Enhancing management of cancer pain: contribution of the internal working model

My Love is Hurting: The Meaning Spouses Attribute to Their Loved Ones’ Pain during Palliative Care

The purpose of this qualitative study was to develop our knowledge of the pain experiences of family members by addressing the meaning of cancer pain to the spouse of a patient receiving palliative care. In particular, this study explored factors associated with the meanings the spouses ascribe to the experience of pain during palliative care and whether the meanings the patients attributed to pain were similar to the meanings held by the spouse. Two different states emerged, the “in-pain state” and the “out of pain state”. The spouses described feelings of helplessness, fear, and unfairness when witnessing their loved one in pain. Once the pain had been controlled, spouses described feelings of peace and relaxation, and felt this meant that the couple could return to their old routines because their spouse was still alive. It was discovered that the meanings placed on the cancer pain differed for the spouse and the patient, with the spouse focusing on future consequences. Implications and suggestions for nursing practice and future research are proposed.

Family caregivers of Palliative Cancer Patients at Home: The puzzle of Pain Management

The purpose of this grounded theory study was to understand the processes used by family care-givers to manage the pain of cancer patients at home. A total of 24 family caregivers participated. They were recruited using purposeful then theoretical sampling. The data sources were taped, transcribed (semi-structured) interviews and field notes. Data analysis was based on Strauss and Corbin's (1998) requirements for open, axial, and selective coding. The result was an explanatory model titled “the puzzle of pain management,” which includes four main processes: “drawing on past experiences”; “strategizing a game plan”; “striving to respond to pain”; and “gauging the best fit,” a decision-making process that joins the puzzle pieces. Understanding how family caregivers assemble their puzzle pieces can help health care professionals make decisions related to the care plans they create for pain control and help them to recognize the importance of providing information as part of resolving the puzzle of pain management.

Symptom clusters among multiethnic groups of cancer patients with pain

OBJECTIVE

Considering recent inconsistent findings on ethnic differences in cancer pain experience, there is a need to clarify the association of ethnicity to cancer pain experience through diverse approaches. However, there currently exist only a small number of studies on ethnic differences in cancer pain experience in general, and few symptom cluster studies specifically related to ethnic differences in cancer pain experience. The purpose of this study was to cluster cancer patients who reported similar cancer pain experience, and to determine ethnic differences in the clusters.

METHOD

This was a secondary analysis of the data from a larger Internet study on cancer pain experience of four major ethnic groups of cancer patients in the United States. Only 388 subjects who responded to the questions on cancer pain, cancer symptoms, and functional status were included for this secondary analysis. The data were analyzed using hierarchical cluster analysis and multinomial logistic analysis.

RESULTS

A three-cluster solution was adopted: 1) Cluster 1 with low pain, low symptoms, and high functional status, 2) Cluster 2 with moderate pain, low symptoms, and moderate functional staus, and 3) Cluster 3 with high pain, moderate symptoms, and low functional status. In Cluster 2, there were ethnic difference in the cancer pain and funtional status scores; Asian Americans reported lower pain scores than did other ethnic groups, and African Americans had higher funtional status scores than did other ethnic groups. In Cluster 3, there were ethnic difference in the symptom scores (p < 0.05); African Americans reported higher symptom scores than did whites.

SIGNIFICANCE OF RESULTS

The results of this study add an important piece of information on ethnic differences in symptom clusters. This study suggests further national scope studies on clustering multiethnic groups of cancer patients by cancer pain experience.

Psychological and behavioural predictors of pain management outcomes in patients with cancer

To better understand the phenomenon of patient-related barriers to cancer pain management and address them more effectively in interventional studies, a theoretical model related to psychological aspects of pain experience and pain-related behaviours was elaborated. The aim of the study was to analyse the impact of patient-related barriers on cancer pain management outcomes following this model. Thirty-three patients responded to the Brief Pain Inventory Pain scale, the Danish Barriers Questionnaire II (DBQ-II), the Hospital Anxiety and Depression scale (HADS), the Danish version of Patient Perceived Involvement in Care Scale measuring the quality of patient-physician pain communication, and the Danish version of Medication Adherence Report Scale (DMARS-4). Statistical analysis was performed with SPSS 16.00. The results of the multivariable linear regression analyses showed that pain intensity was explained by patients' emotional distress (symptoms of anxiety and depression) and that pain relief was explained by cognitive barriers. In conclusion, interventions in emotional distress and patients' concerns may supposedly result in better cancer pain management outcomes.

Barriers to pain management among Lithuanian cancer patients

OBJECTIVES

The objectives of this study are (1) to describe Lithuanian cancer patients' barriers to pain management as well as pain management outcomes, (2) to check the reliability and validity of the questionnaires used in Lithuanian for the first time, and (3) to formulate patient-centered recommendations for better cancer pain management.

METHODS

Thirty patients from the Pain Clinic of Kaunas University of Medicine Hospital responded to the Lithuanian versions of: (1) Brief Pain Inventory pain scale, (2) Barriers Questionnaire-II, (3) Hospital Anxiety and Depression Scale, (4) Modified version of the Perceived Involvement in Care Scale, and (5) Medication Adherence Report Scale.

RESULTS

The translated questionnaires had fear internal consistency reliability and construct validity. Reported average (standard deviation [SD]) pain intensity among Lithuanian cancer patients was 3.9 (1.30) on a scale 0-10. The mean (SD) scores of anxiety and depression among the surveyed patients were 8.7 (4.86) and 7.5 (5.05) on a scale 0-21, respectively. The percentage of the patients, who reported stopping taking pain medicine because of its side effects, was 33.3%. The biggest patients' concerns were about physiological consequences and harmful effects of opioid use. The average (SD) level of perceived communication among Lithuanian patients was 3.1 (0.95) on a scale 0-5, whereas the average level (SD) of self-reported adherence to pain medication among Lithuanians was 13.0 (3.65) on a scale 4-20.

CONCLUSIONS

The authors believe, that to improve cancer pain management in Lithuania (1) more attention should be paid to psychological status of patients, (2) patients should be more educated about the need and consequences of opioid use for cancer pain, and (3) adherence to pain management regimens should be improved.

Patient-related barriers to cancer pain management: a systematic exploratory review

The aim of this review was to systemically explore the current evidence regarding patient-related barriers to cancer pain management to find new areas that might be important for better understanding of patient barriers' phenomenon. The method used in this study was a computerised literature search, carried out in Cochrane Library, Medline (through PubMed), Web of Science and EMBASE databases for the period 1994-2005. Thirty-seven studies, dealing with cognitive, sensory and affective patient-related barriers, as well as studies, describing patients' pain communication and their adherence to analgesic regimen were included and analysed. The dominant part of articles studied cognitive patient-related barriers to cancer pain management, while affective, sensory barriers, as well as pain communication and pain medication adherence were studied in much less extend. However, the findings from different studies regarding relationships between cognitive barriers and pain intensity were not consistent. On the contrary, the quality of pain communication was consistently found to be not satisfactory in some key areas. The associations between more expressed attitudinal as well as sensory barriers and less optimal adherence were also consistent. In conclusions suggestion for the new research areas on patient-related barriers to cancer pain management are made. Firstly, further research is needed to differentiate the role of cognitive, affective and sensory factors with respect to their impact on pain relief, pain communication and medication adherence. Besides that, validated instruments to assess patients' pain communication and adherence to analgesic regimen are lacking.

Clinicians communicating with patients experiencing cancer pain

PURPOSE

Provider-patient communication deficits are often implicated as barriers to adequate cancer pain relief. The purpose of this study was to describe verbal communication behaviors and interactions between providers and patients reporting cancer pain.

METHODS

As part of a multisite clinical trial, we enrolled 17 oncology physician specialists and 84 patient participants who had reported cancer pain or treatment-related pain in the previous week associated with prostate or head and neck cancer. The study baseline clinic visits (N = 84) were audiotaped, transcribed, and entered into non-numerical unstructured data indexing searching and theorizing (NUD.IST) for content analysis. Each text unit in each transcript was coded as to conversation context: pain, additional symptom/side effects, tumor treatment, and/or personal remarks. Clinician questions were coded as either open-ended or closed-ended, clinician interruptions and subject changes were counted, and a measure of verbal dominance was calculated.

RESULTS

The clinicians spent over half the conversations doing the talking. We calculated a close-ended to open-ended question ratio of 5.8:1. In 55% of the visits, the patient with cancer was interrupted by the clinician when the patient attempted to provide information or ask a question. Symptoms/side effects were addressed in practically all visits, whereas sensory pain was addressed in 90% of the visits.

CONCLUSIONS

The clinicians were attentive to daily problems relevant to treatment side effects; however, the results also indicate a pattern of communication during the clinic visit that is typically clinician oriented. The nature of such communication may prevent the patient from sharing significant facts and experiences relevant to cancer pain and thus compromise the quality of pain management.

The effects of a research utilization in-service program on nurses

The objective of this quasi-experimental design study was to evaluate an 8-week course of research utilization training provided for nurses. Eighty-nine nurses participated in the complete study. Age and education background of the nurses in the control group matched that of the participants in the experimental group. The research instruments included a scale of attitudes toward nursing research, a scale of perceived support for nursing research, a research participation questionnaire, and a research utilization questionnaire. Repeated measures analysis of covariance and the Mann-Whitney U test were adopted for statistical analysis. The results showed that there were significant differences in attitudes between the two groups toward research and perceived support of institutions. Participation in research also differed significantly when analyzed at posttests 2 and 6 months after the course. There was no significant difference in research utilization. These results suggest that continuous consultation and assistance should be provided to the nurses after the course, so as to implement the results of research utilization.

Pain management problems in patients' terminal phase as assessed by nurses in Finland

BACKGROUND

This study is part of a larger questionnaire survey concerned with the views of nursing staff on physical, emotional and spiritual support for terminally ill patients and decision making on the transition to the terminal phase of treatment.

AIM

This article discusses the results concerning the prevalence of physical pain in patients and with problems in pain management.

METHODS

A total of 328 nurses working on the inpatient wards of 32 municipal health centres in finland took part. Data were collected with multiple-choice items and one open-ended question, which were part of a larger structured questionnaire. The data were analysed by means of the SPSS statistical software and content analysis.

FINDINGS

Dying patients often suffered from pain, which was most commonly because of cancer. Intractable pain was common. The problems of pain management concerned attitudes and qualifications related to treating pain, the assessment of the pain, pain management per se and the organization of pain management.

CONCLUSION

The study highlights the need to increase pain education, discussion and agreement on the principles of pain management in municipal health centres in Finland.

A feminist critique of research on cancer pain

A number of studies on cancer pain have been conducted but the researchers rarely considered gender and ethnic differences in cancer pain. In this article, nursing research on cancer pain is critiqued from a feminist perspective, and directions for future nursing research are proposed. A total of 82 nursing articles published in the United States were retrieved through MEDLINE and MELVYL data retrieval systems, and analyzed and critiqued in terms of four basic elements of research from a feminist perspective (bias as resources, dependability, credibility and adequacy, and intersubjectivity). In this article, the critique is presented with four themes that may provide reasons why nursing research on cancer pain rarely incorporated gender and ethnic differences: absence of participants' own views and experiences, androcentrism and ethnocentrism, lack of consideration on contextual factors, and distant relationships between researchers and research participants. To overcome the limitations, six critical elements including gender and ethnic sensitivity, avoidance of distorted views, respectfor participants' own views and interests, trust and openness, empowerment, and multiple methods are suggested to be incorporated in future nursing research on cancer pain.