{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T04:23:28Z","timestamp":1793334208956,"version":"4.5.0"},"reference-count":63,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,21]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To identify and explain the challenges of effective pain management in patients with cancer in Iran.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A convergent mixed-methods study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Oncology departments and palliative care units across multiple healthcare institutions in Iran.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Quantitative phase: 320 healthcare providers, including anaesthesiologists, general practitioners, oncologists, nurses and pharmacists, selected via convenience sampling. Qualitative phase: 10 stakeholders, including patients, caregivers, policy makers and clinicians.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Quantitative data were collected using a psychometrically validated 23-item questionnaire assessing knowledge, attitudes and perceived barriers to cancer pain management. Qualitative data were obtained through semistructured interviews and analysed using Graneheim and Lundman\u2019s content analysis method with MaxQDA software. Integration was performed using a side-by-side approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Quantitative data showed that over 65% of providers did not routinely assess pain, and only 29.1% believed pharmacological treatments were effective. Qualitative analysis identified 13 barriers across three domains\u2014professional, patient and organisational\u2014spanning physical, psychological, social and spiritual dimensions. Integrated findings revealed consistent patterns of underassessment, legal and cultural resistance and lack of interdisciplinary collaboration. These converging challenges highlight the need for holistic, system-level reform.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The convergence of quantitative and qualitative data reveals a multilayered system of barriers, professional, patient-related and organisational\u2014rooted in physical, psychological, social and spiritual dimensions. These interlinked challenges contribute to fragmented pain management and limited interdisciplinary coordination. Addressing them requires a holistic reform strategy that integrates structural, cultural and clinical solutions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-104263","type":"journal-article","created":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T05:00:18Z","timestamp":1764478818000},"page":"e104263","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Pain management and its challenges in Iranian cancer patients: a mixed-method study"],"prefix":"10.1136","volume":"15","author":[{"given":"Maryam","family":"Esmaeili","sequence":"first","affiliation":[{"name":"Department of Intensive Care and Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Rassouli","sequence":"additional","affiliation":[{"name":"Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran"},{"name":"School of Nursing, College of Health Sciences, University of Nizwa, Nizwa, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Karami","sequence":"additional","affiliation":[{"name":"Department of Medical Surgical Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samira","family":"Beiranvand","sequence":"additional","affiliation":[{"name":"Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh","family":"Hajibabaee","sequence":"additional","affiliation":[{"name":"Department of Intensive Care and Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9369-5854","authenticated-orcid":false,"given":"Hadis","family":"Ashrafizadeh","sequence":"additional","affiliation":[{"name":"School of Nursing, Student Research Committee, Dezful University of Medical Sciences, Dezful, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,29]]},"reference":[{"key":"2025112921001114000_15.11.e104263.1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.33587"},{"key":"2025112921001114000_15.11.e104263.2","unstructured":"Boyle P , Levin B . 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