Cancer Pain Social Processes and Pain Management in Home Hospice Care

Use of Goals in Cancer Pain Management: A Systematic Review

CONTEXT

Cancer pain is multidimensional and management should be individualized to patient goals. The current standard for pain goal assessment is the personal pain goal (PPG), a numeric rating for tolerable pain intensity. However, the PPG may not accurately capture a personally meaningful goal for tailoring pain management.

OBJECTIVES

Identify how pain goals are used in cancer pain management and types of goals researched.

METHODS

CINAHL, PsychInfo, and PubMed databases and manual searching were used to locate research or scholarship about cancer pain goals. Authors reviewed titles, abstracts and full text to agree on the final sample.

RESULTS

Sixteen articles met inclusion criteria. Study designs included: quality improvement project (1), concept analysis (1), qualitative methods (5), quantitative methods (8), and mixed methods (1). Findings included: goal setting as a key attribute of pain management; achieving personal goals as the outcome of pain management work; qualitative themes discussed personal goals related to pain management; developing a patient pain management resource including a SMART goal; using motivational interviewing to set functional pain goals; PPG assessment was feasible; and achieving PPG equated to having controlled pain when compared to the clinically important difference measure used in research (≥30%). Quantitative studies reported on PPGs only.

CONCLUSION

Currently, assessments for cancer pain goals do not include function, activities, moods, medication effects, or safety that patients wish to achieve as a pain management outcome. Development and testing of multidimensional patient pain goals assessments is warranted so that goals can be consistently assessed, documented, and personally meaningful.

Patient Goals in Hospice Cancer Pain Management: A Total Pain Case Scenario

Evidence-based clinical practice guidelines and hospice agency policies and procedures direct nursing assessment and interventions for the care of persons with cancer-related pain. Guidelines assert that pain should be assessed from a holistic perspective that considers physical, psychological, social, and spiritual aspects. In addition, guidelines maintain that hospice nurses should ascertain patient goals for pain management. Assessment and documentation of goals other than pain intensity goals is an area of nursing practice that has not been developed. Without inclusion of personally meaningful goals in pain assessment instruments, such goals cannot be routinely or consistently included in the hospice care plan. To address the assessment of pain and patient goals for pain management, this scenario-based article merges theoretical knowledge about pain from concept analyses with clinical guideline recommendations. Although research is needed to develop pain goal assessment tools, nurses can use this empirically based approach for asking about goals and integrating them into the plan of care.

Palliative care and quality of life in patients with cancer during the terminal phase. A family/patient perspective

OBJECTIVE

To explore the meaning of palliative care as perceived by the family caregiver and the patient with advanced cancer.

METHOD

Information was collected through in-depth interviews and field diaries to conduct this qualitative research study, with an interpretative phenomenological approach. We adopted Heidegger's perspective for the development of hermeneutic interpretation, and therefore followed the stages of intentionality, reduction, and constitution. We used Bardin's constructs of pre-analysis, coding, categorisation, and interpretation for the discourse analysis.

RESULTS

Seventeen patient-family caregiver dyads were considered. The perceptions of palliative nursing care focused on transpersonal relationships and the discourses referred to a lack of closeness between nursing staff and the patient. This was mainly expressed as a lack of emotional understanding and unmet needs. Themes were drawn from these findings based on developing a transpersonal relationship as a priority, including meeting needs and providing the empathic accompaniment that is fundamental for emotional well-being.

CONCLUSION

From the perspective of the dyads, palliative care covers intangible aspects of care. This requires nursing staff to work collaboratively with colleagues, with other health professionals and interprofessionally, including the institutions involved in care. Further work is required to implement these actions.

Nurse-Led Motivational Interviewing for Setting Functional Cancer Pain Goals

PURPOSE

Persons with advanced cancers experience high rates of pain. Nursing interventions for pain, which are tailored to the individual patient, may support motivation to engage in self-management and should include setting of realistic functional goals. For patients with advanced cancer, functional pain goals include personally important activities, measurable across clinical encounters. However, limited evidence exists regarding nursing assessment of functional pain goals. To address this gap, we piloted use of a motivational interviewing intervention. Motivational interviewing is a clinical technique for clarifying goals and related impediments, such as cognitive and emotional factors underlying pain management behaviors.

DESIGN

Pilot feasibility testing.

METHODS

Palliative care patients with cancer-related pain completed up to four intervention sessions, the Pain Self-Efficacy Questionnaire, and an author-developed acceptability questionnaire. Feasibility success was determined by 60% of participants completing at least two interventions. Fidelity to the intervention was assessed using the Motivational Interviewing Skills for Healthcare Encounters tool.

RESULTS

Sixty-seven percent completed two interventions. Participants reported that interventions were helpful, worthwhile, and recommended. Mean pain self-efficacy scores (0-60 possible) rose from 31.5 (SD = 11.2) at intervention 1 to 35.5 (SD = 13) after intervention 4. Intervention fidelity was maintained.

CONCLUSIONS

Participants were willing to engage in multiple motivational interviewing conversations focused on pain management behaviors related to functional goals. Based on these findings about motivational interviewing for functional goals and patient willingness to set them, these conversations may have a place in clinical care as an element of pain assessment and intervention tailoring.