Sunteți pe pagina 1din 7

Comparison of numerical and verbal

rating scales to measure pain


exacerbations in patients with chronic
cancer pain
 Cinzia Brunelli,
 Ernesto Zecca,
 Cinzia Martini,
 Tiziana Campa,
 Elena Fagnoni,
 Michela Bagnasco,
 Luigi Lanata &
 Augusto Caraceni

Health and Quality of Life Outcomesvolume 8, Article number: 42 (2010) | Download


Citation

Abstract

Background
Numerical rating scales (NRS), and verbal rating scales (VRS) showed to be reliable and
valid tools for subjective cancer pain measurement, but no one of them consistently
proved to be superior to the other. Aim of the present study is to compare NRS and VRS
performance in assessing breakthrough or episodic pain (BP-EP) exacerbations.

Methods
In a cross sectional multicentre study carried out on a sample of 240 advanced cancer
patients with pain, background pain and BP-EP intensity in the last 24 hours were
measured using both a 6-point VRS and a 0-10 NRS. In order to evaluate the
reproducibility of the two scales, a subsample of 60 patients was randomly selected and
the questionnaire was administered for a second time three to four hours later. The
proportion of "inconsistent" (background pain intensity higher than or equal to peak
pain intensity) evaluations was calculated to compare the two scales capability in
discriminating between background and peak pain intensity and Cohen's K was
calculated to compare their reproducibility.

Results
NRS revealed higher discriminatory capability than VRS in distinguishing between
background and peak pain intensity with a lower proportion of patients giving
inconsistent evaluations (14% vs. 25%). NRS also showed higher reproducibility when
measuring pain exacerbations (Cohen's K of 0.86 for NRS vs. 0.53 for VRS) while the
reproducibility of the two scales in evaluating background pain was similar (Cohen's K
of 0.80 vs. 0.77).

Conclusions
Our results suggest that, in the measurement of cancer pain exacerbations, patients use
NRS more appropriately than VRS and as such NRS should be preferred to VRS in this
patient's population.

The Impact of Nurses' Empathic


Responses on Patients' Pain
Management in Acute Care
Watt-Watson, Judy; Garfinkel, Paul; Gallop, Ruth; Stevens, Bonnie; Streiner, David
Nursing Research: July-August 2000 - Volume 49 - Issue 4 - p 191-200
Articles
BUY

 Abstract
 Author Information
Background: Although nurses have the major responsibility for pain management, little is
known about nurses' responses to patients in the process of managing acute pain.
Objective: To examine the relationship between nurses' empathic responses and their patients'
pain intensity and analgesic administration after surgery.
Methods: Two hundred twenty-five patients from four cardiovascular units in three university-
affiliated hospitals were interviewed on the third day after their initial, uncomplicated coronary
artery bypass graft (CABG) surgery about their pain and current pain management.
Concurrently, their nurses' (n = 94) empathy and pain knowledge and beliefs were assessed.
Patient data were aggregated and linked with the assigned nurse to form 80 nurse-patient pairs.
Results: Nurses were moderately empathic, and their responses did not significantly influence
their patients' pain intensity or analgesia administered. Patients reported moderate to severe pain
but received only 47% of their prescribed analgesia. Patients' perceptions of their nurse's
attention to their pain were not positive, and empathy explained only 3% of variance in patients'
pain intensity. Deficits in knowledge and misbeliefs about pain management were evident for
nurses independent of empathy, and knowledge explained 7% of variance
in analgesia administered. Hospital sites varied significantly in analgesic practices and pain
inservice education for nurses.
Conclusions: Empathy was not associated with patients' pain intensity or analgesic
administration.
Complementary and Alternative
Medicine Use, Spending, and Quality of
Life in Early Stage Breast Cancer
Wyatt, Gwen; Sikorskii, Alla; Wills, Celia E.; Su, Hong An
Nursing Research: January-February 2010 - Volume 59 - Issue 1 - p 58-66
doi: 10.1097/NNR.0b013e3181c3bd26
FEATURES
BUY
SDC

 Abstract
 Author Information
 Article Metrics
Background: Up to 80% of women with breast cancer use complementary and alternative
medicine (CAM) therapies to improve quality of life (QOL) during treatment.
Objective: The objective of this study was to explore the association between CAM therapy
use, spending on CAM therapies, demographic variables, surgical treatment, and QOL.
Methods: A secondary analysis was conducted for women with early stage breast cancer (N =
222) who were enrolled in a nursing intervention study after breast surgery. The complementary
therapy utilization instrument included specific CAM therapies used, number of treatments,
and spending. The number of major categories of CAM and the specific CAM therapies used
were analyzed in relation to study variables using proportional odds logistic regression models.
The outcome of spending for major CAM categories was analyzed using linear mixed effects
modeling.
Results: A majority of women (56.8%) used at least one CAM therapy, and the biologically
based therapies category was most frequently used (43.7%). Women with less than a college
level of education were less likely to use CAM (odds ratio [OR] = 0.36, 95% confidence interval
[CI] = 0.15-0.86, p < .01). Women who were employed were more likely to use therapies from
multiple CAM categories (OR = 2.42, 95% CI = 1.00-5.88, p < .05), and those with lower QOL
were more likely to use CAM (OR = 0.97, 95% CI = 0.95-0.99, p < .01). The results support that
women with early stage breast cancer, especially those with lower QOL, are highly likely to use
CAM therapies. Further research is needed on CAM interventions to enhance supportive care
for breast cancer.

Pain Management Knowledge and Attitudes


of Baccalaureate Nursing Students and
Faculty
Author links open overlay panelGloriaDukePhD, RNBarbara K.HaasPhD, RNSusanYarbroughPhD,
RNSallyNorthamPhD, RN
Show more
https://doi.org/10.1016/j.pmn.2010.03.006
The purpose of this study was to determine the knowledge of and attitudes
toward pain in baccalaureate nursing students and faculty to establish a
foundation for a systematic and comprehensive integration of pain content in
the curricula. The descriptive design included a sample of 162 junior and
senior students enrolled in a baccalaureate nursing program in Texas and 16
nursing faculty. The Knowledge and Attitudes Survey Regarding Pain
(KASRP) was used to measure knowledge and attitudes toward pain. A direct
correlation was found between the level of education and the percentage
correct score. Differences found in knowledge and attitudes among the three
levels of students and faculty were significant (df = 3.173; F = 14.07, p < .001).
Senior students nearing graduation scored only 68% (SD = 6.8) with faculty
scoring only slightly better with a mean of 71% (SD = 13). Significant
differences also were found in assessment of pain through case scenarios of a
patient who was smiling and talking as compared to a patient who was lying
quietly and grimacing (X2 = 37.13, p < .05 (df = 24). Reevaluation of the
way pain assessment and treatment are taught is indicated. Further studies
are needed to assess changes in knowledge and attitudes toward pain as
curricular revisions are made.

Cancer‐related pain in palliative care: patients’


perceptions of pain management
Barbro Boström PhD RN RNIC RNT

Marie Sandh MNSc RN RNAN RNT

Dag Lundberg MD PhD FRCA


Bengt Fridlund PhD RN RNAN RNT
First published: 02 February 2004
Aim. The aim of this study was to describe how patients with cancer‐related pain in
palliative care perceive the management of their pain.

Method. Thirty patients were strategically selected for interviews with open‐ended
questions, designed to explore the pain and pain management related to their cancer.
The interviews were analysed using a phenomenographic approach.

Findings. Patients described 10 different perceptions of pain and pain management


summarized in the three categories: communication, planning and trust. In terms of
communication, patients expressed a need for an open and honest dialogue with health
care professionals about all problems concerning pain. Patients expressed an urgent
need for planning of their pain treatment including all caring activities around them.
When they felt trust in the health care organization as a whole, and in nurses and
physicians in particular, they described improved ability and willingness to participate in
pain management. While the findings are limited to patients in palliative care, questions
are raised about others with cancer‐related pain without access to a palliative care
team.

Conclusion. The opportunity for patients to discuss pain and its treatment seems to
have occurred late in the course of disease, mostly not until coming in contact with a
palliative care team. They expressed a wish to be pain‐free, or attain as much pain relief
as possible, with as few side effects as possible.

Knowledge and Attitudes About Cancer


Pain Management: A National Survey of
Italian Hospice Nurses
Bernardi, Matteo RN; Catania, Gianluca RN; Tridello, Gloria PhDS
Cancer Nursing: March-April 2007 - Volume 30 - Issue 2 - p E20-E26
doi: 10.1097/01.NCC.0000265299.25017.24
ARTICLES
BUY

To obtain information about the knowledge and attitudes of Italian hospice nurses concerning cancer
painmanagement and to determine the predictor of nurses' pain management knowledge.
Nationwide descriptive study. Hospice nurses in Italy from 9 hospice units distributed in the north,
center, and south of Italy. Sixty-six nurses completed the questionnaire, indicating a 66.6% response
rate. The Nurses' Knowledge and Attitudes Survey (Italian version) and a background information
form were used to collect the data. Knowledge and attitudes regarding cancer pain. Among the 39
pain knowledge questions assessed, the mean number of correctly answered question was 24.4 (SD
= 4.2), with a range of 15 to 35 items correctly answered. The correct answer rate for the entire
scale, on average, was 62.7% (SD = 28%). Further analysis of items showed that more than 30% of
hospice nurses underestimated the patients' pain and they did not treat the pain in the correct way;
they had an incorrect self-evaluation about their pain management knowledge. Results from
stepwise regression showed that nurses with higher mean correct answer scores had attended more
courses on pain education. From these results, we conclude that there are still significant knowledge
deficits and erroneous beliefs that may hamper treatment of hospice patients in pain. The results of
this study could be useful to institutions involved in the education and application of patient pain
management.

Nurse Moral Distress and Cancer Pain


Management:
An Ethnography of Oncology Nurses in I
ndia
LeBaron, Virginia PhD, APRN; Beck, Susan L. PhD, APRN; Black, Fraser MD; Palat, Gayatri
MBBS
Cancer Nursing: September/October 2014 - Volume 37 - Issue 5 - p 331–344
doi: 10.1097/NCC.0000000000000136
Objective: This ethnographic study explored the experience of MD
with oncology nurses (n = 37) and other providers (n = 22) in India and its potential
relationship to opioid availability.
Methods: Data (semistructured interviews and field observations) were collected at a
300-bed government cancer hospital in urban South India over 9 months. Dedoose
v.4.5.91 supported analysis of transcripts using a coding schema that mapped to an
Integrated Model of Nurse Moral Distress and concepts that emerged from field notes.
Results: Primary themes included “We feel bad,” “We are alone and afraid,” “We are
helpless,” and “We leave it.” A weak link between MD and opioid availability was found.
Conclusions: Participants described significant work-related distress, but the moral
dimension to this distress was less clear as some key aspects of the Integrated Model
of Nurse Moral Distress were not supported. The concept of MD may have limited
applicability in settings where alternative courses of action are unknown, or not feasible,
and where differing social and cultural norms influence moral sensitivity.
Implications for Practice: Improving job-related conditions is prerequisite to creating
an environment where MD can manifest. Educational initiatives in LMICs must account
for the role of the oncology nurse and their contextual moral and professional
obligations.

The McGill Pain Questionnaire as a Multidimensional


Measure in People with Cancer: An Integrative Review
Srisuda Ngamkham, PhD, RN∗
,
Catherine Vincent, PhD, RN†
,
Lorna Finnegan, PhD, APN, CNP‡,§
,
Janean E. Holden, PhD, RN, FAAN#
,
Zaijie Jim Wang, PhD§,‖
,
Diana J. Wilkie, PhD, RN, FAAN∗,§,∗, Correspondence information about the author PhD, RN, FAAN
Diana J. Wilkie Email the author PhD, RN, FAAN Diana J. Wilkie

PlumX Metrics
DOI: https://doi.org/10.1016/j.pmn.2010.12.003
First published in 1975, the McGill Pain Questionnaire (MPQ) is an often-cited pain measure, but there have been no systematic
reviews of the MPQ in cancer populations. Our objective was to evaluate the MPQ as a multidimensional measure of pain in
people with cancer. A systematic search of research that used the MPQ in adults with cancer and published in English from 1975
to 2009 was conducted. Twenty-one articles retrieved through computerized searches and nine studies from manual searches met
the criteria. Review of the 30 studies demonstrated that pain intensity (n = 29 studies) and pain quality (n = 27 studies) were
measured more frequently than pain location, pattern, and behavior parameters. Measuring cancer pain using the MPQ provided
insights about disease sites, magnitude of pain, and effectiveness of treatment and intervention. Additionally, the MPQ data
informed speculations about pain mechanisms, emotional status, overall sensory pain experience, changes in pain over time, and
alleviating and aggravating behaviors/factors. Findings supported the MPQ as an effective multidimensional measure with good
stability, content, construct, and criterion validity and showed sensitivity to treatment or known-group effects. The MPQ is a
valid, reliable, and sensitive multidimensional measure of cancer pain. Cancer pain is a subjective complex experience consisting
of multiple dimensions, and measuring cancer pain with the MPQ may help clinicians to more fully understand whether those
dimensions of cancer pain influence each other. As a result, clinicians can provide better and effective cancer pain management.

S-ar putea să vă placă și