Document Type : Original Article


1 Anesthesiology

2 Epidemiology and Biostatistics, Isfahan University of Medical Sciences, Isfahan

3 Department of Public Health, Golestan University of Medical Sciences, Gorgan

4 Department of Public Health, Birjand University of Medical Sciences, Birjand, Iran


Background: Effective cancer pain management requires accurate knowledge, attitudes,
and assessment skills. The purpose of this study was to obtain information about the
knowledge and attitudes of nurses concerning cancer pain management with the use Health
Belief Model (HBM) as conceptual framework. Materials and Methods: The study was a
descriptive survey and included 98 randomly selected nurses from Alzahra hospital, Isfahan,
Iran. A self‑administered questionnaire which was designed on the basis of HBM was used
to collect the data. Knowledge, attitudes, and HBM constructs regarding cancer pain were
the main research variables. The obtained data were analyzed by SPSS (version11.5) using
descriptive statistics, independent t–test, and Pearson correlation at the significant level of
α=0.05. Results: Ninety‑eight nurses aged 38.7 ± 7.04 years were studied in this survey. From
the 10 pain knowledge questions assessed, the mean number of correctly answered question
was 61.2 (SD=16.5), with a range of 30–100. There was a direct correlation between knowledge
and attitude of nurses with HBM constructs except for perceived barriers and perceived threat.
Among the HBM constructs, the highest score was related to self‑efficacy with mean score of
87.2 (SD=16.4). Conclusions: The findings support the concern of inadequate knowledge
and attitudes in relation to cancer pain management. We believe that basic and continuing
education programs may improve the knowledge level of nursing about pain management.


1. Kuppelomaki M, Lauri S. Cancer patients’ reported experiences of
suffering. Clin J Oncol Nurs 2000;4:45‑6.
2. WHO. Cancer pain relief: With a guide to opioid availability. Geneva:
World Health Organization; 1996.
3. Cohen MZ, Easley MK, Ellis C, Hughes B, Ownby K, Rashad BG,
et al. Cancer pain management and the JCAHO’s pain standards:
An institutional challenge. J Pain Symptom Manage 2003;25:519‑27.
4. de Rond ME, de Wit R, van Dam FS, van Campen BT, den Hartog YM,
Klievink RM. A pain monitoring program for nurses: Effects on
nurses’ pain knowledge and attitude. J Pain Symptom Manage
5. Spross JA, McGuire DB, Schmitt RM. Oncology Nursing Society
position paper on cancer pain. Oncol Nurs Forum 1990;17:825.
6. Ferrell BR, McCaffery M. Nurses’ knowledge about equianalgesia
and opioid dosing. Cancer Nurs 1997;20:201‑12.
7. Plaisance L, Logan C. Nursing students’ knowledge and attitudes
regarding pain. Pain Manag Nurs 2006;7:167‑75.
8. Max MB. Improving outcomes of analgesic treatment: Is education
enough? Ann Intern Med 1990;113:885‑9
9. Howell D, Butler L, Vincent L, Watt‑Watson J, Stearns N. Influencing
nurses’ knowledge, attitudes, and practice in cancer pain
management. Cancer Nurs 2000;23:55‑63.
10. McMillan SC, Tittle M, Hagan S, Laughlin J, Tabler RE. Knowledge
and attitudes of nurses in veterans hospitals about pain management
in patients with cancer. Oncol Nurs Forum 2000;27:1415‑23.
11. Tafas CA, Patiraki E, McDonald DD, Lemonidou C. Testing an
instrument measuring Greek nurses’ knowledge and attitudes
regarding pain. Cancer Nurs 2002;25:8‑14.
12. Bernardi M, Catania G, Tridello G. Knowledge and attitudes about
cancer pain management: A national survey of Italian hospice
nurses. Cancer Nurs 2007;30: E20‑6.
13. Bernardi M, Catania G, Lambert A, Tridello G, Luzzani M. Knowledge
and attitudes about cancer pain management: A national survey of
Italian oncology nurses. Eur J Oncol Nurs 2007;11:272‑9.
14. Brown ST, Bowman JM, Eason FR. Assessment of nurses’ attitudes
and knowledge regarding pain management. J Contin Educ Nurs
15. Pederson C, Parran L. Bone marrow transplant nurses’ knowledge,
beliefs, and attitudes regarding pain management. Oncol Nurs
Forum 1997;24:1563‑71.
16. Ryan P, Vortherms R, Ward S. Cancer pain: Knowledge, attitudes
of pharmacologic management. J Gerontol Nurs 1994;20:7‑16.
17. Hollen CJ, Hollen CW, Stolte K. Hospice and hospital oncology unit
nurses: A comparative survey of knowledge and attitudes about
cancer pain. Oncol Nurs Forum 2000;27:1593‑9.
18. Clarke EB, French B, Bilodeau ML, Capasso VC, Edwards A,
Empoliti J. Pain management knowledge, attitudes and clinical
practice: The impact of nurses’ characteristics and education. J Pain
Symptom Manage 1996;11:18‑31.
19. Ferrell BR, Grant M, Ritchey KJ, Ropchan R, Rivera LM. The pain
resource nurse training program: A unique approach to pain
management. J Pain Symptom Manage 1993;8:549‑56.
20. Visentin M, Trentin L, de Marco R, Zanolin E. Knowledge and
attitudes of Italian medical staff towards the approach and treatment
of patients in pain. J Pain Symptom Manage 2001;22:925‑30.
21. Glanz K, Rimer BK, Lewis FM. Health Behavior and Health Education.
Theory, Research and Practice. San Fransisco: Wiley and Sons;
22. Yildirim YK, Cicek F, Uyar M. Knowledge and attitudes of Turkish
oncology nurses about cancer pain management. Pain Manag Nurs
23. Ger LP, Ho ST, Wang JJ. Physicians’ knowledge and attitudes
toward the use of analgesics for cancer pain management: A survey
of two medical centers in Taiwan. J Pain Symptom Manage
24. McCaffery M, Ferrell BR. Nurses’ knowledge of pain assessment
and management: How much progress have we made? J Pain
Symptom Manage 1997;14:175‑88.
25. McCaffery M, Ferrell B, O’Neil‑Page E, Lester M, Ferrell B.
Nurses’ knowledge of opioid analgesic drugs and psychological
dependence. Cancer Nurs 1990;13:21‑7.
26. Furstenberg CT, Ahles TA, Whedon MB, Pierce KL, Dolan M,
Roberts L, et al. Knowledge and attitudes of health‑care providers
toward cancer pain management: A comparison of physicians,
nurses, and pharmacists in the state of New Hampshire. J Pain
Symptom Manage 1998;15:335‑49.
27. Wells‑Federman C, Arnstein P, Caudill M. Nurse‑led pain
management program: Effect on self‑efficacy, pain intensity,
pain‑related disability, and depressive symptoms in chronic pain
patients. Pain Manag Nurs 2002;3:131‑40.
28. Mamishi N, Behroozishad F, Mohagheghi MA, Eftekhar Z, Shahabi Z.
The study of nurses’ knowledge and attitudes regarding cancer pain
management. HAYAT 2006;12:23‑32.
29. Randall‑David E, Wright J, Porterfield DS, Lesser G. Barriers to
cancer pain management: Home‑health and hospice nurses and
patients. Support Care Cancer 2003;11:660‑5.
30. Yates P, Baker D, Barrett L, Christie L, Dewar AM, Middleton R,
et al. Cancer nursing research in Queensland, Australia: Barriers,
priorities, and strategies for progress. Cancer Nurs 2002;
31. Joranson DE, Gilson AM. Regulatory barriers to pain management.
Semin Oncol Nurs 1998;14:158‑63.
32. Ferrell B, Virani R, Grant M, Vallerand A, McCaffery M. Analysis
of pain content in nursing textbooks. J Pain Symptom Manage
33. O’Brien S, Dalton JA, Konsler G, Carlson J. The knowledge and
attitudes of experience oncology nurses regarding the management
of cancer‑related pain. Oncol Nurs Forum 1996;23:515‑21.
34. Ferrell BR, McGuire DB, Donovan MI. Knowledge and beliefs
regarding pain in a sample of nursing faculty. J Prof Nurs