as one reason why nurses at KNH oncology wards are not keen on attending to their patients. They complained that unlike other nurses who work in specialised wards such as the Intensive Care Unit who are paid 15 per cent extra for recognition, cancer nurses are not paid such extras. “Sometimes, you know, most people want money for motivation. In the ICU they are usually given allowances that we do not get as oncology nurses,” said a participant.

Dr Onsongo had involved 25 nurses working in KNH private wing and the general oncology ward in a study approved by the hospital’s ethics committee.

Participants were nurses who spent at least 50 per cent of clinical duties providing care to cancer patients and had worked in the unit for six months or more. “Nurses in both units do not conduct a comprehensive pain assessment and they do not use validated pain assessment tools,” said Dr Onsongo. The nurses complained of erratic and inadequate training, heavy workload and burnout and lack of pain management guidelines.

Participants said for example they forget to give patients the pain killer, morphine, as required because they have too much work and they are too few especially at night.

But Dr Onsongo says this may not hold true: “Based on my observations, in rare situations in which nurses had fewer patients and the same number of staff, there was no difference in nurses’ approach to pain management.” Some of the nurses reported hesitancy in administering opioids in case patients become addicted or developed breathing problems.

“We might cause respiratory distress, and then actually in a way we are speeding up the death process. We have patients who die in pain; everybody is usually afraid to give morphine; we just fear, it is a dilemma,” said a nurse.

But they also blame patients’ relatives. “Relatives interrupt a lot. They can be so nagging, you are not able to figure out if it is the patient’s genuine pain or the relatives,” said a participant.

There are also patients who believe that unless they get an injection they are not being treated. “So some nurses give normal saline (water) injections to calm the patients down,” says the study.

Dr Onsongo however suggests the case of poor pain management is not exclusive to KNH and could be widespread but can be relieved through sound policies and quality training of nurses. An earlier study among 400 cancer patients at Moi Teaching and Referral Hospital, Eldoret reported 66 per cent had poorly managed pain.

“This study shows that hospitalised patients in Kenya are experiencing pain that is often undertreated,” said the report by in-house doctors, Moi University, Indiana University, US and Brigham and Women’s Hospital, US. A study on cancer pain among 94 patients at Garissa Referral Hospital, published in August (2019) reported that 78 per cent experienced poor pain treatment. “This study found a high prevalence of cancer pain and suboptimal cancer pain management,” says the study led by Fatuma Affey of Umma University.