Differences in cancer pain management between outpatient and inpatient settings: A cross-sectional survey of nursing practices in China

Background Effective cancer pain management is critical for patient quality of life but may vary significantly between inpatient and outpatient care settings. This study aimed to identify and compare pain assessment practices, patient behaviors, and treatment barriers across these environments. Methods A cross-sectional survey was conducted among 730 nursing professionals from 75 hospitals across China. Respondents completed structured questionnaires evaluating pain assessment frequency, methods, treatment responses, and perceived barriers in both inpatient and outpatient settings. Comparative analyses were performed using chi-square tests or Fisher’s exact test. Multivariable adjusted logistic regression models were used to explore the associations. Results Pain assessment was performed more frequently in inpatient settings (79.3%) than outpatient settings (57.6%) (difference, 21.8%; 95% CI, 4.6–38.9%; P < 0.01). Alignment with patients’ self-assessments did not differ significantly (71.9% inpatient vs. 63.6% outpatient; P > 0.05). Patients in inpatient care more often reported pain proactively (60.0% vs. 24.2%; difference, 35.7%; 95% CI: 20.7–50.8%; P < 0.01). Major outpatient barriers included difficulty in patient pain description (90.9% vs. 20.9%; difference, 70%; 95% CI, 59.7–80.2%; P < 0.01), while inpatient settings were affected by provider inattention to pain (82.4% vs. 21.2%; difference, 61.1%; 95% CI, 46.9–75.4%; P < 0.01). The proportion of patients receiving treatment after pain assessment was similar (74.9% inpatient vs. 66.7% outpatient; P > 0.05). However, outpatient nurses reported greater reluctance to prescribe opioids (24.2% vs. 7.0%; difference, 17.2%; 95% CI, 2.5–32.0%; P < 0.01), and outpatient settings saw a higher incidence of ineffective analgesia (33.3% vs. 18.8%; difference, 14.5%; 95% CI, -1.8–30.9%; P < 0.05). Conclusion The exploratory cross-sectional survey suggests that cancer pain managements between outpatient and inpatient settings appear to be different, particularly in assessment frequency, patient communication, and opioid prescribing practices. Targeted, setting-specific interventions may be beneficial to optimize pain control and improve patient outcomes in both environments.