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Ware OD, Cagle JG. The Assessment of Pain and Barriers to Pain Management: A Content Analysis From a National Sample of Hospice Psychosocial Assessments Completed by Social Workers. Am J Hosp Palliat Care 2020; 38:260-265. [PMID: 32909816 DOI: 10.1177/1049909120953809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pain is a multidimensional symptom frequently experienced by hospice patients that is physical, psychological, social, emotional, and spiritual. Medicare regulations require hospices to complete a psychosocial assessment with content such as patient/family adjustment to illness. Furthermore, pain barriers such as concerns about addiction, and fatalism are recognized impediments to high quality pain management. National data concerning whether hospice social workers are paying attention to issues related to patient pain is minimal. Addressing this gap, we randomly sampled 248 hospices nationally and requested a blank copy of their social work psychosocial assessment and reviewed its pain-related content. A total of 105 hospices (response rate 42.3%) provided an assessment for review. Descriptive statistics summarize agency characteristics and whether pain assessment content and pain barrier content were present. Analyses examined whether pain assessment content was included based on agency characteristics. Of the 105 participating agencies, most were non-profit (60%) and located in the South (30.5%). Less than half (47.6%) of the agencies included pain assessment content in their assessment. No associations were observed between having pain assessment content and agency characteristics. None of the assessments included content about 3 barriers to pain management: tolerance, overdose, stigma, and fatalism. Few agencies included other barriers to pain management: addiction (1%), burden (1%), non-adherence (3.8%) and stoicism (18.1%). Agencies which had pain assessment content mostly included other dimensions of pain: psychological (80%), emotional (74%), and social (78%). Hospice social workers can do more to assess and address pain concerns-especially psychological, social, and emotional dimensions.
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Affiliation(s)
- Orrin D Ware
- 12265University of Maryland, School of Social Work, MD, USA
| | - John G Cagle
- 12265University of Maryland, School of Social Work, MD, USA
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Mubita WM, Richardson C, Briggs M. Patient satisfaction with pain relief following major abdominal surgery is influenced by good communication, pain relief and empathic caring: a qualitative interview study. Br J Pain 2020; 14:14-22. [PMID: 32110394 DOI: 10.1177/2049463719854471] [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: 11/15/2022] Open
Abstract
Background Monitoring and improving the quality of care is an ever increasing concern for health care organisations. Measuring the effectiveness of clinical outcomes is done by looking at specific markers of high quality care. Pain management is considered one of the markers of high quality care and satisfaction with pain management is a crucial and important quality assurance marker; yet, we know little about what contributes to a patient's decision about satisfaction. Methods A qualitative study drawing on phenomenological approach aiming to evaluate the perspective of patients experiencing post-operative pain. Patients undergoing major abdominal surgery were recruited from a Renal Transplant and Urology ward in the North of England, UK. Data were collected using in-depth semi-structured interviews and were analysed using Colaizzi's approach. Results Ten patients participated in the study and three themes emerged from the analysis. The findings of this study revealed that in order to achieve satisfaction with the management of pain, patient care has to include information delivery which is timely and adequate according to a patient's individual needs, nurses should have a caring attitude and pain should be well controlled. Conclusion Satisfaction with pain management is influenced by good communication and information transfer, appropriate pain management and an empathic presence throughout.
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Affiliation(s)
- Womba Musumadi Mubita
- Research and Innovation, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Clinical Trials Management Offices, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Cliff Richardson
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Michelle Briggs
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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The Use of Comfort Kits to Optimize Adult Cancer Pain Management. Pain Manag Nurs 2019; 20:25-31. [DOI: 10.1016/j.pmn.2018.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/29/2017] [Accepted: 01/13/2018] [Indexed: 11/18/2022]
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LeBaron VT, Blonquist TM, Hong F, Halpenny B, Berry DL. Screening for Pain in the Ambulatory Cancer Setting: Is 0-10 Enough? J Oncol Pract 2015; 11:435-41. [PMID: 26306620 PMCID: PMC4647066 DOI: 10.1200/jop.2015.004077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this study was to explore concordance between patient self-reports of pain on validated questionnaires and discussions of pain in the ambulatory oncology setting. METHODS Adult, ambulatory patients (N = 452) with all stages of cancer were included. Three pain measures were evaluated: two items from the Symptom Distress Scale (frequency [SDSF] and intensity [SDSI]) and the Pain Intensity Numeric Scale (PINS). Relevant pain was defined as: (1) scores 3 of 5 on SDSF or SDSI or 5 of 10 on the (PINS); or (2) discussion of existing pain in an audio-recorded clinic visit. For each scale, McNemar's test assessed concordance of patient self-reports of relevant pain with discussions of relevant pain in the audio-recorded clinic visit. Sensitivity, specificity, and accuracy were calculated and a receiver operating characteristic analysis evaluated thresholds on self-report pain questionnaires to best identify relevant pain discussed in clinic. RESULTS Identification of relevant pain by self-report was discordant (P < .001) with discussed pain coded in audio-recorded visits for all three measures. Specificity was higher for intensity (SDSI, 0.94; PINS, 0.97) than frequency (SDSF, 0.87); sensitivity was higher for frequency (SDSF, 0.35) than intensity (SDSI, 0.24; PINS, 0.12). Accuracy was higher for the SDS pain items (SDSF, 0.57; SDSI, 0.54) than for PINS (0.48). Receiver operating characteristic analysis curves suggest that lower threshold scores may improve the identification of relevant pain. CONCLUSION Self-report pain screening measures favored specificity over sensitivity. Asking about pain frequency (in addition to intensity) and reconsidering threshold scores on pain intensity scales may be practical strategies to more accurately identify patients with cancer who have relevant pain.
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Affiliation(s)
- Virginia T LeBaron
- University of Virginia School of Nursing, Charlottesville, VA; Dana-Farber Cancer Institute; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services; and Harvard Medical School, Boston, MA
| | - Traci M Blonquist
- University of Virginia School of Nursing, Charlottesville, VA; Dana-Farber Cancer Institute; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services; and Harvard Medical School, Boston, MA
| | - Fangxin Hong
- University of Virginia School of Nursing, Charlottesville, VA; Dana-Farber Cancer Institute; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services; and Harvard Medical School, Boston, MA
| | - Barbara Halpenny
- University of Virginia School of Nursing, Charlottesville, VA; Dana-Farber Cancer Institute; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services; and Harvard Medical School, Boston, MA
| | - Donna L Berry
- University of Virginia School of Nursing, Charlottesville, VA; Dana-Farber Cancer Institute; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services; and Harvard Medical School, Boston, MA
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Zucca A, Sanson-Fisher R, Waller A, Carey M, Fradgley E, Regan T. Medical Oncology Patients: Are They Offered Help and Does It Provide Relief? J Pain Symptom Manage 2015; 50:436-44. [PMID: 26025275 DOI: 10.1016/j.jpainsymman.2015.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 04/21/2015] [Accepted: 04/24/2015] [Indexed: 11/28/2022]
Abstract
CONTEXT Identifying modifiable gaps in the symptom management pathway, as perceived by patients, is the first step to relieving patient suffering. OBJECTIVES The objective is to describe the proportion of patients experiencing treatable cancer-related symptoms who reported 1) a health care provider at the treatment center offered assistance for their symptom, 2) they accepted the assistance offered, and 3) the assistance relieved suffering. Variation in symptom management among treatment centers also was examined. METHODS A survey was done with 528 medical oncology outpatients recruited from six treatment centers. Eight items explored management of prevalent, burdensome, and treatable cancer-related symptoms: pain, fatigue, other physical side effects, and emotional distress. Participants were asked about symptom management provided at the clinic from where they were recruited. Questions referred to the last occasion the patient experienced the symptom. RESULTS Fewer patients were offered help to relieve fatigue (44%) and emotional distress (57%), than pain (90%) and other physical side effects (84%). In most cases, help was not offered as clinic staff were not aware of the patient's symptom. Although the vast majority of patients accepted the help that was offered, more patients accepted help for physical symptoms (pain, 97%; fatigue, 95%; and other side effects, 98%) than emotional symptoms (87%). When care was provided, most patients experienced at least a little relief from pain (99%), fatigue (94%), and emotional distress (96%). Symptom management did not vary significantly by treatment center (P = 0.073). CONCLUSION Quality improvement initiatives must focus primarily on improving providers' awareness of their patients' symptoms and ensuring that patients are subsequently offered help.
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Affiliation(s)
- Alison Zucca
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle, and Hunter Medical Research Institute, Callaghan, New South Wales, Australia.
| | - Rob Sanson-Fisher
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle, and Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Amy Waller
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle, and Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Mariko Carey
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle, and Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Elizabeth Fradgley
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle, and Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Tim Regan
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle, and Hunter Medical Research Institute, Callaghan, New South Wales, Australia
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Rau KM, Chen JS, Wu HB, Lin SF, Lai MK, Chow JM, Huang ML, Wang CJ, Tai CJ, Hwang WL, Lu YC, Chan CH, Hsieh RK. The impact of pain control on physical and psychiatric functions of cancer patients: a nation-wide survey in Taiwan. Jpn J Clin Oncol 2015; 45:1042-9. [PMID: 26292698 PMCID: PMC4622168 DOI: 10.1093/jjco/hyv124] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 07/24/2015] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To investigate the prevalence of pain in cancer patients at different disease statuses, the impact of pain on physical and psychiatric functions of patients and the satisfaction of pain control of patients at outpatient clinic department in Taiwan. METHODS Short form of the Brief Pain Inventory was used as the outcome questionnaire. Unselected patients of different cancers and different disease statuses at outpatient clinic department were included. The impacts of their current pain control on physical function, psychiatric function and the satisfaction of doctors were evaluated. Logistic regression analyses were performed to evaluate whether the interference scale performed identically in the different analgesic ladders. The dependent variables were satisfaction toward physician and treatment. RESULTS A total of 14 sites enrolled 2075 patients in the study. One thousand and fifty-one patients reported pain within the last 1 week. In patients whose diseases deteriorated, >60% of them need analgesics for pain control. Pain influenced physical and psychiatric functions of patients, especially in the deteriorated status. More than 80% of patients were satisfied about current pain control, satisfaction rate related to disease status, pain intensities and treatments for pain. CONCLUSION Our study found that different cancers at different statuses had pain at variable severity. Pain can influence physical and psychological functions significantly. More than 75% of subjects reported satisfaction over physician and pain management in outpatient clinic department patients with cancer pain in Taiwan.
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Affiliation(s)
- Kun-Ming Rau
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung Chang Gung University, College of Medicine, Taoyuan
| | - Jen-Shi Chen
- Division of Medical Oncology in the Hematology and Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan Taiwan and Chang Gung University College of Medicine, Taoyuan
| | - Hung-Bo Wu
- Division of Hematology Oncology, Department of Internal Medicine, Taipei City Hospital, Renai Branch, Taipei
| | - Sheng-Fung Lin
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung Division of Hematology and Medical Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung
| | - Ming-Kuen Lai
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Taoyoun
| | - Jyh-Ming Chow
- Section of Hematology and Oncology, Department of Internal Medicine, Taipei Municipal Wan-Fang Hospital, Taipei Medical University, Taipei
| | - Ming-Lih Huang
- Division of Oncology, Department of Oncology and Cancer Study, Da Chien Hospital, Miaoli
| | - Cyuan-Jheng Wang
- Division of Medical Oncology in the Hematology-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua
| | - Cheng-Jeng Tai
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei
| | - Wen-Li Hwang
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung
| | - Yin-Che Lu
- Division of Hematology-Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi
| | - Chung-Huang Chan
- Division of Hematology and Oncology, Department of Internal Medicine, Poh-Ai Hospital, Yilan
| | - Ruey Kuen Hsieh
- Division of Hematology and Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
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Wang CH, Lee SYC. Undertreatment of caner pain. ACTA ACUST UNITED AC 2015; 53:58-61. [PMID: 26063333 DOI: 10.1016/j.aat.2015.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/06/2015] [Indexed: 11/30/2022]
Abstract
Pain is a burdensome symptom that can commonly exist chronically along the cancer trajectory. Uncontrolled pain will impact on cancer patients' quality of life, even further negatively affect cancer survivors' employment. Based on systemic reviews of studies for past 10 years, the paper reported that although there is enormous advancement on the knowledge of cancer pain and pain management, studies still documented undertreatment of cancer pain globally. Additionally, pain distress a significant portion of cancer survivors. The pain in cancer survivors distinct from the pain related with cancer, instead emphasize on pain related with cancer treatment, such as neuropathic pain, muscular syndrome. Evidence-based pain management with common pain problems in cancer survivors is lacking. Further studies are needed to understand the pain in cancer survivors and to develop effective strategies in helping cancer survivors to manage their pain.
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Affiliation(s)
- Cheng-Hsu Wang
- National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| | - Shiu-Yu C Lee
- Chang Gung Memorial Hospital, Clinic of Internal Medicine, Division of Hematology-Oncology, Department of Internal Medicine, Keelung, Taiwan
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Besse K, Vernooij-Dassen M, Vissers K, Engels Y. The Impact of a National Guideline on the Management of Cancer Pain on the Practice of Pain Assessment and Registration. Pain Pract 2014; 16:148-53. [PMID: 25546262 DOI: 10.1111/papr.12270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/22/2014] [Accepted: 10/10/2014] [Indexed: 12/15/2022]
Abstract
The Dutch clinical practice guideline on the diagnosis and management of pain in patients with cancer was published in 2008 and intensively promoted to healthcare professionals who see patients with cancer. One of the most important recommendations is the systematic registering of the pain and its intensity. To evaluate in which degree this part of the practice guideline is implemented, we analyzed the medical records of patients attending the outpatient oncological clinic in an academic hospital, a large teaching hospital, and 4 smaller peripheral hospitals. None of the participating hospitals assessed pain by a standardized scale. Reference to pain in the medical record happened more frequently in the academic hospital than in the other hospitals. The frequency of recording pain in the medical record in the academic hospital was much higher in this study than the one previously reported, whereas the findings in the other hospitals were comparable. There may be several reasons for the difference in reporting rate of pain in patients with cancer. Our findings indicate that the clinical practice guideline with regard to pain registration is poorly implemented in oncology outpatient clinics. More efforts should be made to generate the awareness for the need of pain registration.
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Affiliation(s)
- Kees Besse
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Myrra Vernooij-Dassen
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud University Nijmegen Medical Centre and Kalorama Foundation, Beek-Ubbergen, The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Keefe FJ, Porter L, Somers T, Shelby R, Wren AV. Psychosocial interventions for managing pain in older adults: outcomes and clinical implications. Br J Anaesth 2013; 111:89-94. [PMID: 23794650 DOI: 10.1093/bja/aet129] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Interest in the use of psychosocial interventions to help older adults manage pain is growing. In this article, we review this approach. The first section reviews the conceptual background for psychosocial interventions with a special emphasis on the biopsychosocial model of pain. The second section highlights three psychosocial interventions used with older adults: cognitive behavioural therapy, emotional disclosure, and mind-body interventions (specifically mindfulness-based stress reduction and yoga). The final section of the paper highlights important future directions for work in this area.
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Affiliation(s)
- F J Keefe
- Department of Psychiatry, Duke University Medical Center, Durham, NC 27705, USA.
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