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Global self-rated clinical confidence and perceived difficulty in cancer pain assessment for older adults with cognitive decline: a secondary cross-sectional study of Japanese nurses
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DOI：10.1186/s12912-026-05213-7.png)
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Abstract
En 中文
Cancer pain assessment in older adults with cognitive decline is clinically demanding. Total nursing tenure may not capture oncology-specific exposure, cognitive impairment-related learning, consultation support, or institutional practice environments. This study examined individual-level correlates of perceived difficulty and an exploratory indirect statistical association through global self-rated clinical confidence. This secondary cross-sectional analysis used questionnaire data from a parent CPAD-CD scale-development study conducted at eight participating hospitals in Hokkaido and Tohoku, Japan. Recruitment began in October 2018, and questionnaires were collected between January 2019 and February 2020. Of 268 questionnaires distributed, 216 were returned and 199 nurses remained after parent psychometric exclusions. The present analysis included 197 nurses with total nursing experience, global self-rated clinical confidence, and CPAD-CD total score. Linear regression with HC3 robust standard errors and 10,000 bootstrap resamples estimated exploratory indirect statistical associations. Retrospectively linked facility membership, where available, was examined in an exploratory fixed-effects sensitivity analysis. Participants had a mean age of 37.6 years, 95.4% were women, and mean nursing experience was 14.4 years. In the clinically adjusted complete-case model (n = 160), global self-rated clinical confidence was associated with lower perceived difficulty (B = -3.250, 95% CI -5.046 to -1.455, p < 0.001), whereas total nursing experience was not statistically associated with confidence (B = 0.063, 95% CI -0.021 to 0.147) or perceived difficulty after confidence adjustment (B = -0.776, 95% CI -1.728 to 0.175). The indirect effect was compatible with zero after clinical adjustment (B = -0.205, BCa 95% CI -0.599 to 0.029). Total nursing tenure alone did not robustly explain perceived difficulty. Global self-rated clinical confidence was consistently associated with perceived difficulty, but this may reflect shared subjective appraisal, common method variance, or reverse causation rather than causal mediation or actual competence. Longitudinal and interventional studies should evaluate more proximal learning and support conditions.
Keywords:
Cancer pain
Older adults
Cognitive decline
Oncology nursing
Self-rated confidence
Cross-sectional studies
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