Words matter when talking about pain: A scoping review of humanistic approaches to SDM in cancer-related pain care.

Abstract

To synthesize evidence on humanistic approach to SDM in cancer-related pain care and examine how communication shapes pain recognition, meaning, and management. We conducted a scoping review following Joanna Briggs Institute methodology and PRISMA-ScR guidelines searching six databases and additional sources from inception to January 2026. We used an integrated mixed-methods synthesis, combining inductive thematic analysis with a deductive classification of humanistic communication characteristics informed by established frameworks. We included 27 studies, predominantly qualitative. Humanistic approaches to SDM most frequently emphasized a supportive orientation, compassion, and attention to individual perspectives. We identified five themes presenting pain as a negotiated, relational, and communicative phenomenon rather than a purely biomedical symptom: (1) pain as a site of contestation and negotiation; (2) pain education as a missing element of care; (3) pain treatment as influenced by biases; (4) pain as emotionally unseen; and (5) pain as best supported through empathetic and collaborative care. Cancer pain communication is a relational and moral process that shapes whether and how pain is recognized, legitimized, and effectively managed. While the literature emphasizes compassionate and patient-centered practices, less attention is given to reflexive and structural dimensions influencing communication. We propose a mnemonic (WORDS) to support clinically competent cancer pain communication and provide actionable clinical guidance for validation, open dialogue, relational presence, tailored education, and shared decision-making. Integrating these practices into clinician training, patient education, and intervention designs may enhance engagement among people living with pain, reduce stigma, and improve pain outcomes.