Sandra LeFort

Randomized controlled trial of a community-based psychoeducation program for the self-management of chronic pain

&NA; Although chronic pain is a frequent cause of suffering and disability and is costly to society, there continues to be limited access to specialty pain clinic services. Hence, there is a need for cost‐effective, accessible interventions that will help people find ways to better manage this difficult problem. This randomized controlled trial examined the effect of a low‐cost, community‐based, nurse‐delivered, group psychoeducation program entitled the Chronic Pain Self‐Management Program (CPSMP). It has a standard protocol that was modified from the successful Arthritis Self‐Management Program (ASMP). One hundred and ten individuals with mixed idiopathic chronic pain conditions were enrolled in the study (75% female; mean age 40 years; mean chronicity 6 years) and were randomly assigned to one of two conditions: the 12‐h (CPSMP) intervention group, or the 3‐month wait‐list control group. Self‐report measures of pain‐related and other quality of life variables as well as two hypothesized mediating variables were collected pre‐treatment and 3 months later by assessors blind to group allocation. One hundred and two subjects completed the study. Results of intention‐to‐treat analysis indicated that the treatment group made significant short‐term improvements in pain, dependency, vitality, aspects of role functioning, life satisfaction and in self‐efficacy and resourcefulness as compared to the wait‐list control group. Because it has a standard protocol, this intervention has the potential to be reliably delivered at low cost in varied urban and rural community settings and hence be more widely accessible to a greater number of people suffering from chronic pain than is currently the case with more specialized pain clinic services. Based on the results of this study, further research evaluating the long‐term impact and potential cost savings to the individual and to the health care system is warranted.

Randomized controlled trial of a psychoeducation program for the self-management of chronic cardiac pain.

Cardiac pain arising from chronic stable angina (CSA) is a cardinal symptom of coronary artery disease and has a major negative impact on health-related quality of life (HRQL), including pain, poor general health status, and inability to self-manage. Current secondary prevention approaches lack adequate scope to address CSA as a multidimensional ischemic and persistent pain problem. This trial evaluated the impact of a low-cost six-week angina psychoeducation program, entitled The Chronic Angina Self-Management Program (CASMP), on HRQL, self-efficacy, and resourcefulness to self-manage anginal pain. One hundred thirty participants were randomized to the CASMP or three-month wait-list usual care; 117 completed the study. Measures were taken at baseline and three months. General HRQL was measured using the Medical Outcomes Study 36-Item Short Form and the disease-specific Seattle Angina Questionnaire (SAQ). Self-efficacy and resourcefulness were measured using the Self-Efficacy Scale and the Self-Control Schedule, respectively. The mean age of participants was 68 years, 80% were male. Analysis of variance of change scores yielded significant improvements in treatment group physical functioning [F=11.75(1,114), P<0.001] and general health [F=10.94(1,114), P=0.001] aspects of generic HRQL. Angina frequency [F=5.57(1,115), P=0.02], angina stability [F=7.37(1,115), P=0.001], and self-efficacy to manage disease [F=8.45(1,115), P=0.004] were also significantly improved at three months. The CASMP did not impact resourcefulness. These data indicate that the CASMP was effective for improving physical functioning, general health, anginal pain symptoms, and self-efficacy to manage pain at three months and provide a basis for long-term evaluation of the program.

Cost of illness for chronic stable angina patients enrolled in a self-management education trial

BACKGROUND Chronic stable angina (CSA) is a major debilitating health problem in Canada. A paucity of relevant cardiovascular data sets has precluded a detailed examination of the impact of interventions on CSA-related costs and its broader economic burden. OBJECTIVES As part of a larger clinical trial, the authors sought to determine the short-term impact of a standardized self-management training program on CSA-related costs. A secondary objective was to estimate the total annualized cost of CSA per patient from a societal perspective. METHODS Pre- and three-month post-test cost data were collected on 117 participants using the Ambulatory Home Care Record. Mean annualized direct, indirect and system-related CSA costs (2003 to 2005) were estimated; total per-patient CSA costs from a societal perspective were calculated as the sum of these costs. RESULTS The mean (+/- SD) age of participants was 68+/-11 years; 80% were male. The program did not impact costs in the short-term. Direct annual out-of-pocket costs, including money paid for health care, travel to appointments, medication, equipment and home support totaled

Clinical ethical conflicts of nurses and physicians

3,267. Indirect costs, reflecting the value of all unpaid time spent by those engaged in angina-related care, were

Evolution of hospital clinical ethics committees in Canada

12,963. System costs, including costs paid by public and private insurers, were

Predictors of the development of chronic pain

2,979. Total estimated annual CSA costs from a societal perspective were

Role of Health Care Professionals in Multidisciplinary Pain Treatment Facilities in Canada

19,209 per patient. CONCLUSIONS These data suggest that CSA imposes a major economic burden, comparable with other prevalent conditions such as chronic noncancer pain. Advancements in self-management training research are needed to help reduce the economic burden of CSA in Canada.

Evaluation of Chronic Pain‐Related Information Available to Consumers on the Internet

Much of the literature on clinical ethical conflict has been specific to a specialty area or a particular patient group, as well as to a single profession. This study identifies themes of hospital nurses’ and physicians’ clinical ethical conflicts that cut across the spectrum of clinical specialty areas, and compares the themes identified by nurses with those identified by physicians. We interviewed 34 clinical nurses, 10 nurse managers and 31 physicians working at four different Canadian hospitals as part of a larger study on clinical ethics committees and nurses’ and physicians’ use of these committees. We describe nine themes of clinical ethical conflict that were common to both hospital nurses and physicians, and three themes that were specific to physicians. Following this, we suggest reasons for differences in nurses’ and physicians’ ethical conflicts and discuss implications for practice and research.

Designing strategies to implement research-based policies and procedures: a set of recommendations for nurse leaders based on the PARiHS framework.

To investigate the current status of hospital clinical ethics committees (CEC) and how they have evolved in Canada over the past 20 years, this paper presents an overview of the findings from a 2008 survey and compares these findings with two previous Canadian surveys conducted in 1989 and 1984. All Canadian hospitals over 100 beds, of which at least some were acute care, were surveyed to determine the structure of CEC, how they function, the perceived achievements of these committees and opinions about areas with which CEC should be involved. The percentage of hospitals with CEC in our sample was found to be 85% compared with 58% and 18% in 1989 and 1984, respectively. The wide variation in the size of committees and the composition of their membership has continued. Meetings of CEC have become more regularised and formalised over time. CEC continue to be predominately advisory in their nature, and by 2008 there was a shift in the priority of the activities of CEC to meeting ethics education needs and providing counselling and support with less emphasis on advising about policy and procedures. More research is needed on how best to define what the scope of activities of CEC should be in order to meet the needs of hospitals in Canada and elsewhere. More research also is needed on the actual outcomes to patients, families, health professionals and organisations from the work of these committees in order to support the considerable time committee members devote to this endeavour.

The Functioning of Hospital Ethics Committees: A Multiple-Case Study of Four Canadian Committees

The purpose of this secondary analysis was to explore the role of potential risk factors in predicting the development of chronic pain. Linear discriminant function analysis was used to derive a prediction equation that maximized the differences between a group of hospitalized patients experiencing acute pain who developed chronic pain (n = 171) and a group whose pain resolved (n = 200). Patients who developed chronic pain reported a higher pain intensity, higher anxiety and distress, less certainty that their pain would resolve, longer hospitalization, less independence in ambulation, a diagnosis of trauma, and less need for surgery. Recognition of these factors could lead to early identification of those individuals with acute pain who are at risk for developing chronic pain.