Jo Ann Dalton

The self-efficacy of family caregivers for helping cancer patients manage pain at end-of-life.

&NA; This preliminary study examined the self‐efficacy of family caregivers with regard to helping cancer patients manage pain at end of life. A sample of 63 family caregivers of hospice‐eligible cancer patients with pain provided ratings of their self‐efficacy in assisting the patient in pain management and rated their own mood and level of caregiver strain. Patients completed measures of pain and quality of life. Data analyses revealed that caregivers who rated their self‐efficacy as high reported much lower levels of caregiver strain as well as decreased negative mood and increased positive mood. Caregiver self‐efficacy in managing the patients pain was related to the patients physical well‐being. In dyads where the caregiver reported high self‐efficacy, the patient reported having more energy, feeling less ill, and spending less time in bed. Considered overall, the results of this study suggest that caregiver self‐efficacy in pain management is important in understanding how caregivers adjust to the demands of caring for cancer patients who have pain at the end of life.

Tailoring cognitive-behavioral treatment for cancer pain.

Though it has been shown that cancer patients report cognitive, behavioral, and physiologic responses to pain, little attention has been paid to the benefits of cognitive-behavioral therapy (CBT) protocols tailored to patient characteristics. To determine whether a profile-tailored CBT treatment program was more effective than either standard CBT or usual care in changing outcomes for patients with cancer-related pain, 131 patients receiving treatment at four sites were randomly assigned to standard CBT, profile-tailored CBT, or usual care. CBT patients attended five 50-minute treatment sessions. When compared to standard CBT patients, profile-tailored CBT patients experienced substantial improvement from baseline to immediately post-intervention in worst pain, least pain, less interference of pain with sleep, and less confusion. From baseline to one-month post-intervention, profile-tailored patients saw greater improvement in less interference of pain with activities, walking, relationships, and sleep; less composite pain interference; and less mobility and confusion symptom distress. Standard CBT and usual care patients experienced little change. Compared to profile-tailored CBT patients, standard CBT patients showed greater improvement at six-months post-intervention with less average pain, less pain now, better bowel patterns, lower summary symptom distress, better mental quality of life, and greater improvement in Karnofsky performance status; usual care patients showed little change. More research is needed to refine the matching of cognitive-behavioral treatments to psychophysiologic patient profiles, and to determine a treatment period that does not burden those patients too fatigued to participate in a five-week program. Delivery of CBT by home visits, phone, or Internet needs to be explored further.

A call for standardizing the clinical rating of pain intensity using a 0 to 10 rating scale

Pain is difficult to measure, regardless of etiology. Furthermore, the measurement of pain is complicated by variation in the use of visual analogue scales as well as other pain assessment measures. This brief article reviews situations contributing to confusion regarding pain intensity measures and argues for consistency in its measurements with adults not experiencing cognitive disorders in the clinical setting.

the Assessment of Discomfort in Elderly Confused Patients: A Preliminary Study

&NA; With the increasing numbers of older adults in our population, nurses are reexamining all aspects of nursing care in order to best meet the needs of these individuals. Normal age changes, the impact of decades of environmental challenges, successful adaptations, acute illnesses, trauma and chronic illnesses combine to create a challenge for accurate and effective assessment of elderly patients. The nurse finds her assessment skills challenged with increasing frequency by the elderly patient who is also acutely confused and experiencing discomfort. The purpose of this study was to explore the clinical utility, validity and reliability of four different approaches to nursing assessment of discomfort with this particularly vulnerable group of elders.

Is patient satisfaction a legitimate outcome of pain management

Though many studies have measured patient satisfaction with pain management using the American Pain Society (APS) Satisfaction Survey or its variants, little is known about the relationship among the survey items, or whether items relate to satisfaction at all. In an effort to refine the measurement of patient satisfaction, a modified version of the APS survey, which was given to 787 patients as part of a study of postoperative pain management in six community hospitals, was subjected to principal components analysis to determine the surveys empirical structure. Correlations among the five components found were low; a weak relationship (r = -0.24) was discovered between pain intensity and satisfaction. A heuristic model estimated by structural equations analysis yielded additional insights. Though many items thought to influence patient satisfaction were not closely related to patient-reported satisfaction, they indicate important clinical factors relevant to quality of care, and thus, to continuing quality improvement (CQI) efforts. Results suggest that satisfaction was influenced by effectiveness of medication, independent of pain intensity, and by communication. Pain severity ratings near the time satisfaction was measured were more influential than earlier ratings.

Fear, alexithymia and cancer pain

The purpose of this study was to examine the differential role of fear, anxiety, alexithymia, family factors and coping in cancer pain. Twenty-seven patients with pain related to cancer, 26 patients with chronic non-cancer pain, 26 patients with chronic illness but no pain (hypertensives) and 24 healthy controls completed a set of questionnaires during an initial interview and recorded severity and duration of pain, pain interference with activities, thoughts, behaviors and physiological responses associated with fear of pain, and coping strategies using a diary once daily for 7 days. In general, cancer patients reported lower pain levels than patients with chronic non-cancer pain. Contrary to anecdotal reports, cancer pain patients did not report fear of pain. Cancer patients and patients with chronic non-cancer pain reported similar levels of trait anxiety which was higher than non-pain patients. Alexithymia, as a measure of emotional expression, was associated with increased duration of pain in the cancer pain patients. Cancer pain patients also reported less use of coping strategies than patients with chronic non-cancer pain. Cancer patients did not report higher levels of family modeling of pain complaints or family use of medication. The perceived family environment of the cancer pain patient did not differ significantly from the 3 other groups. These results do not support anecdotal impressions that the level of reported pain and fear of pain is significantly greater in cancer pain in contrast to non-cancer pain. The results do indicate the importance of emotional expressivity in the modulation of cancer pain where the ability to assess and express emotions was associated with reduced pain.

Education for pain management: A pilot study

Abstract In this experimental study, knowledge of pain perception, interpretation and pain management, perceived ability to decrease pain, use of self-control methods, and rating of pain intensity were measured before and after teaching cancer patients to cope with pain by using distraction, relaxation, and massage. The experimental group demonstrated a statistically significant increase in knowledge. The greatest behavior change was in the use of distraction. A smaller proportion of the experimental group than the control group reported increased use of medication. Recommendations for practice and future research are identified.

Using Reflexology for Pain Management: A Review

More than two thirds of Americans with chronic pain are now using complementary and alternative therapies. One complementary and alternative therapy, reflexology, has a long history and has been found useful on a case-by-case basis. This article provides a review of the literature on the use of reflexology as a therapy in pain management. Although reflexology is widely used, systematic research is needed to examine its effectiveness. To date, however, only a few studies have focused on reflexologys use in pain management. Because reflexology is a noninvasive, nonpharmacological therapy, nurses are in a position to do research on and make decisions about its clinical effectiveness.

Quality of Life and Productivity in Nurses Reporting Migraine

A random sample survey was conducted to determine the prevalence of migraine in nurses and to study its effect on quality of life and productivity. Of the 10 000 nurses sampled, 2949 returned the questionnaire for a response rate of 29.5%. The majority (99%) of respondents were employed and worked in hospitals (60%). According to the International Headache Society (IHS) criteria, 17% of the sample (n=495) were classified as having migraine. An additional 25% (n=750) suffered severe headaches but did not meet IHS criteria for migraine, and the remaining 58% (n=1704) were classified as not having either migraine or severe headaches. The migraineurs had significantly reduced work productivity and quality of life compared to both the severe headache and the nonmigraine nonsevere headache groups. This study will increase awareness and sensitivity of the profession to its colleagues who are migraine sufferers.

Biobehavioral factors in cancer pain

&NA; Despite the presence of pathology in cancer pain, the pain experience in adult cancer patients cannot be totally explained by the extent of such pathology. Unlike chronic benign pain very little research on the role of biobehavioral factors has been conducted to help explain this paradox. The literature on the role of biobehavioral factors in the cancer pain experience is reviewed. A brief review of epidemiology and pathophysiology is presented. Following this, the biobehavioral literature was organized according to research on psychological characteristics and environmental factors. Research addressing affective, cognitive, behavioral and physiological reactions to pain was also discussed. Despite the paucity of studies, the review suggested the following:personality factors do not appear to play a consistent role in the modulation of pain in cancer patients;the work on environmental influences on cancer pain indicate a weak association between such factors as social network and pain intensity;studies on affective state indicate minimal relationships to pain, and lastly,studies on cognitive responses to pain in cancer patients and their influence on the pain experience have not been conducted. To date, in the areas where biobehavioral factors have been investigated, the findings appear modest. However, many potential variables, e.g., self‐esteem, the role of family, the role of models, past or current work environments, social learning factors and responses to pain such as fear, somatization and reattribution have not been explored with cancer patients. While the influence of biobehavioral factors in adult cancer pain appear to be relatively modest, the literature is not extensive. Increased efforts at more precisely determining the input of such factors in cancer pain are warranted, particularly given the role of such variables in other recurrent and chronic pain states.