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Acute postoperative and cancer-related pain management: Patients experiences and perceptions in relation to health-related quality of life and the multidimensionality of pain
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
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. , p. 144
Keywords [en]
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: urn:nbn:se:hh:diva-1906Libris ID: 8871405Local ID: 2082/2301ISBN: 91-628-5575-1 (print)OAI: oai:DiVA.org:hh-1906DiVA, id: diva2:239124
Public defence
(English)
Available from: 2008-09-15 Created: 2008-09-15 Last updated: 2018-02-27Bibliographically approved
List of papers
1. Survey of post-operative patients' pain management
Open this publication in new window or tab >>Survey of post-operative patients' pain management
1997 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 5, no 6, p. 341-349Article in journal (Refereed) Published
Abstract [en]

Although effective pain treatment is available for both cancer-related pain and acute post-operative pain, many patients suffer unnecessarily. The aim of this study was to evaluate post-operative patients' pain management. A descriptive survey study was conducted in a 460-bed acute hospital in the southwestern part of Sweden. One hundred post-operative inpatients, on their second post-operative day, took part in the study. They were consecutively selected from six surgical wards. Data were collected using an interview questionnaire designed by the American Pain Society and analysed by descriptive and inferential statistics. At the time of the interview, 29 of the patients reported moderate to severe pain. Regarding the patients' worst pain experienced during the last 24 h, 79 of them reported moderate to very severe pain. Significant correlations were found between reported poor pain relief after pain medication and high intensity of pain both within the last 24 h and at the time of the interview. Eighty-three patients were satisfied with the way nurses treated their pain, while 64 patients were satisfied with the way physicians treated their pain. However, the higher the pain intensity experienced by the patients the less satisfied they were. The fact that patients do not know what kinds of relief are available may be one reason for the patients expressing satisfaction despite being in pain, another that the patients judge the kindness of the staff rather than their way of treating the pain. The field of pain management is rapidly changing requiring professional knowledge and experience in order to ensure pain management of good quality.

Place, publisher, year, edition, pages
Blackwell Publishing Ltd., 1997
Keywords
Survey, Pain management
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-1865 (URN)10.1046/j.1365-2834.1997.00031.x (DOI)9423405 (PubMedID)2-s2.0-1542737036 (Scopus ID)2082/2260 (Local ID)2082/2260 (Archive number)2082/2260 (OAI)
Available from: 2008-09-09 Created: 2008-09-09 Last updated: 2018-09-11Bibliographically approved
2. A comparison of pain and health-related quality of life between two groups of cancer patients with differing average levels of pain
Open this publication in new window or tab >>A comparison of pain and health-related quality of life between two groups of cancer patients with differing average levels of pain
2003 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 12, no 5, p. 726-735Article in journal (Refereed) Published
Abstract [en]

A study was performed to describe and compare pain and Health-Related Quality of Life (HRQOL) in two groups of cancer patients in palliative care as well as to describe the correlation between pain and HRQOL. ○ Forty-seven patients with mild average pain [Visual Analogue Scale (VAS) < 3] and 28 patients with moderate to severe average pain (VAS > 3) were included. Medical Outcomes Study Short Form (SF-36) was used to evaluate HRQOL, pain intensity levels were measured with the VAS on Pain-O-Meter. ○ Compared to patients with mild pain, patients with moderate to severe pain had statistically significant, higher pain intensity for the items 'pain at time of interview', 'worst pain in the past 24 hours' and 'pain interrupting sleep.' They also had the lowest scores of the SF-36 dimensions: physical functioning, role-physical, and bodily pain. Patients with moderate to severe pain had statistically significant, fewer months of survival. There were statistically significant positive correlations between pain items and negative correlation between pain and SF-36 dimensions. ○ The conclusion is that pain has a negative impact on HRQOL, especially on physical health and that pain increases towards the final stages of life. Even if patients have to endure symptoms such as fatigue and anxiety during their short survival time, dealing with pain is an unnecessary burden, which can be prevented.

Place, publisher, year, edition, pages
Blackwell Publishing Ltd., 2003
Keywords
Cancer, Health-related quality of life, Pain, Palliative care, SF-36
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-1864 (URN)10.1046/j.1365-2702.2003.00777.x (DOI)000184745200014 ()12919219 (PubMedID)2-s2.0-0141957354 (Scopus ID)2082/2259 (Local ID)2082/2259 (Archive number)2082/2259 (OAI)
Available from: 2012-02-01 Created: 2008-09-09 Last updated: 2018-03-23Bibliographically approved
3. Pain and health-related quality of life among cancer patients in final stage of life: a comparison between two palliative care teams
Open this publication in new window or tab >>Pain and health-related quality of life among cancer patients in final stage of life: a comparison between two palliative care teams
2003 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 11, no 3, p. 189-196Article in journal (Refereed) Published
Abstract [en]

A two-centred descriptive study was performed in order to describe and compare pain and health-related quality of life (HRQOL) among cancer patients, in their final stage of life. The patients were cared for by either a nurse-led palliative care team I (PCT I) or a physician-led palliative care team II (PCT II). Forty-six consecutive, stratified patients (PCT I, n = 21 and PCT II, n = 25) participated. The medical outcomes study short form 36 (SF-36) was used for evaluating HRQOL and the Pain-O-Meter for assessing pain. Patients' pain intensity, pain quality and HRQOL showed no significant difference between the two groups PCT I and PCT II. The patients from PCT I had significantly longer survival time (P = 0.017) than those from PCT II. The different composition of the teams being led by nurses or physicians is worth further research; both from the patient's and staff's viewpoint, there may also be cost-benefits worth examining.

Place, publisher, year, edition, pages
Chichester, West Sussex: Blackwell Publishing, 2003
Keywords
Cancer pain, Final stage of life, Health-related quality of life, Pain-o-Meter, Palliative care, SF-36
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-347 (URN)10.1046/j.1365-2834.2003.00360.x (DOI)12694366 (PubMedID)2-s2.0-0037945395 (Scopus ID)2082/660 (Local ID)2082/660 (Archive number)2082/660 (OAI)
Available from: 2006-12-21 Created: 2006-12-21 Last updated: 2018-03-23Bibliographically approved
4. Cancer patients' experiences of care related to pain management before and after palliative care referral
Open this publication in new window or tab >>Cancer patients' experiences of care related to pain management before and after palliative care referral
2004 (English)In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 13, no 3, p. 238-245Article in journal (Refereed) Published
Abstract [en]

Pain is the main problem for patients with cancer referred to palliative care (PC). Pain management in PC requires a multidimensional approach. A questionnaire was used to determine cancer patients' experiences of care related to pain management, before and after being referred to PC, and to also discover possible correlations between pain control and other aspects of care. Seventy-five consecutive patients from two PC teams were included in the study. The patients had experienced a statistically significant (P < 0.01) improvement in care after being referred to PC, despite the fact that pain control had not been optimized. Patients' description of 'pain control' after being referred to PC had a statistically significant correlation with their 'feeling of security' and 'continuity of care' throughout the same period. The conclusion is that care provided in PC is vital to successful pain management. Pain control depends not only on analgesics but also on many other aspects of care provided by the nurse. Continuity of care and the opportunity to talk increases the patients' feeling of security, which is also of utmost importance to successful pain management.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2004
Keywords
Cancer-related pain, Dimensions of pain, Pain management, Palliative care
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:hh:diva-357 (URN)10.1111/j.1365-2354.2004.00465.x (DOI)000222050800004 ()15196227 (PubMedID)2-s2.0-3042557812 (Scopus ID)2082/676 (Local ID)2082/676 (Archive number)2082/676 (OAI)
Available from: 2012-02-01 Created: 2006-12-22 Last updated: 2018-03-23Bibliographically approved
5. Cancer-related pain in palliative care: patients' perceptions of pain management
Open this publication in new window or tab >>Cancer-related pain in palliative care: patients' perceptions of pain management
2004 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 45, no 4, p. 410-419Article 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
Keywords
Cancer-related pain, Communication, Pain management, Perceptions, Phenomenography, Planning, Trust, Nursing
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:hh:diva-356 (URN)10.1046/j.1365-2648.2003.02924.x (DOI)000188720900008 ()14756835 (PubMedID)2-s2.0-1342343180 (Scopus ID)2082/675 (Local ID)2082/675 (Archive number)2082/675 (OAI)
Available from: 2012-02-01 Created: 2006-12-22 Last updated: 2018-03-23Bibliographically approved

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Boström, Barbro

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Citation style
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  • ieee
  • modern-language-association-8th-edition
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Output format
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