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Yu CY, Wang JH, Wang LW, Wang TJ, Liang SY, Wu SF, Lu YY. The influence of opioid-taking self-efficacy and social support on pain management satisfaction in outpatients with cancer pain. Support Care Cancer 2021; 30:805-812. [PMID: 34389908 DOI: 10.1007/s00520-021-06330-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/30/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to explore the correlations between patients' opioid-taking self-efficacy, social support, and their pain management satisfaction, and to evaluate the effect of social support and opioid-taking self-efficacy in explaining the variance in pain management satisfaction. METHODS We used a cross-sectional and correlational research design and recruited 123 cancer patients via convenience sampling. We used the following instruments: the Opioid-Taking Self-Efficacy Scale, the Inventory of Socially Supportive Behavior, and the Chinese version of the Pain Treatment Satisfaction Scale. RESULTS There were significant and negative correlations between opioid-taking self-efficacy and pain management satisfaction (r = - .43, p < .001) and between social support and pain management satisfaction (r = - .47, p < .001). Using a hierarchical regression analysis, social support and opioid-taking self-efficacy explained 17.20% and 5.20%, respectively, of the variance in pain management satisfaction. CONCLUSIONS The results of this study confirm the importance of social support and opioid-taking self-efficacy in influencing pain management satisfaction. We recommend that professional care providers develop relevant intervention aimed at improving patients' pain management satisfaction.
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Affiliation(s)
- Chiung-Yao Yu
- Nursing Department, Cardinal Tien Hospital, 362, Zhongzheng Rd., Xindian Dist, New Taipei City, 23148, Taiwan
| | - Jia-Hua Wang
- Changhua Nursing Home, Ministry of Health and Welfare, No. 1 Hugang Rd., Changhua City, Changhua Country, 500040, Taiwan
| | - Ling-Wei Wang
- Department of Medicine, Taipei Veterans General Hospital, 201, Sec. 2, Shipai Road., Beitou, Taipei, 112, Taiwan
| | - Tsae-Jyy Wang
- College of Nursing, National Taipei University of Nursing and Health Sciences, 365 Ming Te Road, Beitou, Taipei, 112, Taiwan
| | - Shu-Yuan Liang
- College of Nursing, National Taipei University of Nursing and Health Sciences, 365 Ming Te Road, Beitou, Taipei, 112, Taiwan.
| | - Shu-Fang Wu
- College of Nursing, National Taipei University of Nursing and Health Sciences, 365 Ming Te Road, Beitou, Taipei, 112, Taiwan
| | - Yu-Ying Lu
- College of Nursing, National Taipei University of Nursing and Health Sciences, 365 Ming Te Road, Beitou, Taipei, 112, Taiwan
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Gordon DB, Stewart JA, Dahl JL, Ward S, Pellino T, Backonja M, Broad JE. Institutionalizing Pain Management. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/10564950.1999.12098188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Debra B. Gordon
- Debra B. Gordon, RN, MS, is Senior linical Nurse Specialist, University of Wisconsin Hospital & Clinics
| | - James A. Stewart
- James A. Stewart, MD, FACP, is Professor, Department of Medicine, University of Wisconsin Medical School and Comprehensive Cancer Center, University of Wisconsin Hospital & Clinics
| | - June L. Dahl
- June L. Dahl, PhD, is Professor, Department of Pharmacology, University of Wisconsin Medical School
| | - Sandra Ward
- Sandra Ward, RN, PhD, is Associate Professor, University of Wisconsin School of Nursing
| | - Theresa Pellino
- Theresa Pellino, RN, PhD, is Senior Clinical Nurse Specialist, Nursing Research, University of Wisconsin Hospital & Clinics
| | - Miroslav Backonja
- Miroslav Backonja, MD, is Associate Professor, Department of Neurology, University of Wisconsin Medical School
| | - Judith E. Broad
- Judith E. Broad, RN, PhD, is Senior Vice President of Nursing, University of Wisconsin Hospital & Clinics, Madison, WI
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Wilkie DJ, Yao Y, Ezenwa MO, Suarez ML, Dyal BW, Gill A, Hipp T, Shea R, Miller J, Frank K, Nardi N, Murray M, Glendenning J, Perez J, Carrasco JD, Shuey D, Angulo V, McCurry T, Martin J, Butler A, Wang ZJ, Molokie RE. A Stepped-Wedge Randomized Controlled Trial: Effects of eHealth Interventions for Pain Control Among Adults With Cancer in Hospice. J Pain Symptom Manage 2020; 59:626-636. [PMID: 31711969 DOI: 10.1016/j.jpainsymman.2019.10.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
CONTEXT Unrelieved cancer pain at the end of life interferes with achieving patient-centered goals. OBJECTIVE To compare effects of usual hospice care and PAINRelieveIt® on pain outcomes in patients and their lay caregivers. METHODS In a five-step, stepped-wedge randomized, controlled study, 234 patients (49% male, 18% Hispanic, 51% racial minorities) and 231 lay caregivers (26% male, 20% Hispanic, 54% racial minorities) completed pre-pain/post-pain measures. They received usual hospice care with intervention components that included a summary of the patient's pain data, decision support for hospice nurses, and multimedia education tailored to the patient's and lay caregiver's misconceptions about pain. RESULTS The intervention effect on analgesic adherence (primary outcome) was not significant. Post-test worst pain intensity was significantly higher for the experimental group, but the difference (0.70; CI = [0.12, 1.27]) was not clinically meaningful. There was nearly universal availability of prescriptions for strong opioids and adjuvant analgesics for neuropathic pain in both groups. Lay caregivers' pain misconceptions (0-5 scale) were significantly lower in the experimental group than the usual care group (mean difference controlling for baseline is 0.38; CI = [0.08, 0.67]; P = 0.01). CONCLUSION This randomized controlled trial was a negative trial for the primary study outcomes but positive for a secondary outcome. The trial is important for clearly demonstrating the feasibility of implementing the innovative set of interventions.
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Affiliation(s)
- Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA; University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA.
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA; University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA
| | - Miriam O Ezenwa
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA; University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA
| | - Marie L Suarez
- University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA
| | - Brenda W Dyal
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA; University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA
| | - Anayza Gill
- Rainbow Hospice and Palliative Care, Mount Prospect, Illinois, USA
| | - Theresa Hipp
- Horizon Hospice & Palliative Care, Chicago, Illinois, USA
| | - Robert Shea
- Rainbow Hospice and Palliative Care, Mount Prospect, Illinois, USA
| | - Jacob Miller
- Horizon Hospice & Palliative Care, Chicago, Illinois, USA
| | - Karen Frank
- Rainbow Hospice and Palliative Care, Mount Prospect, Illinois, USA
| | - Nargis Nardi
- Rainbow Hospice and Palliative Care, Mount Prospect, Illinois, USA
| | - Michael Murray
- Horizon Hospice & Palliative Care, Chicago, Illinois, USA
| | | | - Jessica Perez
- Horizon Hospice & Palliative Care, Chicago, Illinois, USA
| | - Jesus D Carrasco
- University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA
| | - David Shuey
- University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA
| | - Veronica Angulo
- University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA
| | - Timothy McCurry
- Rainbow Hospice and Palliative Care, Mount Prospect, Illinois, USA
| | - Joanna Martin
- Horizon Hospice & Palliative Care, Chicago, Illinois, USA
| | | | - Zaijie Jim Wang
- Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Robert E Molokie
- Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA; Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA; Jesse Brown VA Medical Center, Chicago, Illinois, USA
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Abstract
This paper describes a unique and exciting way to educate medical/surgical care providers in pain management. The Medical Pathway, consisting of medicine, oncology, renal, and surgery care providers, chose pain management as a quality improvement initiative. Nurses, a pharmacist, a physical therapist, and a representative from the Healing Arts Department constituted the pain management team. The goal of the team was staff education on pain management. This education was accomplished by implementing a yearlong series of traditional lectures and nontraditional teaching techniques, such as “Pain Awareness Days.”
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Affiliation(s)
- Susan L. Ravnan
- University of the Pacific School of Pharmacy and Health Sciences, 3601 Pacific Avenue, Stockton, CA 95211
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Dueñas M, Ojeda B, Salazar A, Fernández-Palacín F, Micó JA, Torres LM, Failde I. Use and satisfaction with the Healthcare System of the chronic pain patients in Spain: results from a nationwide study. Curr Med Res Opin 2016; 32:1813-1820. [PMID: 27400416 DOI: 10.1080/03007995.2016.1211519] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To analyze the use of healthcare resources by chronic pain (CP) patients in Spain and their satisfaction with them. RESEARCH DESIGN AND METHODS A nationwide, cross-sectional study was carried out on a representative sample of 1957 Spanish adults. A telephone survey was conducted with the aim of analyzing the prevalence of CP, the characteristics and consequences of pain, the use of healthcare resources and patients' satisfaction with them. Descriptive, bivariate and multivariate analyses were performed. RESULTS Of the 1957 subjects interviewed, 325 suffered CP. The mean duration of CP was 10 years (SD: 11.3) and 48.9% of the CP sufferers reported severe/unbearable pain. Moreover, about 30% felt sad/very sad or anxious/very anxious, 24.4% had been on sick leave, 12% had left/lost their jobs and 47.2% considered their pain affected their families. Likewise, 92.9% had consulted a healthcare professional due to their CP, on average 3.49 times (SD: 3.9), and 69.2% took medication. In addition, 67.3% and 63.8% were satisfied/very satisfied with the care and the healthcare information they received, respectively. Individuals who reported headache (OR = 0.34) and feeling sad (OR =0.38) were least satisfied with the care they received. In addition, CP sufferers who made greater use of consultations were those who had left/lost their jobs (β = 1.44), those who took medication (β = 1.67), those who considered their pain affected their families (β = 0.97) and those with a shorter duration of pain (β = -0.003). CONCLUSIONS CP produces relevant demands on healthcare resources, conditioned by the consequences within the family and the effects on their employment. To achieve greater patient satisfaction, professionals need to pay particular attention to certain sites of pain and to patients' mental health.
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Affiliation(s)
- María Dueñas
- a Salus Infirmorum Faculty of Nursing , University of Cádiz , Cádiz , Spain
| | - Begoña Ojeda
- b Preventive Medicine and Public Health Area, Faculty of Nursing and Physiotherapy , University of Cádiz , Cádiz , Spain
| | - Alejandro Salazar
- b Preventive Medicine and Public Health Area, Faculty of Nursing and Physiotherapy , University of Cádiz , Cádiz , Spain
| | - Fernando Fernández-Palacín
- c Department of Statistics and Operations Research, Faculty of Sciences , University of Cádiz , Cádiz , Spain
| | - Juan Antonio Micó
- d Department of Neuroscience, Pharmacology and Psychiatry , University of Cádiz, CIBER of Mental Health, CIBERSAM, Instituto de Salud Carlos III , Cádiz , Spain
| | - Luis Miguel Torres
- e Department of Anesthesiology - Critical Care and Pain Management , University Hospital "Puerta del Mar" , Cádiz , Spain
| | - Inmaculada Failde
- b Preventive Medicine and Public Health Area, Faculty of Nursing and Physiotherapy , University of Cádiz , Cádiz , Spain
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Bartoszczyk DA, Gilbertson-White S. Interventions for Nurse-Related Barriers in Cancer Pain Management. Oncol Nurs Forum 2016; 42:634-41. [PMID: 26488832 DOI: 10.1188/15.onf.634-641] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe the findings and critique the studies of interventions for nursing staff to improve pain management in adults with cancer. DATA SOURCES Publications were identified through database searches. Studies that describe interventions to overcome nurse-related barriers in cancer pain management practices were included in this review. DATA SYNTHESIS Nine studies were found that met the inclusion criteria. All studies were experimental and conducted from 1993-2013. CONCLUSIONS Increase in knowledge, change of attitudes and behaviors, and good relationships with specialists were found to be influential in overcoming existing nursing barriers to pain management in cancer survivors. Educational interventions are more effective in increasing knowledge than in improving attitudes. Specialists were acknowledged as important resources and role models for nurses, particularly when trust was established between the two. IMPLICATIONS FOR NURSING A number of interventions have been developed to address healthcare provider barriers. However, scarce literature exists on whether interventions that aim to overcome nurse-related barriers have been successful. This literature review provides critical insights on the effectiveness of interventions aimed to overcome barriers to effective pain management by nurses for adults with cancer
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Abstract
Postthoracotomy pain management is essential imme diately after surgery and crucial for the patient suffering from this problem for a long duration. Understanding the causative and pathophysiological basis for this condition requires frequent assessment and a multidi mensional approach. Inadequate pain control has detri mental effects on the routine activities of patients as well as on their physical and emotional well-being. During the last 2 decades, the understanding of various pain-related issues has been strengthened resulting in early intervention and pain management. Various phar macological modalities including the role of nonopiates, opiates, and adjuvant drugs are helpful in combating postthoracotomy pain. A selective group of patients will benefit from interventional techniques. The treat ment decision requires a clear understanding of the disease and its impact on the patient. There must also be an understanding of risk and benefits as well as cost and benefits for various drugs and techniques before selecting the appropriate therapy.
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Affiliation(s)
- Subhash Jain
- Department of Anesthesiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Samyadev Datta
- Department of Anesthesiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Debra Tundis
- Department of Anesthesiology, Memorial Sloan-Kettering Cancer Center, New York, NY
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Farooq F, Khan R, Ahmed A. Assessment of patient satisfaction with acute pain management service: Monitoring quality of care in clinical setting. Indian J Anaesth 2016; 60:248-52. [PMID: 27141107 PMCID: PMC4840804 DOI: 10.4103/0019-5049.179450] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS Assessment of patient satisfaction is an important tool for monitoring the quality of care in hospitals. The aim of this survey was to develop a reliable tool to assess patient satisfaction with acute pain management service (APMS) and identify variables affecting this so that care can be improved. METHODS A questionnaire was developed and administered to patients after being discharged from APMS care by an unbiased person. Data collected from record included patient demographics, surgical procedure, analgesic modality, co-analgesics and dynamic and static pain scores. Questions included pain expected and pain experienced, APMS response time, quality of pain relief with treatment, professionalism of APMS team, overall experience of pain relief and choosing/suggesting same modality for themselves/family/friends again. Five-point Likert scale was used for most of the options. Statistical analysis was done using SPSS 19. RESULTS Frequency and percentages were computed for qualitative observation and presented on pie chart and histogram. Seventy-one per cent patients expected severe pain while 43% actually experienced it. About 79.4% would choose same analgesia modality in future for self/family/friends. Ninety-nine per cent found APMS staff courteous and professional. About 89% rated their experience of pain management as excellent to very good. CONCLUSION The survey of patients' satisfaction to monitor the quality of care provided by APMS provided positive inputs on its role. This also helps to identify areas requiring improvement in care and as a tool to gauge the quality of care.
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Affiliation(s)
- Fizzah Farooq
- Department of Anaesthesiology, Dow University of Health Sciences, Karachi, Pakistan
| | - Robyna Khan
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Aliya Ahmed
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
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Jho HJ, Kim Y, Kong KA, Kim DH, Choi JY, Nam EJ, Choi JY, Koh S, Hwang KO, Baek SK, Park EJ. Knowledge, practices, and perceived barriers regarding cancer pain management among physicians and nurses in Korea: a nationwide multicenter survey. PLoS One 2014; 9:e105900. [PMID: 25144641 PMCID: PMC4140841 DOI: 10.1371/journal.pone.0105900] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 07/26/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Medical professionals' practices and knowledge regarding cancer pain management have often been cited as inadequate. This study aimed to evaluate knowledge, practices and perceived barriers regarding cancer pain management among physicians and nurses in Korea. METHODS A nationwide questionnaire survey was administered to physicians and nurses involved in the care of cancer patients. Questionnaire items covered pain assessment and documentation practices, knowledge regarding cancer pain management, the perceived barriers to cancer pain control, and processes perceived as the major causes of delay in opioid administration. RESULTS A total of 333 questionnaires (149 physicians and 284 nurses) were analyzed. Nurses performed pain assessment and documentation more regularly than physicians did. Although physicians had better knowledge of pain management than did nurses, both groups lacked knowledge regarding the side effects and pharmacology of opioids. Physicians working in the palliative care ward and nurses who had received pain management education obtained higher scores on knowledge. Physicians perceived patients' reluctance to take opioids as a barrier to pain control, more so than did nurses, while nurses perceived patients' tendency to under-report of pain as a barrier, more so than did physicians. Physicians and nurses held different perceptions regarding major cause of delay during opioid administration. CONCLUSIONS There were differences between physicians and nurses in knowledge and practices for cancer pain management. An effective educational strategy for cancer pain management is needed in order to improve medical professionals' knowledge and clinical practices.
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Affiliation(s)
- Hyun Jung Jho
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Yeol Kim
- Division of Cancer Management & Policy, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Kyung Ae Kong
- Clinical Trial Center, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Dae Hyun Kim
- Department of Pain and Anesthesiology, Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Jin Young Choi
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Eun Jeong Nam
- Department of Nursing, Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Jin Young Choi
- Department of Nursing, Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Sujin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Kwan Ok Hwang
- Korean Hospice & Palliative Nurse Association, Daejeon, Republic of Korea
| | - Sun Kyung Baek
- Department of Medical Oncology and Hematology, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Eun Jung Park
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
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Ista E, van Dijk M, van Achterberg T. Do implementation strategies increase adherence to pain assessment in hospitals? A systematic review. Int J Nurs Stud 2012; 50:552-68. [PMID: 23245966 DOI: 10.1016/j.ijnurstu.2012.11.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 11/07/2012] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Pain assessment and reassessment is an essential part of the treatment of hospitalised patients and must be integrated in pain management protocols. Yet nurses' adherence to pain assessment recommendations is problematic. We sought to review the comparative evidence for implementation strategies aiming to improve nurses' adherence to pain assessment recommendations in hospitalised patients. DESIGN Systematic review using the narrative method. DATA SOURCES PubMed (MEDLINE), CINAHL, Cochrane library and hand searching. REVIEW METHODS Studies published since 1990, reporting implementation strategies that aimed to improve nurses' adherence to pain assessment recommendations in hospitalised patients were included. According to the Cochrane Effective Practice and Organization of Care group (EPOC) classification system, strategies were categorized as directed at: health professionals, organizations, financing, or regulations. Given the heterogeneity in strategies, samples, outcomes and settings, evidence from the studies was synthesized using a narrative approach. RESULTS From 743 initial citations, 23 studies were included. They reported a variety of implementation strategies, but only directed at health professionals and/or organizations. In seven studies, a single strategy was applied (e.g. education or feedback). The remaining 16 studies used multifaceted approaches. The effectiveness of the implementation strategies varied. In all studies but one, adherence rates had improved after implementation compared to the before measurement, by 9% up to 49%. These effects were measured at different time points after completion of the implementation, ranging from 2 weeks to 6 months. Half of the reviewed studies reported an adherence rate of 80% or higher after implementation activities; other reported rates ranging from 24 to 80%. In two controlled studies the adherence to pain assessment recommendations increased significantly when feedback was provided compared to no feedback. Sustained effects were reported in three studies. CONCLUSIONS Based on this systematic review we conclude that implementation strategies to improve nurses' adherence to pain assessment recommendations vary but generally address professionals and organizational aspects. Educational and feedback strategies are often used and seem largely effective. Due to the heterogeneity of the implementation strategies it is not possible to recommend one preferred strategy. The level of evidence for strategies to improve pain assessment recommendations is limited however, as well-conducted studies are lacking.
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Affiliation(s)
- Erwin Ista
- Intensive Care Unit, Department Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
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Yennurajalingam S, Kang JH, Hui D, Kang DH, Kim SH, Bruera E. Clinical response to an outpatient palliative care consultation in patients with advanced cancer and cancer pain. J Pain Symptom Manage 2012; 44:340-50. [PMID: 22699092 DOI: 10.1016/j.jpainsymman.2011.09.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 09/12/2011] [Accepted: 09/15/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT There is limited published data regarding the outcomes of palliative care consult on cancer pain treatment at the first follow-up visit. OBJECTIVES The primary aim of this study was to determine pain treatment response to an outpatient palliative care consultation at the first follow-up visit for patients with cancer pain. METHODS Data from consecutive patients (n=1612) who were referred to the outpatient Supportive Care Center at The University of Texas M. D. Anderson Cancer Center and completed the Edmonton Symptom Assessment System at their initial and subsequent visits from January 2003 to December 2010 were reviewed. All patients received interdisciplinary care led by palliative care specialists following an institutional protocol. Pain treatment response was defined as a ≥2 point or ≥30% reduction from baseline. Using logistic regression models, predictive factors associated with pain treatment response were assessed. RESULTS The mean (SD) baseline pain was 5.36 (2.9). Of the 1612 patients, 462 (29%) rated their pain as mild (numeric rating scale [NRS] score 0-3), 511 (32%) as moderate (NRS score 4-6), and 639 (39%) as severe (NRS score 7-10). Almost half (728 of 1612 [45%]) of the patients achieved pain treatment response. However, 228 of 728 (31%) responding patients still had pain ≥4 at the first follow-up visit in 15 days on average. Of the 462 patients with mild pain at baseline, 147 (32%) had worse pain at the first follow-up visit. Factors associated with clinical response were baseline pain intensity (odds ratio [OR] per point 1.4; P<0.01), fatigue (OR per point 1.01; P=0.014), and Edmonton Symptom Assessment System symptom burden (OR per point 1.01; P=0.039). CONCLUSION More than half of the patients with moderate/severe pain were nonresponders, and about one-third of the patients with mild pain had an increase in pain severity to moderate/severe levels at the first follow-up. More frequent follow-up visits, phone calls, and interdisciplinary clinics may improve pain control.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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Dalal S, Hui D, Nguyen L, Chacko R, Scott C, Roberts L, Bruera E. Achievement of personalized pain goal in cancer patients referred to a supportive care clinic at a comprehensive cancer center. Cancer 2012; 118:3869-77. [PMID: 22180337 PMCID: PMC3310943 DOI: 10.1002/cncr.26694] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 09/28/2011] [Accepted: 10/12/2011] [Indexed: 11/12/2022]
Abstract
BACKGROUND Cancer pain initiatives recommend using the personalized pain goal to tailor pain management. This study was conducted to examine the feasibility and stability of personalized pain goal, and how it compares to the clinical pain response criteria. METHODS Records of 465 consecutive cancer patients seen in consultation at the Supportive Care Clinic were reviewed. Pain relief was assessed as clinical response (≥30% or ≥2 point pain reduction) and personalized pain goal response (pain ≤ personalized pain goal). RESULTS One hundred fifty-two (34%), 95 (21%), and 163 (37%) patients presented with mild (1-4), moderate (5-6), and severe (7-10) pain, respectively. Median age (59 years), males (52%), and advanced cancer status (84%) did not differ by pain category. Median personalized pain goal at initial clinic consult was 3 (interquartile range, 2-3), was similar across pain groups, and remained unchanged (P = .57) at follow-up (median, 14 days). Clinical response was higher among patients with severe pain (60%) as compared with moderate (40%) and mild pain (33%, P < .001). Personalized pain goal response was higher among patients with mild pain (63%) as compared with moderate (44%) and severe pain (27%, P < .001). By using personalized pain goal response as the gold standard for pain relief, the sensitivity of clinical response was highest (98%) among patients with severe pain, but it had low specificity (54%). In patients with mild pain, clinical response was most specific for pain relief (98%), but had low sensitivity (52%). CONCLUSIONS Personalized pain goal is a simple patient-reported outcome for pain goals. The majority of patients were capable of stating their desired level for pain relief. The median personalized pain goal was 3, and it was highly stable at follow-up assessment.
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Affiliation(s)
- Shalini Dalal
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Zernikow B, Meyerhoff U, Michel E, Wiesel T, Hasan C, Janssen G, Kuhn N, Kontny U, Fengler R, Görtitz I, Andler W. Pain in pediatric oncology - children's and parents' perspectives. Eur J Pain 2012; 9:395-406. [PMID: 15979020 DOI: 10.1016/j.ejpain.2004.09.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Accepted: 09/23/2004] [Indexed: 11/24/2022]
Abstract
There is a lack of valid epidemiological data on malignancy-associated pain in modern pediatric oncology. Pediatric oncology patients (self-assessment) and their parents from 28 hospitals were questioned using age-adapted, structured interviews and validated pain assessment tools. Pain intensity was measured by the NRS and Bieri faces scale. We conducted 363 interviews with patients and their parents, and 46 with the parents alone (if patients <2.5 years). Pain was reported at the time of the interview or within the last 24 h, 7 d, or 4 weeks in 15%, 28%, 50% and 58% of cases, respectively. The proportion of patients suffering severe to maximal pain (NRS>3; Bieri>2) increased significantly (p=0.001, chi2 test). The median pain intensity for the most severe pain episode within the last 4 weeks was 6.7 (NRS 0-10). Adverse effects of anti-tumor therapy were the most frequent cause of pain. Multivariate analyses depicted general physical condition either "severely reduced" (ASA status 3) (OR 4.0, 95% CI 1.1-14.7, p=0.037) or "moderately reduced" (ASA status 2) (OR 1.8, 95% CI 1.1-2.9, p=0.018), "in-patient status" (OR 1.8, 95% CI 1.2-2.9, p=0.010), and "co-morbidity present" (OR 3.5, 95% CI 1.1-10.7, p=0.030) as risk factors for severe to maximal pain. General anesthesia was the only factor significantly (OR 0.14, 95% CI 0.05-0.39, p<0.01) associated with a reduction in the proportion of patients suffering severe to maximal pain during bone marrow aspiration. Our data emphasize both the importance of in-house acute pain control and the need for general anesthesia during painful procedures in pediatric oncology.
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Affiliation(s)
- Boris Zernikow
- Children's Hospital Datteln, Witten/Herdecke University, Dr.-Friedrich-Steiner Str. 5, D-45711 Datteln, Germany.
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Bisht M, Bist SS, Dhasmana DC, Saini S. Quality of life as an outcome variable in the management of advanced cancer. Indian J Med Paediatr Oncol 2011; 31:121-5. [PMID: 21584216 PMCID: PMC3089919 DOI: 10.4103/0971-5851.76194] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Though well recognized in the West, palliative care and quality of life are relatively newer concepts in a developing country like India. The aim of this study was to assess the effect of palliative care on pain and quality of life and to identify the association between the two. STUDY DESIGN Observational prospective study. MATERIALS AND METHODS Patients with advanced cancer, receiving palliative drug therapy, were recruited from a tertiary care hospital. City of Hope Medical Center Quality of Life Survey and visual analog scale (VAS) were used to assess the quality of life and cancer pain severity, respectively. RESULTS A total of 100 patients were included in the study. Palliative drug therapy produced a significant reduction in pain scores expressed as mean ± SD in VAS [7.13 ± 2.2 vs. 2.62 ± 2.1 (P<0.001) after 1 month in 93 patients; 7.06 ± 2.1 vs. 2.47 ± 2.1 (P<0.001) after 1 month and 2.02 ± 1.9 (P<0.001) after 2 months in 51 patients]. Also, significant improvement in the quality of life scores [919.78 ± 271.3 vs. 1280.65 ± 306.8 (P<0.01) after 1 month in 93 patients; 950.39 ± 238.2 vs. 1336.67 ± 291 (P<0.01) after 1 month and 1405.49 ± 368.3 (P<0.01) after 2 months in 51 patients] was obtained. There was a high correlation between the average change of pain intensity and quality of life scores (r= -0.53, P<0.02). Overall, a reduction in pain resulted in significant improvement in the quality of life (P<0.001). CONCLUSION This study emphasizes the role of palliative care and, more importantly, pain management in improving the quality of life of advanced cancer patients.
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Affiliation(s)
- Manisha Bisht
- Department of Pharmacology, Himalayan Institute of Medical Sciences, HIHT University, Jolly-grant, Dehradun - 248 140, Uttarakhand, India
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Adolph MD. Inpatient palliative care consultation: enhancing quality of care for surgical patients by collaboration. Surg Clin North Am 2011; 91:317-24, viii. [PMID: 21419254 DOI: 10.1016/j.suc.2010.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hospital-based surgeons will likely encounter palliative care service colleagues more frequently, given the growth of approved fellowships and hospital palliative care programs. Surgeons may consult with palliative care colleagues to help patients and families manage pain and other symptoms, cope with the distress of acute and chronic illness, manage complex decisions at end-of-life, and negotiate through a critical illness (or combinations thereof). Inpatient palliative care consultation has been shown to improve quality of care, including quality of life and satisfaction of patients, families, and referring clinicians.
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Affiliation(s)
- Michael D Adolph
- Division of Surgical Oncology, Pain & Palliative Medicine Service, James Cancer Hospital, Ohio State University College of Medicine, Columbus, OH 43210, USA.
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Bisht M, Bist SS, Dhasmana DC, Saini S. Effect of Palliative Drug Therapy on Quality of life in Advanced Head and Neck Cancer Patients. Indian J Otolaryngol Head Neck Surg 2011; 63:220-2. [PMID: 22754798 DOI: 10.1007/s12070-011-0259-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Advanced cancer patients are managed by palliative care and its main aim is to provide best possible quality of life to the patients by symptom management. Pain is the most agonizing symptom experienced by advanced head and neck cancer patients. Control of pain hence requires more attention by the caregiver in order to improve their quality of life. Recently quality of life issues have emerged as a main focus of cancer treatment as compared to conventional increase in survival rate. This study mainly focuses on the effect of palliative drug therapy on quality of life.
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Affiliation(s)
- Manisha Bisht
- Himalayan Institute of Medical Sciences (HIHT University) Jolly Grant, Dehradun, 248140 Uttaranchal India
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Prescribed opioids adherence among Taiwanese oncology outpatients. Pain Manag Nurs 2011; 14:155-60. [PMID: 23972866 DOI: 10.1016/j.pmn.2011.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 02/09/2011] [Accepted: 02/15/2011] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to evaluate adherence to prescribed opioids in Taiwanese oncology outpatients and to examine the associations between various demographic and medical characteristics and prescribed opioids adherence. Ninety-two outpatients who had taken prescribed opioid analgesics for cancer-related pain at least once in the past week participated in this study. Patients were asked to recall the dose of each opioid analgesic that they had taken in the past 24 hours. Mean adherence rates were calculated for analgesic adherence. For mean adherence rates, all opioid analgesics were converted to morphine equivalents. The results of this study reveal a priority issue of poor opioid analgesic adherence. The adherence rate of 63.6% for the around-the-clock opioid analgesics in this study is well below acceptable levels. Also, an adherence rate of 30.9% for the as-needed opioid analgesics is very low. This study identified that women tend to be less adherent to their prescribed opioid analgesic regimen than men. Findings of this study suggest that to improve pain control, efforts to promote patients' opioid regimen adherence should be given high priority. Clinicians should be particularly aware that there may be some gender difference in adherence to prescribed opioid analgesics. There is a need for better programmatic efforts to improve analgesic adherence.
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Kroenke K, Theobald D, Wu J, Norton K, Morrison G, Carpenter J, Tu W. Effect of telecare management on pain and depression in patients with cancer: a randomized trial. JAMA 2010; 304:163-71. [PMID: 20628129 PMCID: PMC3010214 DOI: 10.1001/jama.2010.944] [Citation(s) in RCA: 235] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Pain and depression are 2 of the most prevalent and treatable cancer-related symptoms, yet they frequently go unrecognized, undertreated, or both. OBJECTIVE To determine whether centralized telephone-based care management coupled with automated symptom monitoring can improve depression and pain in patients with cancer. DESIGN, SETTING, AND PATIENTS Randomized controlled trial conducted in 16 community-based urban and rural oncology practices involved in the Indiana Cancer Pain and Depression (INCPAD) trial. Recruitment occurred from March 2006 through August 2008 and follow-up concluded in August 2009. The participating patients had depression (Patient Health Questionnaire-9 score > or = 10), cancer-related pain (Brief Pain Inventory [BPI] worst pain score > or = 6), or both. INTERVENTION The 202 patients randomly assigned to receive the intervention and 203 to receive usual care were stratified by symptom type. Patients in the intervention group received centralized telecare management by a nurse-physician specialist team coupled with automated home-based symptom monitoring by interactive voice recording or Internet. MAIN OUTCOME MEASURES Blinded assessment at baseline and at months 1, 3, 6, and 12 for depression (20-item Hopkins Symptom Checklist [HSCL-20]) and pain (BPI) severity. RESULTS Of the 405 participants enrolled in the study, 131 had depression only, 96 had pain only, and 178 had both depression and pain. Of the 274 patients with pain, 137 patients in the intervention group had greater improvements in BPI pain severity over the 12 months of the trial whether measured as a continuous severity score or as a categorical pain responder (> or = 30% decrease in BPI) than the 137 patients in the usual-care group (P < .001 for both). Similarly, of the 309 patients with depression, the 154 patients in the intervention group had greater improvements in HSCL-20 depression severity over the 12 months of the trial whether measured as a continuous severity score or as a categorical depression responder (> or = 50% decrease in HSCL) than the 155 patients in the usual care group (P < .001 for both). The standardized effect size for between-group differences at 3 and 12 months was 0.67 (95% confidence interval [CI], 0.33-1.02) and 0.39 (95% CI, 0.01-0.77) for pain, and 0.42 (95% CI, 0.16-0.69) and 0.41 (95% CI, 0.08-0.72) for depression. CONCLUSION Centralized telecare management coupled with automated symptom monitoring resulted in improved pain and depression outcomes in cancer patients receiving care in geographically dispersed urban and rural oncology practices. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00313573.
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Affiliation(s)
- Kurt Kroenke
- Center for Implementing Evidence-Based Practice, Richard Roudebush VA Medical Center, Indianapolis, IN, USA.
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Goebel JR, Sherbourne CD, Asch SM, Meredith L, Cohen AB, Hagenmaier E, Lanto AB, Simon B, Rubenstein LV, Shugarman LR, Lorenz KA. Addressing Patients' Concerns about Pain Management and Addiction Risks. Pain Manag Nurs 2010; 11:92-8. [DOI: 10.1016/j.pmn.2009.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 02/22/2009] [Accepted: 03/31/2009] [Indexed: 10/20/2022]
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Effect of an Audit and Feedback Intervention on Hospitalized Oncology Patients' Perception of Nurse Practitioner Care. J Nurs Care Qual 2010; 25:87-93. [DOI: 10.1097/ncq.0b013e3181b7050d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Beck SL, Towsley GL, Berry PH, Lindau K, Field RB, Jensen S. Core aspects of satisfaction with pain management: cancer patients' perspectives. J Pain Symptom Manage 2010; 39:100-15. [PMID: 19879107 DOI: 10.1016/j.jpainsymman.2009.06.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2009] [Revised: 06/01/2009] [Accepted: 06/17/2009] [Indexed: 11/18/2022]
Abstract
CONTEXT The coexistence of high levels of satisfaction and high levels of pain has been perplexing. OBJECTIVES The aims of this study were to 1) describe patient expectations related to the experience of cancer-related pain, 2) explore the cognitive processes and meaning that underlie patient judgments about satisfaction and dissatisfaction with pain management, and 3) explore the discrepancies between ratings of high satisfaction with pain management with high pain intensity. METHODS The sample included 33 patients: 18 with advanced cancer and 15 experiencing pain after a surgery for a cancer diagnosis. All patients had experienced "worst pain" of at least moderate intensity and were interviewed using standard pain measures from the American Pain Society Patient Outcome Questionnaire and open-ended questions about the underlying meaning of their answers. We systematically analyzed the transcribed qualitative data using NVivo software. RESULTS Fifty-five percent of patients were females and were aged 25-78 years. Most (75%) were satisfied or very satisfied with their overall pain management. Key findings indicate that for some, the worst pain rating was often brief, even momentary. Most patients expected pain relief. Four key themes were important to the quality of pain management: being treated right, having a safety net, being in a partnership with their health care team, and having pain treatment that was efficacious. Key aspects of the patient-provider relationship that mattered were how the nurses and doctors behaved toward them and how quickly they responded to reports of pain. For some, an important factor was whether they had control of the amount of pain they experienced. CONCLUSION The findings inform measurement of patient satisfaction with the quality of pain management.
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Affiliation(s)
- Susan L Beck
- University of Utah College of Nursing, Salt Lake City, Utah 84112-5880, USA.
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Abstract
PURPOSE Using a feminist perspective, the relationship between acculturation and cancer pain experience was explored. DESIGN This was a cross-sectional, correlational Internet study among 104 Hispanic and 114 Asian cancer patients. The instruments included both unidimensional and multidimensional cancer pain measures. FINDINGS There were significant differences in cancer pain scores by country of birth. Yet there was no significant association of acculturation to cancer pain scores. DISCUSSION AND CONCLUSIONS This study indicated inconsistent findings. IMPLICATIONS FOR PRACTICE To provide directions for adequate cancer pain management, further studies with a larger number of diverse groups of immigrant cancer patients are needed.
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Affiliation(s)
- Eun-Ok Im
- University of Texas, Austin, TX, USA.
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Kroenke K, Theobald D, Norton K, Sanders R, Schlundt S, McCalley S, Harvey P, Iseminger K, Morrison G, Carpenter JS, Stubbs D, Jacks R, Carney-Doebbeling C, Wu J, Tu W. The Indiana Cancer Pain and Depression (INCPAD) trial Design of a telecare management intervention for cancer-related symptoms and baseline characteristics of study participants. Gen Hosp Psychiatry 2009; 31:240-53. [PMID: 19410103 PMCID: PMC2743872 DOI: 10.1016/j.genhosppsych.2009.01.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 01/29/2009] [Accepted: 01/30/2009] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Pain and depression are two of the most prevalent and treatable cancer-related symptoms, each present in at least 20-30% of oncology patients. Both symptoms are frequently either unrecognized or undertreated, however. This article describes a telecare management intervention delivered by a nurse-psychiatrist team that is designed to improve recognition and treatment of pain and depression. The enrolled sample is also described. METHODS The Indiana Cancer Pain and Depression study is a National Cancer Institute-sponsored randomized clinical trial. Four hundred five patients with cancer-related pain and/or clinically significant depression from 16 urban or rural oncology practices throughout Indiana have been enrolled and randomized to either the intervention group or to a usual-care control group. Intervention patients receive centralized telecare management coupled with automated home-based symptom monitoring. Outcomes will be assessed at 1, 3, 6 and 12 months by research assistants blinded to treatment arms. RESULTS Of 4465 patients screened, 2185 (49%) endorsed symptoms of pain or depression. Of screen-positive patients, about one-third were ineligible (most commonly due to pain or depression not meeting severity thresholds or to pain that is not related to cancer). Of the 405 patients enrolled, 32% have depression only, 24% have pain only and 44% have both depression and pain. At baseline, participants reported an average of 16.8 days out of the past 4 weeks during which they were confined to bed or had to reduce their usual activities by > or =50% due to pain or depression. Also, 176 (44%) reported being unable to work due to health reasons. CONCLUSIONS When completed, the Indiana Cancer Pain and Depression trial will test whether centralized telecare management coupled with automated home-based symptom monitoring improves outcomes in cancer patients with depression and/or pain. Findings will be important for both oncologists and mental health clinicians confronted with oncology patients' depression or pain.
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Affiliation(s)
- Kurt Kroenke
- Department of Medicine, Indiana University, Indianapolis, IN 46202, USA.
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Zhang CH, Hsu L, Zou BR, Li JF, Wang HY, Huang J. Effects of a pain education program on nurses' pain knowledge, attitudes and pain assessment practices in China. J Pain Symptom Manage 2008; 36:616-27. [PMID: 18599261 DOI: 10.1016/j.jpainsymman.2007.12.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2007] [Revised: 12/07/2007] [Accepted: 12/28/2007] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to develop, implement, and evaluate the impact of a Pain Education Program (PEP) for nurses in China. The effects of PEP were measured in a quasi-experimental design. A total of 196 nurses who met the inclusion criteria from five nursing units in two teaching hospitals participated in the study. Randomization took place at the hospital level to select experimental and control groups. The research intervention was the PEP, which had two components: (1) to educate nurses about pain management and (2) to implement daily pain assessment by using the Changhai Pain Scale. The duration of PEP was five weeks and intervention methods included focused education, group activity, and individual instruction. After the baseline data were collected, PEP was implemented in the experimental group. The control group (n=90) received no intervention, and the experimental group (n = 106) received six hours of focused education training. During the fourth and fifth weeks of the training program, the researcher and the faculty instructed nurses in five nursing units on how to use the Changhai Pain Scale to assess patients' pain levels and demonstrated how to document pain condition in the nursing records. Nurses in both groups filled out a set of questionnaires, which included a background information form and the Nurses' Knowledge and Attitude Survey form, before the PEP (T1), at one month after the PEP (T2), and at three months after the PEP (T3). Nurses in the experimental group who received the PEP had a significant improvement in their pain knowledge and attitudes. Their scores on the Nurses' Knowledge and Attitude Survey increased from 15.67 at T1 to 26.13 at T2 and 35.14 at T3. The scores of nurses in the control group were unchanged (from 15.20 at T1 to 14.29 at T2 and 14.93 at T3, P>0.05). In addition, experimental group nurses had an improvement in pain assessment. The percentage of nurses who correctly used the Changhai Pain Scale to assess patients' pain intensity increased significantly after the PEP, and the increased usage of the assessment tool between experimental and control groups also shows a statistical difference in trend (chi(2)=93.281, P<0.001). The PEP has been demonstrated to be effective in improving nurses' pain knowledge, attitudes, and assessment.
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Brink-Huis A, van Achterberg T, Schoonhoven L. Pain management: a review of organisation models with integrated processes for the management of pain in adult cancer patients. J Clin Nurs 2008; 17:1986-2000. [PMID: 18705779 DOI: 10.1111/j.1365-2702.2007.02228.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES This paper reports a review of the literature conducted to identify organisation models in cancer pain management that contain integrated care processes and describe their effectiveness. BACKGROUND Pain is experienced by 30-50% of cancer patients receiving treatment and by 70-90% of those with advanced disease. Efforts to improve pain management have been made through the development and dissemination of clinical guidelines. Early improvements in pain management were focussed on just one or two single processes such as pain assessment and patient education. Little is known about organisational models with multiple integrated processes throughout the course of the disease trajectory and concerning all stages of the care process. DESIGN Systematic review. METHOD The review involved a systematic search of the literature, published between 1986-2006. Subject-specific keywords used to describe patients, disease, pain management interventions and integrated care processes, relevant for this review were selected using the thesaurus of the databases. CONCLUSION Institutional models, clinical pathways and consultation services are three alternative models for the integration of care processes in cancer pain management. A clinical pathway is a comprehensive institutionalisation model, whereas a pain consultation service is a 'stand-alone' model that can be integrated in a clinical pathway. Positive patient and process outcomes have been described for all three models, although the level of evidence is generally low. Evaluation of the quality of pain management must involve standardised measurements of both patient and process outcomes. RELEVANCE TO CLINICAL PRACTICE We recommend the development of policies for referrals to a pain consultation service. These policies can be integrated within a clinical pathway. To evaluate the effectiveness of pain management models standardised outcome measures are needed.
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Affiliation(s)
- Anita Brink-Huis
- Centre for Quality of Care Research, WOK 117, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Abstract
Cancer pain is estimated to occur in 30% to 70% of patients with early-stage cancer and 60% to 95% with advanced cancer. Current research shows that cancer pain continues to be undertreated despite the availability of analgesics and established guidelines to maximize their effectiveness. The purpose of this study was to describe oncology patients' pain experience during an episode of hospitalization with particular emphasis on exploring the relationship between oncology patients' beliefs about pain and the treatment they received. Consecutive patients (n = 126) were interviewed 48 hours after admission to an urban and a regional hospital in Australia; 47.6% of patients had experienced moderate to severe pain in the previous 24 hours but had only received 40.4% of available analgesic. Patients held varying beliefs about pain and pain treatments in particular, 41% held strong beliefs about the potential for addiction to narcotics. Patients who held this belief reported higher current pain, worst pain intensity, and higher average pain intensity in the previous 24 hours. Effective pain management in the inpatient oncology setting continues to be an important clinical issue, and patients do not receive all available pain treatment. There may be an important association between patients' beliefs about pain and pain management and the pain management they receive.
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Dulko D. Audit and Feedback as a Clinical Practice Guideline Implementation Strategy: A Model for Acute Care Nurse Practitioners. Worldviews Evid Based Nurs 2007; 4:200-9. [DOI: 10.1111/j.1741-6787.2007.00098.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Assessing patients’ satisfaction and intensity of pain as outcomes in the management of cancer-related pain. Eur J Oncol Nurs 2007; 11:424-33. [DOI: 10.1016/j.ejon.2007.09.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Revised: 09/12/2007] [Accepted: 09/12/2007] [Indexed: 11/23/2022]
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Goldberg GR, Morrison RS. Pain management in hospitalized cancer patients: a systematic review. J Clin Oncol 2007; 25:1792-801. [PMID: 17470871 DOI: 10.1200/jco.2006.07.9038] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assist cancer centers in improving pain management, we conducted a systematic review of institutional interventions designed to improve the assessment and treatment of pain in hospitalized cancer patients. METHODS We performed a MEDLINE search for all English-language articles published from January 1966 through February 2006 using the medical subject headings terms of pain or pain measurement and outcome assessment (health care) or quality assurance (health care). Selected bibliographies were also searched. Studies were reviewed if they included clinical interventions directed at improving the treatment of cancer pain across an institution or nursing unit. Meta-analyses and randomized controlled trials or other controlled studies were included where possible. If no such trials were identified, then the best evidence available from studies with other designs was included. RESULTS Five interventions were identified. These interventions included professional and patient education, instituting regular pain assessment (pain as a vital sign), audit of pain results and feedback to clinical staff, computerized decisional support systems, and specialist-level pain consultation services. Most studies were small in size and used quasiexperimental pre-post test designs. Successes were reported in increasing patient satisfaction, increasing documentation of pain intensity, and improving nurses' knowledge and attitudes. No study reported successful interventions that consistently improved patients' pain severity. CONCLUSION Although professional knowledge and attitudes about pain and nursing pain assessment rates have been shown to be improvable, no systematic, hospital-wide intervention has yet to be associated with improvement in pain severity. Future research on the development of new interventions, perhaps targeted specifically at physicians, is urgently needed.
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Affiliation(s)
- Gabrielle R Goldberg
- Division of Hematology and Medical Oncology, Samuel Bronfman Department of Medicine, Mount Sinai School of Medicine, New York 10029, USA
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Cooke L, Smith-Idell C, Dean G, Gemmill R, Steingass S, Sun V, Grant M, Borneman T. "Research to Practice": A Practical Program to Enhance the Use of Evidence-Based Practice at the Unit Level. Oncol Nurs Forum 2007; 31:825-32. [PMID: 15252437 DOI: 10.1188/04.onf.825-832] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To assist clinical nurses in translating research into clinical practice. DATA SOURCES City of Hope Quality-of-Life (QOL) Model to guide presentations and discussion, research utilization theories, and evidence-based practice literature. DATA SYNTHESIS Based on percentage of individual participant involvement, the four domains of QOL, and a knowledge survey. OUTCOMES Attendance, discussion, QOL domain ranking, satisfaction, and pre- and postknowledge scores. Attendance averaged 13 individuals; average discussion participation was 54%. The psychological QOL domain was most important (58%), and discussion averaged a score of 3 (1 = slow to 5 = lively). A one-point increase (scale 1-5) measured a change in knowledge. CONCLUSIONS The challenge for nursing assessment is to fully address patient issues in the psychological domain. IMPLICATIONS FOR NURSING A practical program can be formulated to bring evidence-based practice to the clinical setting.
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Affiliation(s)
- Liz Cooke
- City of Hope National Medical Center, Duarte, CA, USA.
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Lorenz KA, Lynn J, Dy S, Wilkinson A, Mularski RA, Shugarman LR, Hughes R, Asch SM, Rolon C, Rastegar A, Shekelle PG. Quality measures for symptoms and advance care planning in cancer: a systematic review. J Clin Oncol 2006; 24:4933-8. [PMID: 17050878 DOI: 10.1200/jco.2006.06.8650] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Measuring quality of care for symptom management and ascertaining patient goals offers an important step toward improving palliative cancer management. This study was designed to identify systematically the quality measures and the evidence to support their use in pain, dyspnea, depression, and advance care planning (ACP), and to identify research gaps. METHODS English-language documents were selected from MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO (1995 to 2005); Internet-based searches; and contact with measure developers. We used terms for each domain to select studies throughout the cancer care continuum. We included measures that expressed a normative relationship to quality, specified the target population, and specified the indicated care. Dual data review and abstraction was performed by palliative care researchers describing populations, testing, and attributes for each measure. RESULTS A total of 4,599 of 5,182 titles were excluded at abstract review. Of 537 remaining articles, 19 contained measures for ACP, six contained measures for depression, five contained measures for dyspnea, and 20 contained measures for pain. We identified 10 relevant measure sets that included 36 fully specified or fielded measures and 14 additional measures (16 for pain, five for dyspnea, four for depression, and 25 for ACP). Most measures were unpublished, and few had been tested in a cancer population. We were unable to describe the specifications of all measures fully and did not search for measures for pain and depression that were not cancer specific. CONCLUSION Measures are available for assessing quality and guiding improvement in palliative cancer care. Existing measures are weighted toward ACP, and more nonpain symptom measures are needed. Additional testing is needed before the measures are used for accountability, and basic research is required to address measurement when self-report is impaired.
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Affiliation(s)
- Karl A Lorenz
- Veterans Affairs Greater Los Angeles Healthcare System, Division of General Internal Medicine, Los Angeles, CA 90073, USA.
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Malouf J, Andión O, Torrubia R, Cañellas M, Baños JE. A survey of perceptions with pain management in Spanish inpatients. J Pain Symptom Manage 2006; 32:361-71. [PMID: 17000353 DOI: 10.1016/j.jpainsymman.2006.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2006] [Indexed: 11/30/2022]
Abstract
The aim of this study was to document the satisfaction with pain management in a Spanish inpatient population and its relationship with pain ratings. Two hundred fifty inpatients of four departments were interviewed: Surgery, Orthopedics, Gynecology, and Internal Medicine. A 32-item questionnaire was used, and the main variables evaluated were pain severity, dissatisfaction with pain management and caregivers, and patient expectations regarding pain relief. Relationships among the variables were analyzed by means of Spearman's correlation between item scores and regression analysis. Median satisfaction scores were consistent with "very satisfied." Mean (SD) worst pain during the past 24 hours was 68.8 (27.5) on a 100 mm visual analogue scale. "Dissatisfaction with Pain Management" correlated positively with "Dissatisfaction with Medical Staff" (0.42), and inversely with "Pain Now" (-0.41) and "Expected Pain Relief" (-0.38). Regression analysis showed that "Dissatisfaction with Pain Management" was dependent on "Pain Now," "Least Pain," and "Dissatisfaction with Medical Staff," with statistically significant beta weight values of 0.277, 0.197, and 0.280, respectively. The study shows that patients were highly satisfied with pain management, even when they were in pain. Moreover, it establishes that patient dissatisfaction with treatment was highly related to the satisfaction with caregivers and pain intensity.
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Affiliation(s)
- Jorge Malouf
- Department of Experimental and Health Sciences , School of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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Hansson E, Fridlund B, Hallström I. Effects of a Quality Improvement Program in Acute Care Evaluated by Patients, Nurses, and Physicians. Pain Manag Nurs 2006; 7:93-108. [PMID: 16931415 DOI: 10.1016/j.pmn.2006.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hospitalized patients have a right to be assessed for pain and receive optimal pain management, but inadequate pain management is still widely prevalent. Different quality improvement (QI) approaches have been used to improve patients' experience of pain, with varied results. The aim of this study was to implement a QI program and evaluate its effects on pain management routines in acute care, experienced by patients, nurses, and physicians. A cross-sectional intervention study was conducted with patients, nurses, and physicians assigned to a control group for 2 months in 2002 and an intervention group for 2 months in 2003. Implementation of a QI program, including pain policy and an educational program for the health care professionals, was evaluated with questionnaires. Nurses' assessment of pain at rest and pain with movement with pain rating scales increased (p < .001) after the intervention. Nurses participating in the educational program increased their knowledge of pain and changed their pain management routines and search habits for pain-related websites on the Internet. The number of patients assessed with pain rating scales increased (p = .011), but no difference was seen in patients' experience of pain severity, interference with function, or use of nonpharmacologic methods. Younger and higher-educated patients seemed to prefer a more active participation role in their pain management than did older and low-educated patients. In future research it would be valuable to illuminate patients' possibilities to participate in pain management further and test different implementation methods with varied length of educational programs including follow-ups for the whole team and the patients in acute care.
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Dihle A, Helseth S, Kongsgaard UE, Paul SM, Miaskowski C. Using the American Pain Society's patient outcome questionnaire to evaluate the quality of postoperative pain management in a sample of Norwegian patients. THE JOURNAL OF PAIN 2006; 7:272-80. [PMID: 16618471 DOI: 10.1016/j.jpain.2005.11.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Revised: 09/30/2005] [Accepted: 11/03/2005] [Indexed: 12/16/2022]
Abstract
UNLABELLED In the United States, quality improvement (QI) approaches have been used to evaluate pain management. However, the use of QI approaches to evaluate the quality of patient care is just emerging in many European countries. The purposes of this study, using the American Pain Society's QI Standards, were: to describe changes over time, in pain severity, in pain interference with function, and in the doses of analgesics administered; to describe patients' level of satisfaction with postoperative pain management; and to determine the relationships between pain severity and patient outcomes. Results from a sample of patients who underwent orthopedic surgery suggest that undertreatment of pain persists across the first 5 postoperative days and that pain's level of interference with function decreases significantly between the third and fifth postoperative days. As in other studies, despite high pain intensity scores, patients reported high levels of satisfaction with postoperative pain management. PERSPECTIVE Findings suggest that the undertreatment of pain results in significant decrements in function over the first 5 postoperative days. Future studies designed to improve the quality of postoperative pain management need to use multimodal approaches and evaluate not only pain intensity, but improvements in function as critical outcome measures.
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Affiliation(s)
- Alfhild Dihle
- Faculty of Nursing, Oslo University College, Oslo, Norway.
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Morrison RS, Meier DE, Fischberg D, Moore C, Degenholtz H, Litke A, Maroney-Galin C, Siu AL. Improving the management of pain in hospitalized adults. ARCHIVES OF INTERNAL MEDICINE 2006; 166:1033-9. [PMID: 16682579 PMCID: PMC3045761 DOI: 10.1001/archinte.166.9.1033] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Pain is a major quality issue. The objective of this study was to evaluate the effectiveness of a series of interventions on pain management. METHODS This controlled clinical trial (April 1, 2002, to February 28, 2003) involved the staggered implementation of 3 interventions into 2 blocks of matched hospital units. The setting was an 1171-bed hospital. A total of 3964 adults were studied. Interventions included education, standardized pain assessment using a 1- or 4-item (enhanced) pain scale, audit and feedback of pain scores to nursing staff, and a computerized decision support system. The main outcome measures were pain assessment and severity and analgesic prescribing. RESULTS Units using enhanced pain scales had significantly higher pain assessment rates than units using 1-item pain scales (64% vs 32%; P<.001), audit and feedback of pain results was associated with increases in pain assessment rates compared with units in which audit and feedback was not used (85% vs 64%; P<.001), and the addition of the computerized decision support system was associated with significant increases in pain assessment only when compared with units without audit and feedback (79% vs 64%; P<.001). The enhanced pain scale was associated with significant increases in prescribing of World Health Organization step 2 or 3 analgesic for patients with moderate or severe pain compared with the 1-item scale (83% vs 66%; P=.01). The interventions did not improve pain scores. CONCLUSIONS A clinically meaningful pain assessment instrument combined with either audit and feedback or a computerized decision support system improved pain documentation to more than 80%. The enhanced pain scale was associated with improved analgesic prescribing. Future interventions should be directed toward altering physician behavior related to titration of opioid analgesics.
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Affiliation(s)
- R Sean Morrison
- Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Strassels SA, McNicol E, Suleman R. Postoperative pain management: A practical review, part 1. Am J Health Syst Pharm 2005; 62:1904-16. [PMID: 16141110 DOI: 10.2146/ajhp040490.p1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE The pharmacotherapy and assessment of postoperative pain in general pharmacy practice settings are reviewed. SUMMARY Numerous factors related to all levels of society and the health care system contribute to suboptimal treatment of postoperative pain, despite awareness of this challenge for at least the past 30 years and the availability of potent analgesics and tools to help clinicians care for persons with postoperative pain. The consequences of acute pain include clinical, economic, and patient-reported outcomes; thus, improving the treatment of postoperative pain has the potential to improve health care from a broad perspective. Opioids remain the cornerstone of treatment of postoperative pain. Multimodal analgesia also has the potential to improve the pharmacotherapy of postoperative pain. In addition to the appropriate use of drugs, it is important that clinicians be comfortable with equianalgesic dosage conversion, helping ensure that analgesic-related adverse effects are minimal, assessing pain and function, and incorporating this information into patient care. CONCLUSION Providing optimal management of postoperative pain is a vital goal for all health care providers. There is substantial potential for pharmacists to help meet this goal.
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Affiliation(s)
- Scott A Strassels
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle 98195, USA.
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Roth W, Kling J, Gockel I, Rümelin A, Hessmann M, Meurer A, Gillitzer R, Jage J. Dissatisfaction with post-operative pain management—A prospective analysis of 1071 patients. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.acpain.2005.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Mendoza T, Mayne T, Rublee D, Cleeland C. Reliability and validity of a modified Brief Pain Inventory short form in patients with osteoarthritis. Eur J Pain 2005; 10:353-61. [PMID: 16051509 DOI: 10.1016/j.ejpain.2005.06.002] [Citation(s) in RCA: 288] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Revised: 06/10/2005] [Accepted: 06/13/2005] [Indexed: 11/28/2022]
Abstract
The Brief Pain Inventory short form (BPI-sf) is a validated, widely used, self-administered questionnaire developed to assess the severity of pain and the impact of pain on daily functions. A modified version was used daily in randomised control trials of patients with arthritis undergoing treatment with cyclooxygenase-2 specific inhibitors and non-steroidal anti-inflammatory drugs. Results indicate that the modified BPI-sf, much like the original scale, was internally reliable, consistent over time, and had good construct, as well as convergent and predictive validity in assessment of patients suffering from conditions of chronic pain. Each scale and individual pain intensity item refers to changes in osteoarthritis pain associated with medication use. The modified BPI-sf, like the parent scale, is a valid and reliable tool for situations in which pain is assessed daily and minimises the burden placed on patients to record information necessary for scientific investigations.
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Affiliation(s)
- Tito Mendoza
- Pain Research Group, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, 77030, USA.
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Yun YH, Park SM, Lee K, Chang YJ, Heo DS, Kim SY, Hong YS, Huh BY. Predictors of prescription of morphine for severe cancer pain by physicians in Korea. Ann Oncol 2005; 16:966-71. [PMID: 15857848 DOI: 10.1093/annonc/mdi180] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study was undertaken to identify predictors of the prescription of strong opioids, which are important for the management of severe cancer pain, by Korean physicians. METHODS A questionnaire based on a hypothetical case designed to assess the prescription of morphine by physicians was administered to 800 specialists in the Korea Cancer Association, of whom 147 (18.4%) responded, and to 2200 specialists in the Korean Academy of Family Medicine, of whom 388 (17.6%) responded. We used a multidimensional approach to identify the predictors of prescription of morphine by physicians. RESULTS In the hypothetical case scenario, only 16.5% of the respondents stated that they would prescribe morphine for severe cancer pain. Multiple logistic regression analysis showed that physicians with a positive attitude regarding opioid addiction [odds ratio (OR) 2.62; 95% confidence interval (CI) 1.54-4.46], experience of pain assessment (OR 2.09; 95% CI 1.13-3.87), recent residency training (OR 2.27; 95% CI 1.30-4.0) and positive self-evaluation as an oncology specialist (OR 2.60; 95% CI 1.41-4.78) were more likely to prescribe morphine. None of the 13 variables in the knowledge dimension significantly predicted prescription of morphine for severe cancer pain. CONCLUSIONS The results of the survey suggest that we need to develop strategies to develop a positive attitude toward opioids, to increase experience in pain assessment and to improve cancer pain management training among Korean physicians.
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Affiliation(s)
- Y H Yun
- Quality of Cancer Care Branch, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
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Chang YJ, Yun YH, Park SM, Lee SW, Park HA, Ro YJ, Huh BY. Nurses' willingness to maximize opioid analgesia for severe cancer pain, and its predictor. Support Care Cancer 2005; 13:743-51. [PMID: 15827729 DOI: 10.1007/s00520-005-0791-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Accepted: 02/02/2005] [Indexed: 11/25/2022]
Abstract
GOALS OF WORK The effectiveness of cancer pain management (CPM) is influenced by nurses' willingness to maximize opioid analgesia for severe cancer pain. The purposes of this study were to identify the willingness of nurses to provide maximum-dose opioids whenever needed for CPM and to determine its associated predictors. METHODS This multicenter study was conducted among the entire total of registered nurses in seven large hospitals in Korea. Its overall response rate was 41.6%, and the data from 930 who responded (40.1%) were analyzed. We utilized a three-step, multidimensional, multiple logistic regression to identify the predictors of nurses' willingness. MAIN RESULTS Only 255 nurses (27.4%) indicated that they recommended the maximum dose of opioids whenever it was needed. The respondents who were more likely to recommend morphine showed the following characteristics: older nurses (odds ratio, OR, 1.57; confidence interval, CI, 1.13-2.19); they knew the effectiveness of opioids for CPM (OR 1.53; CI 1.06-2.20); rarely concerned about a patient's addiction to opioids (OR 2.16; CI 1.48-3.15), or to a family member's addiction (OR 1.81; CI 1.20-2.73); prior experience with pain assessment tools (OR 1.62; CI 1.11-2.37); practical experience caring for cancer patients with pain over 51% (OR 1.55; CI 1.09-2.19). CONCLUSIONS Our multicenter study suggested that in order to improve nurses' willingness to recommend opioids liberally in CPM: (1) attitudes about fear of opioid addiction must be changed; (2) the efficiency of opioids in CPM must be taught; and (3) implementation of pain assessment tools must be undertaken.
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Affiliation(s)
- Yoon Jung Chang
- Cancer Information Branch, Research Institute, National Cancer Center, Goyang, South Korea
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Ellis P, Robinson P, Ciliska D, Armour T, Brouwers M, O'Brien MA, Sussman J, Raina P. A Systematic Review of Studies Evaluating Diffusion and Dissemination of Selected Cancer Control Interventions. Health Psychol 2005; 24:488-500. [PMID: 16162043 DOI: 10.1037/0278-6133.24.5.488] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With this review, the authors sought to determine what strategies have been evaluated (including the outcomes assessed) to disseminate cancer control interventions that promote the uptake of behavior change. Five topic areas along the cancer care continuum (smoking cessation, healthy diet, mammography, cervical cancer screening, and control of cancer pain) were selected to be representative. A systematic review was conducted of primary studies evaluating dissemination of a cancer control intervention. Thirty-one studies were identified that evaluated dissemination strategies in the 5 topic areas. No strong evidence currently exists to recommend any one dissemination strategy as effective in promoting the uptake of cancer control interventions. The authors conclude that there is a strong need for more research into dissemination of cancer control interventions. Future research should consider methodological issues such as the most appropriate study design and outcomes to be evaluated.
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Affiliation(s)
- Peter Ellis
- Hamilton Regional Cancer Centre, Hamilton, ON, Canada
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Abstract
Uncontrolled postoperative pain continues despite abundant research in the area. The purposes of the paper are to review how past research influences our understanding of pain in the postsurgery context and to argue for a methodological shift towards naturalistic inquiry. Such a shift incorporates the complexities of pain assessment and management in the clinical practice environment. Decisions regarding pain are often examined outside of the contextual concerns of clinical practice. Research approaches have involved analyses of nurse and patient-related factors associated with pain. These approaches do not account for complex interactions that occur between nurses, patients and the dynamic environment in which these interactions take place. The failure of research to address the context of pain decisions has several implications. It limits our understanding of why pain continues despite ongoing research and it does not enable evaluation of clinical strategies to improve pain decision-making and pain outcomes for patients.
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Affiliation(s)
- Mari Botti
- Alfred/Deakin Nursing Research Centre, School of Nursing, Faculty of Health and Behavioural Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
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Jones KR, Fink R, Pepper G, Hutt E, Vojir CP, Scott J, Clark L, Mellis K. Improving Nursing Home Staff Knowledge and Attitudes About Pain. THE GERONTOLOGIST 2004; 44:469-78. [PMID: 15331804 DOI: 10.1093/geront/44.4.469] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Effective pain management remains a serious problem in the nursing home setting. Barriers to achieving optimal pain practices include staff knowledge deficits, biases, and attitudes that influence assessment and management of the residents' pain. DESIGN AND METHODS Twelve nursing homes participated in this intervention study: six treatment homes and six control homes, divided evenly between urban and rural locations. Three hundred licensed and unlicensed nursing home staff members completed written knowledge and attitude surveys at baseline, and 378 staff members completed the surveys after intervention implementation. RESULTS Baseline results revealed notable knowledge deficits in the areas of pharmacology, drug addiction and dependence, side effect management, and nonpharmacologic management-strategy effectiveness. Significant differences were noted by job title (registered nurse/licensed practical nurse/certified nursing assistant). Case studies displayed a knowledge application problem, with nurses often filtering resident pain reports through observed resident behaviors. The intervention led to significant improvement in knowledge scores in some, but not all, the treatment homes. Perceived barriers to effective pain management showed a significant decline across all study nursing homes. IMPLICATIONS Knowledge deficits related to pain management persist in nursing homes. An interactive multifaceted educational program was only partially successful in improving knowledge across settings and job categories. Attitudes and beliefs appear more difficult to change, whereas environmental and contextual factors appeared to be reducing perceived barriers to effective pain management across all participating nursing homes.
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Affiliation(s)
- Katherine R Jones
- School of Nursing, Yale University, 100 Church St. S., Box 9740, New Haven, CT 06536-0740, USA.
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Abstract
Pain management is an essential component of quality care delivery for the critically ill patient. Because outcomes are difficult to predict in the intensive care unit (ICU), high-quality pain management and palliative therapy should be a goal for every patient. For those patients actively dying, palliation may be among the main benefits offered by the health care team. Appropriate palliation of pain begins with the use of effective strategies for recognizing, evaluating,and monitoring pain. Skill in pain management requires knowledge of both pharmacologic and nonpharmacologic therapies. This article focuses on expertise in the use of opiates to facilitate confident and appropriate pain therapy. To optimize palliative therapy, symptoms are best addressed by interdisciplinary care teams guided by models that acknowledge a continuum of curative therapies and palliative care.
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Affiliation(s)
- Richard A Mularski
- Veterans Affairs Greater Los Angeles Healthcare System, Division of Pulmonary & Critical Care Medicine, University of California-Los Angeles, Los Angeles, CA 90073, USA.
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McNeill JA, Sherwood GD, Starck PL. The hidden error of mismanaged pain: a systems approach. J Pain Symptom Manage 2004; 28:47-58. [PMID: 15223084 DOI: 10.1016/j.jpainsymman.2003.11.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2003] [Indexed: 10/26/2022]
Abstract
Undertreatment of pain resulting in physiological, psychosocial, and economic consequences continues despite targeted improvement approaches. Starck et al. propose a systems framework for study of pain management errors. This secondary analysis examined pain outcomes of hospitalized inpatients to determine factors predicting adequate pain management. Data were collected from 964 hospitalized adult patients in the southwestern United States. The American Pain Society Patient Outcome Questionnaire and a demographic and chart audit form were used to collect data. The Pain Management Index (PMI) was computed for all participants. Results revealed that 30% of patients were undertreated for pain, with 67.5% reporting severe worst pain ratings (7 on a 0-10 scale). Non-whites, the elderly, and women had significantly higher pain ratings and higher proportions of negative PMI scores. Logistic regression predicted adequate pain management based on analgesic rating, ethnicity, age, and educational level with 0.89 accuracy. The study findings support conceptualizing mismanagement of pain as a medical error. An intervention model describes the use of a systems approach to identify high risk patients and ensure effective pain management practices for all.
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Affiliation(s)
- Jeanette A McNeill
- University of Texas-Houston Health Science Center, School of Nursing, Houston, Texas 77030, USA
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Ravaud P, Keïta H, Porcher R, Durand-Stocco C, Desmonts JM, Mantz J. Randomized clinical trial to assess the effect of an educational programme designed to improve nurses' assessment and recording of postoperative pain. Br J Surg 2004; 91:692-8. [PMID: 15164436 DOI: 10.1002/bjs.4506] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of an intervention designed to improve postoperative pain assessment and recording by nurses. METHODS This cluster randomized clinical trial included two intervals of 3 months each: a preintervention observational study (period 1) followed by a period of intervention (period 2). Six surgical wards were randomly assigned to receive either an experimental intervention, including educational seminars for nurses on pain, pain assessment and the use of a visual analogue scale (n = 3), or standard care (control group; n = 3). The main outcome measures were the percentage of patients in whom pain was assessed, number of pain assessments per patient and postoperative pain intensity scores. RESULTS A total of 2278 patients were included. Significant improvements were found in the percentage of patients in whom pain was assessed and the number of daily pain assessments per patient in the intervention group between periods 1 and 2. In contrast, these outcomes were unchanged between the two intervals in wards randomized to standard care. During period 2, pain scores at 48 h were significantly decreased in the intervention wards compared with those in the control group. CONCLUSION An educational programme dedicated to nurses strongly increased the use of regular pain assessment, and may have contributed to a modest improvement in postoperative analgesia.
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Affiliation(s)
- P Ravaud
- Département d'Epidémiologie et INSERM EMI 0357, Faculté Lariboisière-Saint-Louis (Université Paris 7) et INSERM ERM 0321, Paris, France
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Affiliation(s)
- R Sean Morrison
- Hertzberg Palliative Care Institute, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York 10029, USA.
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