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Cancer-related pain in palliative care: patients' perceptions of pain management
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
Halmstad University, School of Social and Health Sciences (HOS).
Halmstad University, School of Social and Health Sciences (HOS).
2004 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 45, no 4, 410-419 p.Article in journal (Refereed) Published
Abstract [en]

Background: Pain is still a significant problem for many patients with cancer, despite numerous, clear and concise guidelines for the treatment of cancer-related pain. The impact of pain cognition on patients' experiences of cancer-related pain remains relatively unexplored. Aim: The aim of this study was to describe how patients with cancer-related pain in palliative care perceive the management of their pain. Method: Thirty patients were strategically selected for interviews with open-ended questions, designed to explore the pain and pain management related to their cancer. The interviews were analysed using a phenomenographic approach. Findings: Patients described 10 different perceptions of pain and pain management summarized in the three categories: communication, planning and trust. In terms of communication, patients expressed a need for an open and honest dialogue with health care professionals about all problems concerning pain. Patients expressed an urgent need for planning of their pain treatment including all caring activities around them. When they felt trust in the health care organization as a whole, and in nurses and physicians in particular, they described improved ability and willingness to participate in pain management. While the findings are limited to patients in palliative care, questions are raised about others with cancer-related pain without access to a palliative care team. Conclusion: The opportunity for patients to discuss pain and its treatment seems to have occurred late in the course of disease, mostly not until coming in contact with a palliative care team. They expressed a wish to be pain-free, or attain as much pain relief as possible, with as few side effects as possible.

Place, publisher, year, edition, pages
Blackwell Publishing , 2004. Vol. 45, no 4, 410-419 p.
Keyword [en]
Cancer-related pain, Communication, Pain management, Perceptions, Phenomenography, Planning, Trust, Nursing
National Category
Other Medical Sciences not elsewhere specified
Identifiers
URN: urn:nbn:se:hh:diva-356DOI: 10.1046/j.1365-2648.2003.02924.xISI: 000188720900008PubMedID: 14756835Scopus ID: 2-s2.0-1342343180Local ID: 2082/675OAI: oai:DiVA.org:hh-356DiVA: diva2:237535
Available from: 2012-02-01 Created: 2006-12-22 Last updated: 2017-07-06Bibliographically approved
In thesis
1. Acute postoperative and cancer-related pain management: Patients experiences and perceptions in relation to health-related quality of life and the multidimensionality of pain
Open this publication in new window or tab >>Acute postoperative and cancer-related pain management: Patients experiences and perceptions in relation to health-related quality of life and the multidimensionality of pain
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis describes patients in acute postoperative pain as well as patients with acute cancer-related pain in palliative care, and their experiences and perceptions of pain management in relation to HRQOL and the multidimensionality of pain. A combination of qualitative and quantitative methods was chosen. Data were collected using interviews and questionnaires; APS, SF:36 and a new developed questionnaire PC-PPQ measuring care related to pain management in palliative care. For assessing pain VAS and Pain-o-Meter were used. The study group consisted of 100 patients on their second postoperative day, and of 75 patients with cancer-related pain from two palliative care teams. The result showed that at the time of the interview 29 of the patients with postoperative pain reported a pain > 3 on VAS and 79 reported VAS > 3 as worst pain past 24 hours. The higher the intensity of pain the less satisfied the postoperative patients were with the nurses´ way of treating their pain. Thirty-three patients stated that they had received information regarding the importance of pain relief. Patients with postoperative pain as well as patients with cancer-related pain had been prescribed analgesics mostly a combination of Paracetamol, NSAID and opioid. Of the 75 patients with cancer-related pain and in palliative care 22 patients reported pain >3 on POM-VAS and 47 patients reported >3 on POM-VAS as worst pain past 24 hours. Twenty-eight patients reported an average pain > 3 on POM-VAS past 24 hours. Twenty-four patients used the words troublesome or tiring when describing their affective pain. Sensory pain was described as prickling or sore by 15 patients. The patients perceived their pain as “aching all over” and expressed a wish for pain relief as well as a fear for increased pain. HRQOL especially physical functioning decreased for patients with average pain > 3. Being cared for by a nurseled or a physician-led palliative care team indicated no statistically significant differences for patients´ HRQOL or pain intensities. The patients had experienced a statistically significant better care after being referred to a palliative care team, despite that pain control had not been optimized. Patients expressed a need for communication, planning and trust in order to improve pain management. Continuity of care and the opportunity to talk increase the patients feeling of security, as well as improved their perceived pain control. Structured ongoing discussion concerning pain management from an early stage of the disease or already preoperatively can provide an important intervention to meet the results of this thesis. Pain assessment covering the multidimensionality of pain, and pain treatment plans including both pharmacological and non-pharmacological treatment are further important interventions.

Place, publisher, year, edition, pages
Lund: Lunds Universitet, 2003. 144 p.
Keyword
American Pain Society, Postoperative pain, Palliative care, Neoplasms, Health-Related Quality of life, Patient care management, Patients, Pain management, Pain-o-Meter, nursing care, SF-36
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-1906 (URN)2082/2301 (Local ID)91-628-5575-1 (ISBN)2082/2301 (Archive number)2082/2301 (OAI)
Public defence
(English)
Available from: 2008-09-15 Created: 2008-09-15 Last updated: 2016-04-13Bibliographically approved

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Boström, BarbroSandh, MarieFridlund, Bengt
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