Emergency department nurses’ experiences and perceptions in managing breakthrough cancer pain: a qualitative study

Breakthrough cancer pain is a frequent and distressing condition that significantly impairs quality of life. Emergency department nurses play a critical role in breakthrough cancer pain recognition and management, yet their experiences remain underexplored. This study aimed to explore the experiences and perceptions of emergency department nurses regarding the recognition and management of breakthrough cancer pain. This study employed a qualitative descriptive design, which is particularly suitable for exploring participants’ subjective experiences and perceptions in a straightforward, naturalistic manner. Fourteen ED nurses from three tertiary hospitals in Hangzhou, China, participated in semi-structured interviews between January and June 2025. Data were analyzed thematically using Braun and Clarke’s six-step approach, with the aid of NVivo 14 software to facilitate data organization and coding. Four major themes emerged: (1) recognition and assessment challenges, including difficulty distinguishing breakthrough cancer pain from background pain and lack of standardized tools; (2) emotional and professional burden, characterized by distress, helplessness, and burnout; (3) practical coping strategies, such as rapid collaboration with physicians, reliance on clinical experience, and involving families; and (4) educational and systemic needs, highlighting the demand for standardized guidelines, targeted training, and interdisciplinary collaboration. Emergency department nurses face substantial challenges in managing breakthrough cancer pain, balancing clinical urgency with resource constraints while enduring significant emotional strain. Tailored education, standardized assessment tools, and systemic improvements may help inform strategies to enhance nursing competence and contribute to patient outcomes.