Tore Pedersen

Characteristics of breakthrough cancer pain and its influence on quality of life in an international cohort of patients with cancer.

Objectives Breakthrough cancer pain (BTP) represents a treatment challenge. Objectives were to examine the prevalence and characteristics of BTP in an international sample of patients with cancer, and to investigate the relationship between BTP and quality of life (QoL). Methods This was an observational cross-sectional multicentre study. Participating patients completed self-report questionnaires on a touch-screen laptop computer, including the Brief Pain Inventory, Alberta Breakthrough Pain Assessment Tool (ABPAT) and European Organisation for Research and Treatment of Cancer 30-item Core Quality of Life Questionnaire (EORTC QLQ-C30). The study was performed in 17 centres in 8 countries and involved 4 languages (Norwegian, Italian, German and English). Results Records from a convenience sample of 978 patients with advanced cancer were analysed; mean age was 62.2 years, 48.3% were women and 84.4% had metastatic disease. A total of 296 patients (30%) had no pain, defined as worst pain in the past 24 hours <1 on a 0–10 scale. Of the 682 patients with a pain score ≥1, 393 (58%) reported no BTP on the screening item, while 289 (30%) confirmed flare ups of BTP. Patients with BTP reported significantly higher pain intensity scores (<0.001) than patients without BTP; 57.1% of patients rated BTP at its worst as being severe: ≥7 on a 0–10 scale. Time from onset to peak intensity was <10 min for 42.9%, and average time to pain relief was 27.1 min. BTP was commonly triggered by medication wearing off (28%). Patients with BTP had significantly worse mean outcomes on 10 of 15 functional and symptom scales of the EORTC QLQ-C30 (<0.001). Severe pain intensity in the last week was a powerful predictor of BTP (OR 4.1) and poor QoL (OR 1.9). Conclusions BTP is highly prevalent with prolonged episodes despite analgaesics, and has a pervasive impact on QoL. Patients reporting high pain intensity should be carefully evaluated for BTP and efficacy of analgaesic treatment, to provide optimal pain management and improve QoL. Trial registration number NCT00972634; Results.

Affective forecasting of value creation: professional nurses' ability to predict and remember the experienced value of a telemedicine diagnostics ICT service

New innovations that can transform societies and improve life for people are increasingly being asked for. Unfortunately, some avenues of research indicate that users of these new innovations may be inaccurate when they predict or remember the value of such new offerings. For example, the rapid development of new ICT services in areas such as health care may imply opportunities for better life conditions and well-being, but may also involve complicated predictions for users about the value they will create. New innovations may face adoption difficulties if users make inaccurate predictions or remember falsely the value that such innovations might have. In this study, 48 nurses predicted, experienced, and remembered the value of a new ICT service they used to diagnose an external skin lesion on a patient. Results showed significant differences between predicted and experienced value as well as between a service with high technical quality and the same service with lower technical quality; the value was underestimated at the time of prediction, as compared to actual experience, and the value of a high-quality ICT service was substantially more underestimated than the value of a low-quality ICT service. The results provide a novel and comprehensive understanding of how employees predict and experience the value of ICT service innovations.