Cancer pain awareness and communication practices among physicians in China: a nationwide mixed-methods study

Effective cancer pain management remains a global challenge, often hindered by gaps in physician knowledge, attitudes, and institutional awareness. This study aimed to assess Chinese physicians' understanding, perceptions, and practices related to cancer pain management through a national mixed-methods survey and interview study. A nationwide mixed-methods study was conducted between September 2019 and September 2024 to assess cancer pain management practices. The quantitative component involved a large-scale online survey distributed across 29 provinces to capture broad trends in physician knowledge and clinical behavior. To ensure a comprehensive evaluation, the study integrated a qualitative component through semi-structured interviews with frontline clinicians, aiming to gain deeper insights into unmet clinical needs and systemic barriers. A multi-step analytical approach was used to examine the relationship between physician demographics-such as education and specialized training-and their pain management awareness. Among 2,188 respondents, the majority were early-career physicians at tertiary hospitals. While a high percentage recognized the multi-dimensional nature of cancer pain, including sensory and social factors, practical assessment relied heavily on rapid subjective scales. Quantitative analysis demonstrated that higher educational levels and specific clinical exposure, such as oncology department rotations, were significant predictors of stronger pain management awareness. Conversely, a reliance on non-opioid medications was associated with lower awareness levels. Qualitative findings corroborated these trends, revealing a predominant reliance on pharmacological interventions and a critical need for structured multidisciplinary training. This study identifies potential knowledge gaps and variability in cancer pain management practices among physicians in China. The findings suggest that targeted training programs, interdisciplinary collaboration, and the standardization of assessment tools may be beneficial to improve clinical outcomes and patient quality of life. Furthermore, these results underscore the need to address resource disparities to promote more equitable pain care across different regions.