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Emanuel G, Verne J, Forbes K, Hounsome L, Henson KE. Community prescribing for cancer patients at the end of life: a national study. BMJ Support Palliat Care 2023; 13:e361-e372. [PMID: 34083319 DOI: 10.1136/bmjspcare-2021-002952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Good end-of-life care is essential to ensure dignity and comfort in death. To our knowledge, there has not been a national population-based study in England of community prescribing of all drugs used in end-of-life care for patients with cancer. METHODS 57 632 people who died from malignant cancer in their own home or in a care home in 2017 in England were included in this study. National routinely collected data were used to examine community prescriptions dispensed for drugs for symptom control and anticipatory prescribing by key sociodemographic factors in the last 4 months of life. RESULTS 94% of people who died received drugs to control their symptoms and 65% received anticipatory prescribing. Prescribing increased for the symptom control drug group (53% to 75%) and the anticipatory prescribing group (4% to 52%) over the 4-month period to death. CONCLUSIONS Most individuals who died of cancer in their own home or a care home were dispensed drugs commonly used to control symptoms at the end of life, as recommended by best-practice guidance. Lower prescribing activity was found for those who died in a care home, highlighting a potential need for improved end-of-life service planning.
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Affiliation(s)
- Gabrielle Emanuel
- National Disease Registration Service, Public Health England, London, UK
| | - Julia Verne
- National End of Life Care Intelligence Network, Public Health England, Bristol, UK
| | - Karen Forbes
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Luke Hounsome
- National Disease Registration Service, Public Health England, London, UK
| | - Katherine E Henson
- National Disease Registration Service, Public Health England, London, UK
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Abahussin AA, West RM, Wong DC, Ziegler LE, Allsop MJ. Supporting Pain Self-Management in Patients With Cancer: App Development Based on a Theoretical and Evidence-Driven Approach. JMIR Cancer 2023; 9:e49471. [PMID: 37812491 PMCID: PMC10594136 DOI: 10.2196/49471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND To inform the development of an intervention, it is essential to have a well-developed theoretical understanding of how an intervention causes change, as stated in the UK Medical Research Council guidelines for developing complex interventions. Theoretical foundations are often ignored in the development of mobile health apps intended to support pain self-management for patients with cancer. OBJECTIVE This study aims to systematically set a theory- and evidence-driven design for a pain self-management app and specify the app's active features. METHODS The Behavior Change Wheel (BCW) framework, a step-by-step theoretical approach to the development of interventions, was adopted to achieve the aim of this study. This started by understanding and identifying sources of behavior that could be targeted to support better pain management. Ultimately, the application of the BCW framework guided the identification of the active contents of the app, which were characterized using the Behavior Change Technique Taxonomy version 1. RESULTS The theoretical analysis revealed that patients may have deficits in their capability, opportunity, and motivation that prevent them from performing pain self-management. The app needs to use education, persuasion, training, and enablement intervention functions because, based on the analysis, they were found the most likely to address the specified factors. Eighteen behavior change techniques were selected to describe precisely how the intervention functions can be presented to induce the desired change regarding the intervention context. In other words, they were selected to form the active contents of the app, potentially reducing barriers and serving to support patients in the self-management of pain while using the app. CONCLUSIONS This study fully reports the design and development of a pain self-management app underpinned by theory and evidence and intended for patients with cancer. It provides a model example of the BCW framework application for health app development. The work presented in this study is the first systematic theory- and evidence-driven design for a pain app for patients with cancer. This systematic approach can support clarity in evaluating the intervention's underlying mechanisms and support future replication.
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Affiliation(s)
- Asma A Abahussin
- Department of Biomedical Technology, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Robert M West
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - David C Wong
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Lucy E Ziegler
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Matthew J Allsop
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
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Hodge FS, Line Itty T, Arbing RH, Samuel-Nakamura C. A window into pain: American Indian cancer survivors' drawings. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:1031347. [PMID: 36341151 PMCID: PMC9634249 DOI: 10.3389/fpain.2022.1031347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/04/2022] [Indexed: 11/12/2022]
Abstract
In order to explore the cultural constructs of pain, a series of focus groups were held among adult American Indian (AI) cancer survivors and their caregivers in the Southwest USA. Thirteen focus groups held at four sites (reservation, urban setting, hospital and clinic) elicited information on the barriers to cancer pain management. In response to facilitator questions about cancer pain and existing measurement scales, participants drew pictures to better explain their pain type (i.e., "pounding"), intensity (i.e., "spider web-like"), and other more abstract aspects of their pain episodes. Noting this novel outlet, subsequent groups were prompted for illustrations of pain. A total of 17 drawings were collected from focus group participants. We discuss seven of the drawings that best opened a window into the lived experience of pain, reflected through the eyes of cancer survivors. This study provides evidence that self-expression through color, imagery and written personal accounts provides more accurate depictions of pain for Southwest AI cancer survivors than pain scales alone. It is hypothesized that cultural modes of communication (i.e., storytelling) and intergenerational influences of artwork led to the depiction of pain in drawings. Suggestions for further exploration of the use of the pain drawings for pain assessment in healthcare settings are included.
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Affiliation(s)
- Felicia S. Hodge
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States,Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States,Correspondence: Felicia S. Hodge
| | - Tracy Line Itty
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States
| | - Rachel H.A. Arbing
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States
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Marinangeli F, Saetta A, Lugini A. Current management of cancer pain in Italy: Expert opinion paper. Open Med (Wars) 2021; 17:34-45. [PMID: 34950771 PMCID: PMC8651060 DOI: 10.1515/med-2021-0393] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/20/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Chronic pain and breakthrough cancer pain (BTcP) have a high prevalence in all cancer types and cancer stages, combined with a significant physical, psychological, and economic burden. Despite efforts to improve appropriate management of cancer pain, a poor assessment and guilty undertreatment are still reported in many countries. The purpose of this expert opinion paper is to contribute to reduce and clarify these issues with a multidisciplinary perspective in order to share virtuous paths of care. Methods Common questions about cancer pain assessment and treatment were submitted to a multidisciplinary pool of Italian clinicians and the results were subsequently discussed and compared with the findings of the published literature. Conclusion Despite a dedicated law in Italy and effective treatments available, a low percentage of specialists assess pain and BTcP, defining the intensity with validated tools. Moreover, in accordance with the findings of the literature in many countries, the undertreatment of cancer pain is still prevalent. A multidisciplinary approach, more training programs for clinicians, personalised therapy drug formulations, and virtuous care pathways will be essential to improve cancer pain management.
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Affiliation(s)
- Franco Marinangeli
- Department of Anesthesiology Intensive Care and Pain Treatment, University of L'Aquila, Località Coppito, Piazzale Salvatore Tommasi, 1-67100, L'Aquila, Italy
| | - Annalisa Saetta
- Department of Oncology and Hematology, Humanitas Clinical and Research Center, 20089 Rozzano (Milan), Italy
| | - Antonio Lugini
- Department of Oncology, San Giovanni-Addolorata Hospital, 00184, Rome, Italy
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Hadjisavva IC, Papastavrou E, Kouta C. Knowledge and Attitudes of Home Care Nurses in Cyprus in the Management of Cancer Pain. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/1084822320957287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pain is a common symptom for cancer patients. It is a problem for themselves and their relatives. Nurses are confronted with the treatment of cancer pain in their everyday clinical practice. Efficient management requires accurate and appropriate knowledge, positive attitudes, and competent evaluation skills. The aim is to explore the knowledge and attitudes of Cypriot home care nurses in pain management of cancer patients. Regarding methodology, a quantitative descriptive design was used and the data were collected with the Greek version of the McCaffery and Ferrell Nurses’ Knowledge and Attitudes Survey Regarding Pain questionnaire along with a demographic questionnaire. The sample of the study consisted of home care nurses working in non-profit organizations in Cyprus ( n = 31). For the analysis of data, the SPSSv.21. was used and the statistical significance was set to the p = .05. Results revealed of the total of 35 questions only 13 were answered correctly by the 80% of the participants. Limited knowledge was reported mainly on the duration of action, the effect and dosage of Pethidine, the risk of addiction and the use of non-medication interventions. Significant differences were found to the level of knowledge as regards the age and the experience of nurses. In the case study exercise, it was found that false assessment of pain was related to wrong decisions. Nurses’ attitudes seemed to be positive. In conclusion, the study revealed the knowledge deficits and need for continuous education of home care nurses on the assessment and management of pain for patients with cancer. Empowering nurses with better skills to deal with pain, a most distressing symptom of cancer, will result in a better quality of life for patients. However, the integration of pain management within the national cancer strategies is also very important.
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Al-Masri D, Wilbur K, Elazzazy S, Hassan AA, Wilby KJ. Law, Culture, and Fear: A Qualitative Study of Health Professionals' Perceptions of Narcotic Use Related to Cancer Pain. J Pain Palliat Care Pharmacother 2020; 34:55-62. [PMID: 32091944 DOI: 10.1080/15360288.2019.1704340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Studies have shown barriers to appropriate narcotic use in the Middle East have negatively impacted patient outcomes. This study aimed to explore health professionals' perspectives regarding opioid use for cancer patients in Qatar. Eight focus groups were conducted with physicians, pharmacists, and nurses. An eight-question topic guide framed discussions and targeted contextual barriers and cultural beliefs. Focus groups were audio-recorded and transcribed verbatim. Thematic analysis was used to identify the following themes: narcotic use process, patient-related factors, and healthcare professional-related factors. Laws and regulations were identified as major barriers to appropriate narcotic access, prescribing, and administration. Government-imposed restrictions on permitted dispensed quantities and associated paperwork impeded continuity of patient care and pain relief. The influence of a patient's culture underpinned patient-related barriers, including fear of addiction and family members discouraging opioid use. Fear of prescribing for patient addiction and accusation of inappropriate prescribing by authorities were identified as health professional-related barriers. Facilitators included patient and provider education, as well as the availability of specialized teams to assess and treat cancer-related pain. Findings show narcotic utilization is not simply influenced by a single factor or subset of factors but by a multitude of factors that can be both independent and interrelated.
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Affiliation(s)
- Dania Al-Masri
- Dania Al-Masri, BSc(Pharm), MSc(Pharm), is with the College of Pharmacy, Qatar University, Doha, Qatar; Kerry Wilbur, BSc(Pharm), ACPR, PharmD, MPH, is with the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada; Shereen Elazzazy, BSc(Pharm), PharmD, is with the Department of Pharmacy - Clinical Services, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Azza A. Hassan, MB BCh, MSc, MD, is with the Supportive & Palliative Care Unit, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Kyle J. Wilby, BSP, ACPR, PharmD, PhD, is with the School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Kerry Wilbur
- Dania Al-Masri, BSc(Pharm), MSc(Pharm), is with the College of Pharmacy, Qatar University, Doha, Qatar; Kerry Wilbur, BSc(Pharm), ACPR, PharmD, MPH, is with the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada; Shereen Elazzazy, BSc(Pharm), PharmD, is with the Department of Pharmacy - Clinical Services, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Azza A. Hassan, MB BCh, MSc, MD, is with the Supportive & Palliative Care Unit, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Kyle J. Wilby, BSP, ACPR, PharmD, PhD, is with the School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Shereen Elazzazy
- Dania Al-Masri, BSc(Pharm), MSc(Pharm), is with the College of Pharmacy, Qatar University, Doha, Qatar; Kerry Wilbur, BSc(Pharm), ACPR, PharmD, MPH, is with the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada; Shereen Elazzazy, BSc(Pharm), PharmD, is with the Department of Pharmacy - Clinical Services, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Azza A. Hassan, MB BCh, MSc, MD, is with the Supportive & Palliative Care Unit, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Kyle J. Wilby, BSP, ACPR, PharmD, PhD, is with the School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Azza A Hassan
- Dania Al-Masri, BSc(Pharm), MSc(Pharm), is with the College of Pharmacy, Qatar University, Doha, Qatar; Kerry Wilbur, BSc(Pharm), ACPR, PharmD, MPH, is with the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada; Shereen Elazzazy, BSc(Pharm), PharmD, is with the Department of Pharmacy - Clinical Services, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Azza A. Hassan, MB BCh, MSc, MD, is with the Supportive & Palliative Care Unit, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Kyle J. Wilby, BSP, ACPR, PharmD, PhD, is with the School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Kyle J Wilby
- Dania Al-Masri, BSc(Pharm), MSc(Pharm), is with the College of Pharmacy, Qatar University, Doha, Qatar; Kerry Wilbur, BSc(Pharm), ACPR, PharmD, MPH, is with the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada; Shereen Elazzazy, BSc(Pharm), PharmD, is with the Department of Pharmacy - Clinical Services, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Azza A. Hassan, MB BCh, MSc, MD, is with the Supportive & Palliative Care Unit, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Kyle J. Wilby, BSP, ACPR, PharmD, PhD, is with the School of Pharmacy, University of Otago, Dunedin, New Zealand
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