Documente Academic
Documente Profesional
Documente Cultură
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.
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.
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.
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.
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.
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.