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Knowledge, attitude, and practice regarding cancer pain management in Southwest China: a two-center cross-sectional
Xuexing Wang1, Youxian Dou2, Junyu Liu2
1Department of Oncology, Anning First People's Hospital Affiliated to Kunming University of Science and Technology, Anning, China.
Background:
Cancer pain management depends partly on patients' knowledge, attitudes, and practices (KAP), but evidence from Southwest China remains limited. This study assessed cancer pain-related KAP, identified factors associated with Practice, and explored whether Attitude statistically accounted for the association between Knowledge and Practice.
Methods:
A two-center cross-sectional study was conducted among 523 patients with cancer-related pain at two tertiary hospitals in Southwest China. Data were collected using a self-developed KAP questionnaire, and domain scores were standardized to a 0-100 scale. Preliminary psychometric properties were assessed using internal consistency, item-level analyses, and confirmatory factor analysis. Factors associated with Practice were examined using multivariable linear regression. Exploratory indirect-effect analyses were performed using the PROCESS macro.
Results:
The mean standardized scores were 61.3 ± 32.6 for Knowledge, 62.0 ± 21.1 for Attitude, and 53.3 ± 28.9 for Practice; 51.6% of participants had poor Practice scores. Higher Knowledge score and peri-urban or urban residence were associated with higher Practice scores, whereas greater current pain intensity, age ≥60 years, and female sex were associated with lower Practice scores. Stage IV disease was positively associated with Practice after adjustment and remained generally consistent in the education-adjusted sensitivity model, although unadjusted analyses showed the opposite direction. Neither unadjusted nor covariate-adjusted exploratory indirect-effect analysis supported a statistically significant indirect association through Attitude.
Conclusion:
Among tertiary-hospital patients with cancer pain in Southwest China, Practice was comparatively lower than Knowledge and Attitude. Improving cancer pain-management practice may require attention to knowledge-to-action translation, symptom burden, and care-context factors rather than knowledge or attitudes alone. Future prospective, multicenter, and community-based studies are needed to validate the questionnaire and clarify temporal relationships among KAP domains.