Oncology Nurses' Knowledge, Attitudes, and Factors in Cancer Pain – A Systematic Review

Krishna Prasanth Baalann1, Danti Joseph2, Ashni Bhandari3, Pallavi Kulkarni4*, Gaurav Agarwal5, Shilpi Agarwal6

1Department of Community Medicine, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu 600044, India; Bharath Institute of Higher Education and Research, Chromepet, Chennai- 600 073, Tamil Nadu, India

2Department of Physiology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu 600044, India

3Epidemiologist and Biostatistician, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu 600044, India

4Department of Pharmacology, KLE's Jagadguru Gangadhar Mahaswamigalu Moorsavirmath Medical College, Hubballi. KLE Academy of Higher Education and Research, Belagavi - 590010, Karnataka, India

5Department of Pharmacy, Panipat Institute of Engineering and Technology, Panipat, Haryana 132102, India

6Panipat Institute of Engineering and Technology, Panipat, Haryana 132102, India

*Corresponding Author’s Email: pallavik3085@gmail.com

ABSTRACT

Background: This systematic study thoroughly examines the detailed knowledge, attitudes, and complex aspects influencing oncology nurses' cancer pain treatment. This study aims to investigate the challenges and potential avenues confronted by oncology nurses specializing in cancer pain treatment; a thorough exploration of diverse scholarly resources was undertaken. Methods: The inquiry encompassed an exhaustive literature review from prominent databases, including Web of Science, SCI, Scopus, Science Direct, and ProQuest. Employing an ethical and systematic methodology, a comprehensive examination was conducted into a broad spectrum of studies encompassing the understanding, attitudes, and variables related to addressing pain in cancer patients among oncology nurses. Results: The evaluation focused on improving oncology nurses' knowledge and attitudes towards cancer pain management. Nurses' knowledge levels were assessed, revealing a wide range from 5.13% to 84%. Doctors demonstrated superior knowledge and attitudes compared to nurses. Nurses showed a mean score of 20.08 out of 39 (51.5%) in pain management, while doctors scored 24.3 out of 39 (62.3%). The study emphasizes the need for tailored educational interventions to address knowledge gaps and improve cancer pain management practices among nurses. Conclusion: This systematic analysis underscores the need for accurate cancer pain treatments, highlighting gaps in oncology nurses' knowledge and the need for tailored educational programs.

Keywords: Assessment Tools; Attitudes; Clinical Recommendations; Competency Evaluations; Cultural Influences; Knowledge; Oncology; Pain Management; Systematic Review

INTRODUCTION

Effective pain management for cancer patients is a critical aspect of oncology nursing care. It requires a thorough awareness of the information, attitudes, and many other elements that influence clinical practices. This systematic analysis delves into the intricate landscape of oncology nurses' involvement in managing cancer pain. The study explores the challenges and benefits of this specific field by delving into various literature sources. The final objective is to provide specific therapeutic suggestions and improve the skills and expertise of oncology nurses. Pain, acknowledged as the fifth vital indicator in cancer patients, is a substantial, resource-intensive, and distressing experience that underlies cancer pathology. This factor shapes its impact on the overall well-being of individuals coping with cancer (Keene et al., 2023). Managing cancer pain remains a formidable challenge in cancer therapy for individuals (Al Qadire et al., 2023). Effective cancer pain management is a pivotal facet of patient care that holds significance across all types and stages of cancer (Modderkolk et al., 2023).

Considering the vital role of nurses as integral members of the healthcare team, their knowledge, attitudes, and skills are indispensable for adeptly handling cancer pain (Gudhoor, Ganachari & Salimath, 2023). Considering the significant impact these symptoms have on the quality of life of cancer patients, it is essential to delve into the complexities of Cancer Pain Management (CPM) and the crucial role that nurses play in this area. A comprehensive examination is necessary to grasp the intricate interplay between psychological, biological, and societal factors contributing to the onset and progression of cancer pain (Xie et al., 2023). This investigation is especially crucial in the context of improving medical procedures that prolong the lives of patients in the late stages of cancer, which adds complexity to the range of pain they feel (McCabe et al., 2023). When it comes to managing cancer pain, it becomes clear that nurses play a crucial role due to their direct engagement in patient care (Uzunkaya Oztoprak & Terzioglu, 2024). Their duty comprises the technical parts of pain evaluation, drug delivery, and the intricate skill of empathetic communication and patient education (Phothikul & Seven, 2023). As primary healthcare professionals, nurses act as caretakers for pain management, guaranteeing that treatment approaches are tailored to each patient's distinct requirements and choices (Jimenez et al., 2023). This systematic study aims to clarify the complexities of the information base, attitudes, and variables that influence oncology nurses' important role in CPM. The subsequent sections outline the methodology, present significant results, engage in a detailed debate, and draw conclusions that enhance our understanding of cancer pain treatment, offering crucial insights for both research and clinical practice. In the following parts, the chosen study techniques that have been published will present the findings and finish with their valuable insights relevant to the study and clinical applications in the treatment of cancer pain. The Edmonton Classification System for Cancer Pain (ECS-CP) is a tool developed to identify complex pain syndromes in cancer patients (Sánchez Ortega, 2024).

METHODOLOGY

Eligibility Criteria

The selected studies encompass diverse methodologies, including cross-sectional analysis, descriptive questionnaire surveys, nationwide surveys, and quantitative investigations (Yee etal., 2023). Each study endeavors to evaluate the knowledge and attitudes of oncology nurses regarding managing cancer pain (Shih et al., 2023). Across all investigations, the inclusion criteria consistently focused on registered nurses actively engaged in oncology units, ensuring a targeted assessment of individuals directly involved in delivering care to cancer patients (Rassouli et al., 2015). The participants' age bracket spans from 21 to 65 years, reflecting the broad age spectrum observed among professionals in the oncology nursing field, representing the wide variety of ages seen in oncology nursing (Liu et al., 2023). The inclusion requirements included the desire to participate, a minimum required work experience (varying from three to six months), and possession of applicable credentials, such as nursing practice certifications issued by a competent body (Maskor et al.,2021). The search tactics used in these investigations are distinguished by a systematic strategy, which includes formulating study inquiries, identifying relevant keywords, using electronic databases, and implementing a systematic screening procedure (Dreismann et al., 2023).

The meticulous adherence to methodological standards highlights the dedication to promoting inclusiveness and thoroughly examining the available material. The gender distribution of participants in the study exhibited variability, with stated percentages ranging from mostly female to a combination of male and female individuals. This acknowledgment recognizes and encompasses the variety of genders in the field of cancer nursing, which in turn enhances the understanding of study results by considering subtler and more detailed factors. The qualifying criteria combined lead to a rich and varied dataset, enabling a comprehensive examination of oncology nurses' knowledge and perspectives regarding managing cancer pain. This method guarantees the inclusion of diverse viewpoints from various geographical locations and demographic groups, strengthening the results' reliability and relevance. The methodological approach employed for this systematic review strictly adheres to the principles outlined in the Cochrane Handbook for Systematic Reviews, and the documentation aligns with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses tool (Liu, 2023). The outcome data were retrieved from the information supplied in the individual studies, and each study included in the analysis had a minimum sample size of 20 patients . The studied population consisted of nurses in inpatient units specializing in cancer (Altarawneh et al., 2023). The current study focused on thoroughly examining the areas of knowledge, attitudes, relevant variables, and suggestions for improvement among inpatient nurses working in cancer settings.

Search Strategy

The search strategy employed in this extensive examination followed a systematic approach to identify pertinent literature and evaluate the perspectives and viewpoints of oncology nurses regarding cancer pain management. A comprehensive exploration was conducted on electronic databases, including PubMed, CINAHL, Cochrane Library, Proquest, and Scopus. The search terms were thoughtfully constructed, encompassing a combination of keywords and medical subject headings (MeSH) directly related to the study (Ma et al., 2023). The keywords incorporated in the investigation were "management of cancer pain," "nurses specializing in oncology," "knowledge," "attitudes," "assessment of pain," and "healthcare professionals." The emphasis was placed on publications in the English language, covering the timeframe from 2000 to 2018 for contemporary relevance. The inclusion criteria prioritized studies examining oncology nurses across diverse global locations, including Turkey, Iran, Ethiopia, China, Norway, Korea, Jordan, Nigeria, and Saudi Arabia. The search methodology also targeted studies utilizing various approaches, such as cross-sectional studies, surveys, and questionnaire-based surveys. The exhaustive search methodology aimed to capture a diverse range of studies, presenting varied perspectives on the knowledge and attitudes of oncology nurses in different cultural and professional settings. The process of selecting relevant publications involved meticulous screening, data extraction, and analysis to ensure crucial findings for the subsequent sections of this comprehensive assessment. To ensure a comprehensive overview of relevant studies PROSPERO database was referred for information on ongoing or recently completed systematic reviews, particularly on the medical subject (Buchanan et al., 2020).

Study Selection and Data Extraction

Following the designated study procedure and entry requirements, two persons thoroughly examined titles and abstracts, eliminated duplicate studies, and carefully evaluated the full texts to extract the necessary information. Collaborative decision-making resolved differences among the studies in selecting the final included papers, ensuring agreement in the best interest of the review's objective. When there was a shortage of necessary information, the authors of the relevant papers were directly approached. During the data extraction process, a variety of factors were considered, including the primary author, the nation of origin, the participation rate, the publication year, the sample size, the ultimate sample size, the target demographic, participant age, participant gender, the sampling strategy, and the data collection methodologies. The evaluation included many elements about the potential for bias and the measures used to evaluate outcomes. These elements included the study's goals, the tools and methods used, the metrics used to assess knowledge and attitudes, variables relevant to the study, impediments encountered throughout the study, and suggestions for enhancing future studies. The rigorous methodology used for data extraction guarantees the reliability and thoroughness of the material obtained from the study featured.

Evaluation of Quality

This evaluation tool is comprised of ten specific criteria that appraise the study quality by focusing on two primary aspects: external validity, which encompasses the evaluation of factors like the sampling frame, target population, sampling methodology, and minimal nonresponse bias, and internal validity, which entails the scrutiny of the data collection method, study instrument, case definition, and mode of data collection. This evaluation tool provides a structured and thorough approach to assessing the quality of a study, considering both external and internal validity as critical components in ensuring the reliability and credibility of research findings.

Outcomes Selection of Studies

A thorough analysis of the existing academic literature was conducted, in which a collection of 852 papers was originally located via careful database searches. After removing unnecessary entries, a carefully selected group of 685 papers received a thorough examination based on their titles and abstracts. Following that, an assessment for qualification was carried out on 85 papers by thoroughly examining all their texts. Seventy-five full-text articles were excluded for various reasons, such as not being relevant to the target population (35), being literature or narrative reviews (15), being letters to the editor (8), not having complete textual content (4), being in a language other than English (6) and lacking methodological rigor and quality (7).

As a result, a carefully chosen to set of 10 studies was identified as the body of evidence for the subsequent systematic review (Fig. 1).

Figure 1: The Procedure for Choosing Studies for a Systematic Review is Shown in the PRISMA Flow Diagram

Characteristics of the Study

Table 1 provides a thorough summary of 10 separate studies examining the understanding, attitudes, and variables that impact the treatment of cancer pain among nurses in oncology departments. The design, precise objectives, study locations, targeted age groups, eligibility requirements, and noteworthy characteristics of the applied search approach distinguish each study. The study by Yildirim, Cicek and Uyar (2008) and colleagues employed a cross- sectional approach to assess the insights and perceptions of Turkish oncology nurses in three hospitals. The participants in the study were between the ages of 21 and 50. The study by Bernardi et al., (2007) was a descriptive survey at four cancer hospitals in Korea. The study focused on registered nurses who had a minimum of six months of practical experience in oncology, aged 21 to 59. Moreover, employing a range of study methodologies, such as cross- sectional, exploratory, and web-based surveys, the subsequent studies have investigated the understanding and perspectives of oncology nurses in different international contexts, encompassing Iran, Ethiopia, China, Norway, Korea, Jordan, Nigeria, and Saudi Arabia. The studies included various ages, genders, and criteria for selecting participants. This reflects a comprehensive collection of study efforts focused on managing cancer pain in the specialist field of oncology nursing (Table 1).

Table 1: Summary of Included Studies Assessing Oncology Nurses' Understanding, Perspectives, and Influencing Factors in Cancer Pain Management

Nurses' Understanding and Disposition Towards CPM

Significant variations emerge when examining nurses' perspectives on cancer pain management across diverse cultural and professional contexts. In the investigation led by Yildirim (Yildirim, Cicek & Uyar, 2008), focusing on Turkish oncology nurses, the mean score for correctly answering pain-related questions was deemed inadequate, registering at 35.41%. Despite this, nurses expressed positive attitudes toward pain management, albeit with lingering misconceptions. Factors such as age, nursing education level, and years of experience were identified as influencing comprehension of pain management. According to Bernardi et al., (2007), Korean oncology nurses had a moderate level of knowledge, with an average of 21.4 correctly answering pain-related questions (SD = 5.5). The study highlighted that prior educational background and the extent of emphasis on pain management in undergraduate nursing curricula played crucial roles in acquiring and applying pain management knowledge. Admass et al., (2020) found that oncology nurses' knowledge and attitude towards cancer pain treatment were inadequate, with only 31.44% demonstrating a satisfactory level of understanding. Significant correlations were noted between nurses' educational attainment and knowledge and attitude. The study by Yu et al., (2021) indicated an insufficient understanding of cancer pain treatment. Higher education levels are positively correlated with knowledge, despite reporting favourable attitudes. Additionally, the study revealed that more years of experience in cancer nursing were associated with a higher level of understanding. The investigation by Elumelu et al., (2014) disclosed that nurses at Nigerian tertiary health institutions demonstrated insufficient overall knowledge, with only 18% having undergone formal training in cancer pain management. Contributing factors included a lack of structured education, unfamiliarity with opioid administration practices, and an inadequate grasp of pain evaluation and treatment methods. These findings underscore the need for targeted educational interventions and training programs to enhance nurses' knowledge and attitudes regarding cancer pain management. It is crucial to acknowledge the contextual elements influencing these aspects across diverse healthcare settings (Table 2).

Table 2: Diverse Perspectives from Various Studies Regarding Nurses' Attitudes and Understanding of the Management of Cancer Pain

Factors and obstacles associated with the understanding of CPM:

The study thoroughly reviews the complex topic of cancer pain management, highlighting different clinical recommendations, therapies, and challenges that significantly affect oncologist nurses' expertise base. The first two studies argued for the implementation of ongoing education, essential principles, and cross-disciplinary cooperation. These ideals align with the main objective of promoting a vibrant and knowledgeable healthcare staff. The highlighted limitations, such as the absence of standardized tools and cultural obstacles, emphasize the need to develop cultural competency and implement globally applicable tools. This finding emphasizes the necessity for enhancing pain assessment and treatment practices, indicating a commitment to ongoing self-evaluation and quality improvement. The study conducted by Shahriary et al., (2015) from Iran offers a score range that represents positive attitudes, highlighting the importance of having a positive mentality in the quest for knowledge. In a study conducted in Ethiopia, Admass et al., (2020) highlight the association between education levels and knowledge among Ethiopian oncology nurses. This challenges existing beliefs and emphasizes the importance of education in changing attitudes. The survey reveals that a mere 7.2% of nurses demonstrated satisfactory knowledge and attitudes, highlighting the pressing need for focused interventions to address the existing knowledge deficit. Yu et al.,'s (2021) study underscores the significance of precision and competence in pain treatment procedures, particularly in terms of accuracy levels. This study establishes a standard for the desirable degree of expertise in this field. The study conducted by Utne, Smastuen and Nyblin (2019) from Norway proposes a complete method that supports the implementation of required education, frequent evaluation, and interdisciplinary teamwork. This approach aligns with the principles of holistic care and ongoing professional growth. The study conducted by Darawad et al., (2019) in Jordan distinguishes between doctors and nurses, revealing possible deficiencies in knowledge and highlighting the need for fair and extensive education across many healthcare fields. The Nigeria study by Elumelu et al., (2014) and her colleagues demonstrates a dedication to comprehending and tackling obstacles unique to the Nigerian setting. The study emphasizes the importance of treatments designed to suit the local environment. The study conducted by Alqahtani and Jones (2015) in Saudi Arabia identifies several obstacles to acquiring information and emphasizes the need for creative and study- supported educational approaches. These studies highlight the need for ongoing education, collaborating across different fields, understanding other cultures, and maintaining a positive attitude while dealing with the complex issues of managing cancer pain. The authors support the adoption of individualized treatments that take regional variations into account and stress the importance of gaining knowledge in shaping the viewpoints and understanding of cancer nurses (Table 3).

Enhancing the Knowledge and Attitude of Nurses Regarding CPM: Clinical Recommendations

The third list is a compilation of medical recommendations to improve nurses' attitudes and understanding of cancer-related pain management. This compilation of clinical recommendations aims to enhance nurses' understanding and perspectives regarding CPM. The recommended solutions embody the values the healthcare community holds, emphasizing the significance of ongoing education, multidisciplinary cooperation, and the incorporation of technological breakthroughs. The first set of suggestions, which includes Turkey, Korea, Iran, Ethiopia, and China, emphasizes the need for continuous education and training, well-defined guidelines, multidisciplinary cooperation, and the effective use of technology. Interventions that align with this include customized strategies, peer assistance, mentor guidance, and simulation learning. The limitations identified include the absence of standardized pain assessment instruments, cultural and language obstacles, and attitudinal impediments. The "Attitude" reports, which demonstrate a mean precision in responses at 35.41% and positively correlate with the duration of oncologist nursing experience, highlight concerns about the nursing staff's limited understanding and perspectives on cancer pain management. The second set of suggestions in the study conducted in Norway, Korea, Jordan, Nigeria, and Saudi Arabia emphasizes the need for ongoing education and training programs, multidisciplinary teamwork, and adherence to clinical standards. Interventions include several methods, such as seminars, online courses, simulation training, and the use of technology. Barriers include organizational concerns, individual beliefs, linguistic obstacles, and cultural difficulties. A distinct "attitude" in the Korean setting suggests oncology nurses reasonably understand pain (68.5%). Still, they need to enhance their skills in pain evaluation and treatment.

The study conducted by Yu et al., (2021) in China highlights educational and quality enhancement efforts in pain treatment, specifically targeting the issue of inadequate pain management training. The "Attitude" component incorporates a scoring mechanism (26% scoring) that assigns higher scores to indicate more favourable attitudes. It promotes consistent training in cancer pain treatment, revising the curriculum, adhering to national criteria, and engaging in conferences and workshops. Notwithstanding these suggestions, the "attitude" demonstrates a general lack of knowledge and a negative attitude among Ethiopian oncology nurses. The education degree is considerable, but no notable difference depends on prior training or work experience. The stated number indicates that a mere 7.2% of oncology nurses exhibited commendable knowledge and attitude, serving as a distinct quantitative outcome. The sixth set of suggestions consists of continuing education programs that specifically emphasize the fundamental concepts of pain management. Interventions include continuing educational initiatives and using the KASRP for assessment. Obstacles include insufficient knowledge and training, limited resource access, and misunderstandings. The "Attitude" survey reveals that the average precision of oncology nurses in managing cancer pain is 63.5%, below the acceptable accuracy level. The study by Utne, Smastuen, and Nyblin (2019) proposes the implementation of compulsory education, specialized training, curriculum integration, frequent evaluation, cooperation across different disciplines, and ongoing improvement. Interventions include instructional initiatives, simulation training, discussions involving many disciplines, consistent feedback, and following pain management recommendations. Barriers include limited education, unfavourable attitudes, limited time availability, communication difficulties, and insufficient resources, with the omission of the specific barrier of "attitude." The topic encompasses pain evaluation, drug and non-drug approaches to pain relief, and individuals' perspectives on pain control. However, there is no documented information on the precise impediments, and the "attitude" in question is poorly defined.

According to Darawad et al., (2019), including evidence-based recommendations, providing ongoing education, and using pain assessment instruments to enhance understanding are recommended. Both nurses and physicians demonstrated sufficient understanding and perspectives regarding the management of cancer-induced pain. Physicians had much superior knowledge and more favourable views than nurses, achieving 62.3% and 51.5%, respectively. The Nigeria study by Elumelu et al., (2014) suggests strategies such as ongoing education, multidisciplinary training, mentoring, resource accessibility, and skills evaluations. Interventions include a range of techniques, including the use of medications, non-medication approaches, collaboration among different healthcare disciplines, patient education, and palliative care. The hurdles have not been documented, and the "attitude" assessment mostly focuses on evaluating the levels of knowledge at a Nigerian tertiary health institution. The study in Saudi Arabia by Alqahtani and Jones (2015) suggests using modern educational interventions to enhance nurses' attitudes and understanding of pain treatment. Interventions in Saudi Arabian hospitals consist of formulating and executing plans supported by evidence. Obstacles include inadequate general knowledge and limited engagement in studies or appropriate courses. Nevertheless, the "attitude" is not well defined. These recommendations demonstrate the dedication to ongoing education, teamwork, and patient-focused treatment in oncology nursing. They also recognize and tackle healthcare providers' difficulties managing cancer pain (Table 3).

Table 3: Clinical Recommendations, Interventions, Barriers of Knowledge, and Overlap Attitude in Studies on Cancer Pain Management Among Nurses

DISCUSSION

Many important factors that contribute to the Understanding, Attitudes, and Actions (KAP) conversation are identified by selected studies. The identified gaps in knowledge levels, as evidenced by various study endeavours, underscore a substantial deficiency in the fundamental understanding of managing cancer pain within the oncology nursing community (Bouya et al., 2019). Addressing this knowledge gap becomes paramount in evaluating their ability to deliver effective pain treatment. Despite generally positive attitudes among oncology nurses toward pain management, the presence of recurrent misunderstandings emphasizes the necessity for targeted interventions. Examining selected studies highlights key elements of attitudes, recognizing their generally favourable orientation while also pinpointing areas requiring corrective actions. Investigating the effects of demographic and professional parameters, such as nursing education level, age, and years of experience, offers valuable insights into the factors influencing the proficiency levels among oncology nurses in managing pain in cancer patients (El-Rahman, Al kaladeh & Muhbes, 2013). the study utilized by Yildirim, Cicek & Uyar (2008) the minimum mean score for accurately answered pain-related questions to indicate overall knowledge, revealing an average correct response rate of 35.41%. The average number of accurately answered questions was documented as 13.81±5.02 out of 39, highlighting the challenges and lack of understanding among surveyed Turkish oncology nurses regarding cancer pain treatment. Conversely, Darawad et al., (2019) study disclosed the highest average score with doctors demonstrating greater knowledge and attitudes, achieving an average score of 24.3 out of 39 (62.3%). In contrast, nurses obtained a slightly lower average score of 20.08 out of 39 (51.5%). The score disparity underscores differences in comprehension and perspectives on managing cancer pain between doctors and nurses. The study delved into nurses’ favourable stance on managing cancer pain, revealing a minimum average score of 7.2% and a maximum average of 68.5%. The results underscore notable variations in nurses’ perspectives across different study studies, emphasizing the necessity for targeted interventions and training initiatives to enhance their understanding and approach to cancer-related pain relief. The discussion focused on the strategies for establishing a work environment that promotes support, including the implementation of specific educational initiatives. Structured educational programs specifically designed to target and fill the identified gaps in knowledge while promoting a culture of ongoing learning are of utmost importance for successfully treating cancer pain (Kan et al.,2020). In the realm of cancer pain management, persistent training initiatives are indispensable for sustaining and augmenting the proficiency of oncology nurses in this specialized domain. The findings of the chosen study emphasized the significance of customizing treatments to unique healthcare settings, taking into account the cultural and contextual variables (Viale & Schwartz, 2004). Comprehending and dealing with these discrepancies enhance the efficacy of suggested tactics. The ideas and guidelines function as a roadmap for enhancing the overall expertise of oncology nurses in this specific field (Evans et al., 2020). The paper presents a thorough framework for comprehending the difficulties and possibilities in cancer nursing practices associated with CPM. The presence of deficiencies in knowledge levels among oncology nurses is consistently seen across many studies.

The average results indicate a need for more expertise and emphasize the immediate need for focused interventions. Although there is a general acceptance of favourable attitudes towards pain treatment, the presence of persisting misunderstandings poses a significant obstacle that must be addressed by targeted remedial actions. The analysis of demographic and professional aspects, as outlined in the findings, confirms their substantial impact on levels of knowledge, underscoring the need for customized educational approaches. The debate emphasized the significance of educational initiatives. Implementing customized programs that consider demographic and professional criteria is a feasible option to overcome the knowledge gaps among oncology nurses (Dias dos Passos & Palucci Marziale, 2020). Ongoing educational interventions are necessary for maintaining and improving competency, and continuous training efforts support this requirement. The ever-changing nature of managing pain in cancer patients is well-suited for well-organized programs that can adapt to changing best practices. The disparities in knowledge levels across diverse cultural settings underscore the need for treatments tailored to individual situations to maximize results. Artificial intelligence assists nurses in managing cancer pain by providing evidence-based analysis, proposing individualized treatment and therapy strategies, and optimizing the monitoring process. It improves evaluations, maximizes interventions, and aids in decision-making. While AI is beneficial, it enhances nurses’ knowledge and improves treatment. However, it only partially replaces nurses’ crucial function in patient-centric pain management (Table 4).

Table 4: Overall Summary of Key Points, Challenges, and Recommendations on Various Factors of KAP Discussed in the Selected Studies

CONCLUSION

This systematic analysis underscores the critical importance of treatments that prioritize precision. Oncology nurses play a pivotal role in managing cancer pain, yet research consistently indicates a lack of sufficient information and persistent misunderstandings in this particular area. The study thoroughly comprehends the problems and possibilities necessary for oncology nursing practices to treat cancer pain. Although nurses generally have good views towards pain treatment, there are clear gaps in knowledge across different demographic and professional groups. This highlights the immediate need for focused educational programs that address various needs and settings. Implementing programs that consider cultural sensitivity and the ability to adapt to developing best practices can lead to practical solutions. These initiatives seek to effectively tackle knowledge gaps and misunderstandings. Therefore, by providing oncology nurses with the necessary expertise and knowledge, we can establish a comprehensive framework that improves the management of cancer-related pain and improves the overall well-being of patients.

Conflict of Interest

The authors declare that they have no competing interests.

ACKNOWLEDGEMENT

The authors would like to thank management KLE’s Jagadguru Gangadhar Mahaswamigalu Moorsavirmath Medical College, Hubballi, India and KLE Academy of Higher Education and Research, India.

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