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Table 9 Summary of free-text survey responses related to managing cancer pain in Nepal

From: A survey of cancer care institutions in Nepal to inform design of a pain management mobile application

Theme

Exemplar Survey Responses

Access to Palliative Care Services

It would be better if palliative care services could be made accessible in rural areas of Nepal as well.

[There is] no expert team outside the [Kathmandu] valley, medicines (morphine and other narcotics) are not easily available outside the valley, no palliative care is provided outside the valley.

Cancer Pain is Common and Challenging

Cancer pain management is one of the challenging conditions for the palliative care worker.

70% of patients have some sort of pain. But most don’t speak about it, they only talk about it if asked.

In Nepal the cancer patient are more than other countries. Poor people cannot afford to be checked by a doctor. And then some people die due to lack of money and lack of knowledge and due to disease condition.

Training and Awareness of Palliative Care

Education regarding cancer and pain in cancer must be provided to all the specialties. Pain management is poor in our country not due to patients’ ignorance but lack of awareness among health care providers.

I’m working in palliative care center since 16 years but lot of Nepali people (health workers) have no knowledge about the service. Need quality training.

[Patients in pain] are unmanaged at home so must train lower level health worker for community service [in palliative care].

More education and knowledge for patient and caregiver about pain.

We need sensitizing course not only for nurses and doctors, but for all staff.

Nepalese people believe that cancer pain is untreatable. Most of the cancer patient with pain think that morphine causes addiction. So, I think there is need of more awareness regarding cancer pain management through various workshops and training programs in rural areas too.

Concerns Related to Opioids

In our palliative care unit patient come with severe pain to worse pain. Some patients worry to take morphine and refuse to take.

Morphine not easily available in every health sector and fentanyl also not available and more expensive.

Health care providers have knowledge but cannot apply in practice. Prescription pad/paper are not easily available.

In Nepal there is very low use of opioids analgesics like morphine due to fear of respiratory depression which is very less (only 1% of cases) so training to the doctors and nurses regarding this should be done.

Last few years, cancer pain management has improved in our country with the availability of access of drugs like morphine. As patient present most of the times in advance stage our focus to provide quality of life has improved with better pain management.