Pain and health-related quality of life among cancer patients in final stage of life: a comparison between two palliative care teams

Younger age is associated with greater pain expression among patients with knee or hip osteoarthritis scheduled for a joint arthroplasty

BACKGROUND

This study describes how patients with knee or hip osteoarthritis (OA), scheduled for arthroplasty, characterize their pain qualitatively and quantitatively and investigates whether differences exist in pain expression between younger and older patients, and between men and women.

METHODS

One hundred eight patients scheduled for a joint arthroplasty completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) or Hip Disability and Osteoarthritis Outcome Score (HOOS) and a health-related quality of life question. Pain was assessed using the visual analogue scale (VAS), KOOS/HOOS and the Pain-o-Meter (POM) consisting of 12 sensory and 11 affective words (POM-Words). Frequency of analgesics use was assessed and preoperative radiographs were graded. ANOVA was used to test differences in pain expression with age (< 65 vs. ≥65 years), sex, and affected joint as independent factors.

RESULTS

Patients < 65 years of age used more affective words (POM) and words with higher affective intensity (median scores 8 (3-39), 5.5 (2-27) respectively), than older patients, despite having less radiographically advanced OA. They also reported more symptoms (KOOS/HOOS) than older patients. However, pain ratings, as measured by VAS and KOOS/HOOS pain, did not differ between younger and older adults. Women reported more frequent analgesics use (45.7 and 26.5% respectively) and rated their pain higher than men (mean POM-VAS = 42 (SD 24) and 31 (SD 19); respectively). No differences existed between sexes for sensory or affective POM-Words, or radiographic grade of OA. With age and sex as independent factors, a significant difference between knee and hip OA remained for sensory POM-words intensity scores.

CONCLUSIONS

Younger adults scheduled for arthroplasty expressed pain using more affective words and words with higher intensity and had less radiographically advanced OA than older adults. However, VAS and KOOS/HOOS pain subscales could not distinguish the difference in pain expression. Thus, the POM may be a valuable tool for assessment of pain.

Effect on symptom control of structured information given to patients receiving chemotherapy

PURPOSE

The performance of a planned education model in patients receiving chemotherapy can alleviate the side effects of chemotherapy and thus can increase the quality of the patients' lives. In accordance with this view, this study was conducted with the purpose of examining the effect of planned education given to patients receiving chemotherapy on their symptom control.

METHODS

The study was quasi-experimental. A sample of 120 patients participated, of which 60 were in the experimental group (EG) and 60 were in the control group (CG). A patient data form and the chemotherapy symptom assessment scale (C-SAS) were used in order to collect the data. Median, Mann-Whitney U test and Wilcoxon signed rank test were used to analyze the data.

RESULTS

There were statistically significant decreases in the frequencies of the following symptoms: nausea, vomiting, constipation, pain, infectious signs, problems of mouth and throat, problems of skin and nails, appetite changes, weight loss or weight gain, feeling distressed/anxious, feeling pessimistic and unhappy, unusual fatigue, difficulty sleeping. Also, there were statistically significant decreases in the severity of eleven symptoms and on the discomfort levels of nine symptoms.

CONCLUSION

In the study, the planned education provided by the health-care providers had a positive effect on the symptom control of patients receiving chemotherapy.

[Development and evaluation of "Hospice Smart Patient" service program]

PURPOSE

The purpose of this study was to develop and implement the Hospice Smart Patient Program and to evaluate its effectiveness.

METHODS

It was quasi-experimental non-equivalent pre-post study. Breast cancer patients who underwent surgery, chemotherapy or radiotherapy, or who needed palliative care, participated in the study. Participants were divided into two groups, experimental and control groups based on their preferences. The program was developed after literature review and discussion among experts on hospice and palliative care. Participants who were in the experimental group received either face-to-face or phone "Hospice Smart Patient" Service at least once a week for 5 months.

RESULTS

There was a significant difference in quality of life and communication skill between the two groups after the service was provided. In addition, participants in experimental group showed improved decision making skills, mastery sense, and understanding of hospice and palliative care, which would be beneficial in improving their quality of life.

CONCLUSION

We have concluded that the "Hospice Smart Patient" Program is useful for cancer patients in decision making, improving self-control and choosing hospice care to improve their quality of life.

[Effects of a palliative care program based on home care nursing]

PURPOSE

This study was done to develop and test a palliative care program based on home care nursing.

METHODS

A quasi-experimental design was employed. Changes in the variables were evaluated to test effects of the developed program. Participants were patients with terminal cancer and their families receiving home care nursing from six hospitals (experimental group: 24 and control group: 22). Data collection was conducted from February to October, 2006. chi-square test, Fisher's exact test, t-test, Mann-Whitney U test and repeated measures ANOVA were used to analyse the data.

RESULTS

Hypothesis 1, the experimental group receiving this program will experience less pain (severe, average, weak pain) than the control group, was supported. Hypothesis 2, the experimental group will have less symptom experience than the control group, was supported. Hypothesis 3, the experimental group will have higher QOL than the control group, was supported and the last hypothesis 4, family burden in the experimental group will be less than the control group, was supported.

CONCLUSION

The home care nursing based palliative program developed in this study was found to be an effective program to reduce patient pain and symptom experience, to improve patient QOL and to decrease family burden.

Reliability and validity of the EORTC QLQ-C30 in palliative care cancer patients

Palliative care aims at improving the patient’s quality of life. The assessment of this quality of life (QoL) is crucial for the evaluation of palliative care outcome. Many patients require hospital admissions for symptom control during their cancer journey and most of them die in hospitals, although they would like to stay at home until the end of their lives. In 1986, the European Organization for Research and Treatment (EORTC) initiated a research programme to develop an integrated, modular approach for evaluating the quality of life of patients participating in international clinical trials. This questionnaire measures cancer patients’ physical, psychological and social functions and was used in a wide range of clinical cancer trials with large numbers of research groups and also in various other non-trial studies. The aim of this study was to evaluate the psychometric properties, especially the reliability, validity and applicability of the EORTC QLQ-C30 in a German sample of terminally ill cancer patients receiving palliative care in different settings. The questionnaire was well accepted in the present patient population. Scale reliability was good (pre-treatment 0.80) especially for the functional scale. The results support the reliability and validity of the QLQ-C30 (version 3.0) as a measure of the health-related quality of life in German cancer patients receiving palliative care treatment.

Interdisciplinary teams in palliative care: a critical reflection

The notion of the interdisciplinary team as integral to the delivery of palliative care emerges clearly and consistently in palliative care philosophy and practice discourses. Many studies have found clear benefits of interdisciplinary palliative care teams. The empirical evidence supporting such teams, however, is not all positive. It is perhaps timely and appropriate to examine critically how palliative care interdisciplinary teams provide optimum support for patients and families. This article examines the notion that palliative care interdisciplinary teams are universally or inevitably effective and identifies potential barriers and constraints to effective teamwork. In particular, it is suggested that there is a need for careful examination of how teams function in the realm of 'psychosocial' care, and ways to look beyond rhetoric are articulated in order to facilitate teams to function more efficiently to provide optimum patient care.

Descriptions of pain in elderly patients following orthopaedic surgery

The aims of this study were to investigate what words elderly patients, who had undergone hip surgery, used to describe their experience of pain in spoken language and to compare these words with those used in the Short-Form McGill Pain Questionnaire (SF-MPQ) and Pain-O-Meter (POM). The study was carried out at two orthopaedic and two geriatric clinical departments at a large university hospital in Sweden. Altogether, 60 patients (mean age =77) who had undergone orthopaedic surgery took part in the study. A face-to-face interview was conducted with each patient on the second day after the operation. This was divided into two parts, one tape-recorded and semi-structured in character and one structured interview. The results show that a majority of the elderly patients who participated in this study verbally stated pain and spontaneously used a majority of the words found in the SF-MPQ and in the POM. The patients also used a number of additional words not found in the SF-MPQ or the POM. Among those patients who did not use any of the words in the SF-MPQ and the POM, the use of the three additional words 'stel' (stiff), 'hemsk' (awful) and 'rad(d)(sla)' (afraid/fear) were especially marked. The patients also combined the words with a negation to describe what pain was not. To achieve a more balanced and nuanced description of the patient's pain and to make it easier for the patients to talk about their pain, there is a need for access to a set of predefined words that describe pain from a more multidimensional perspective than just intensity. If the elderly patient is allowed, and finds it necessary, to use his/her own words to describe what pain is but also to describe what pain is not, by combining the words with a negation, then the risk of the patient being forced to choose words that do not fully correspond to their pain can be reduced. If so, pain scales such as the SF-MPQ and the POM can create a communicative bridge between the elderly patient and health care professionals in the pain evaluation process.