Validation of the Barriers and Facilitators of Chronic Cancer Pain Self-Management Instrument

Cancer pain significantly affects patients' quality of life, yet facilitators and barriers to patient pain self-management remain poorly understood. This study aimed to quantitatively validate and test the Barriers and Facilitators of Chronic Cancer Pain Self-Management (BFCCPSM) instrument, which identifies barriers and facilitators of chronic pain self-management among people with cancer using Creswell and Clark typology.

Through a quantitative approach, this study evaluated the BFCCPSM instrument, the first tool to assess both facilitators and barriers facing patients in home settings.

The study sample comprised 200 patients who were recruited using online platforms and from an oncology center. Nine factors (51 items) were identified through principal component analysis and showed acceptable construct validity and internal consistency (65.8% of the variance explained and Cronbach's α = 0.70-0.88, respectively). The tool was composed of two main constructs: barriers (patient-health care provider relationship, fear of side effects, addiction concerns, negative beliefs, psychological stressors, discrimination, transportation) and facilitators (family, friends, and social support and self-efficacy and active role).

Significant differences were observed between groups (i.e., age, marital status, and race), which supported the criterion validity of the instrument. Noteworthy is that transportation and discrimination were reported as novel barriers, whereas social support and self-efficacy were the main facilitators.

Despite the study limitations represented by the length of the survey and the included sample size, the BFCCPSM contributes to filling a gap in the field, as it addresses factors previously unmet in the self-management of chronic cancer pain, providing a basis for person-centered interventions and health equity. Future studies should validate the instrument with other populations and refine its factors.

Identifying barriers and facilitators to chronic cancer pain self-management can inform targeted strategies to improve health equity and reduce bias in care. Use of the BFCCPSM instrument within quality improvement initiatives may support organizational and provider-level interventions, including addressing transportation barriers and enhancing key facilitators such as social support and self-efficacy, across patient, provider, and health system levels.