Authors: Cuixia Yan BPh, Cho Lee Wong, Celeste LY Ewig, Jingqi Zhang MS, Haiying Huang BN, Feng-Gui Wei, Chi-kong Li, Hui Zhang, Yin Ting Cheung.
Background: The provision of supportive care is increasingly a priority of quality care in pediatric oncology settings. In China, the quality of supportive care services may vary among regions because of differences in social and health indicators.
Objectives: To evaluate Chinese pediatric oncology practitioners’ pain management practices, and identify barriers to optimal pain control in children with cancer undergoing invasive procedures in China.
Methods: Oncology practitioners were recruited from pediatric cancer centers and professional groups in Hong Kong and mainland China through convenience sampling. Respondents completed a paper-based or electronic structured questionnaire. Chi-square test was conducted to compare practitioners’ responses across geographical regions of their practices.
Results: The sample (n=304) consisted of pediatric oncologist/hematologists (n=149, 49%) and allied health professional (n=155, 51%), who practiced in the South China region (n=189, 62%) and North China/other regions (n=115, 38%). As compared to practitioners from the South China region, practitioners from the North/other regions were less likely to administer procedural sedation during lumbar puncture (78% vs 48%; P<0.0001) and bone marrow aspiration (72% vs 46%; P=0.0012). Regardless of region, practitioners identified the lack of formal training (72%) and dedicated staff (77%), and restricted access to sedative drugs (70%), as major barriers to adopting procedural sedation. Physicians who practiced in South China were more likely than those in North China/ other regions to report the use of opioids for moderate-to-severe pain, such as morphine (70% vs 49%; P=0.013) which is the recommended first-line strong opioid for persistent pain in children. Practitioners indicated parents’ concerns with opioid addiction (73%), safety (76%) and stigma (63%). Practitioners also reported inadequate knowledge in dosing opioids (48%) and side effects management (48%). Overall, 37% of practitioners perceived that even with existing measures, children still experienced severe pain (pain score of 5-10) during procedures.
Conclusion: Our results suggest the relative inadequacy of procedural control in certain regions of China. We have identified potential institutional barriers and gaps in physicians’ knowledge and education about the use of procedural sedation and strong analgesics. There is an urging need to empower oncology practitioners and review policies to facilitate implementation of procedural sedation for children in China.
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