Patient knowledge, attitudes, and practices regarding postoperative patient-controlled analgesia: a cross-sectional study using structural equation modelling

Effective postoperative pain management is crucial for recovery, and Patient-Controlled Analgesia (PCA) provides an important self-administration method for pain relief. However, inadequate understanding can hinder its optimal use. Therefore, this study aimed to explore patients’ knowledge, attitudes, and practices (KAP) regarding postoperative PCA. A cross-sectional study was conducted among postoperative patients using a self-designed KAP questionnaire through a non-random, non-probability convenience sampling method at one hospital from September 12, 2023 to December 25, 2023. Structural Equation Modeling (SEM) analysis was conducted to examine the relationship between knowledge, attitude, and practice. The study enrolled 451 participants, averaging 48.76 ± 15.87 years in age, with 42.35% utilizing intravenous PCA. The knowledge, attitude, and practice scores were 9.10 ± 3.87 (out of 24), 19.02 ± 3.96 (out of 30), and 29.95 ± 7.24 (out of 50), respectively. SEM revealed a direct positive influence of knowledge on practice (β = 0.538, P = 0.012) and a direct negative influence of knowledge on attitude (β = -0.355, P = 0.009), with no significant direct effect of attitude on practice. Patients demonstrated insufficient knowledge, negative attitudes, and suboptimal practices regarding postoperative PCA. The negative knowledge-attitude correlation may be attributed to a phenomenon of blind optimism or the bliss of ignorance, where patients with lower knowledge exhibit more favorable, albeit ungrounded, attitudes toward PCA. Additionally, the failure of attitudes to influence practice highlights that favorable beliefs alone cannot drive behavioral change without skill-building and systemic support. Despite single-center and convenience sampling limitations, these findings underscore the need for nuanced interventions addressing both psychological complexities and practical barriers to PCA use.