Cancer-related pain in palliative care: patients' perceptions of pain management 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. 410
Cancer patients' experiences of care related to pain management before and after palliative care referral 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.
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
InledningAkut smärta kan utvecklas till långvarig smärta, därför bör patienter med smärta behandlas så tidigt som möjligt under sjukdomsförloppet (1). Förutom lidandet för patienten och anhöriga kan patienters smärta leda till många kontakter med hälso-och sjukvård. Hälso-och sjukvårdspersonal måste därför vara medveten om problemet, inge förtro-ende och tillit så att patienter med smärta får snabb och korrekt bedömning och lämplig behandling (2). Strohbuecker m fl.(3) fann att 63% av patienter inneliggande på ett universitetssjukhus hade upplevt måttlig till svår smärta under de senaste 24 timmarna. Fyrtioen procent av patienter som hade opererats rapporterade måttlig till svår smärta första postoperativa dygnet (4). I en multinationell studie framkom att 19% procent av vuxna personer rapporterade långvarig smärta i mer än 6 månader (5). Femtiosex procent av vuxna patienter med en malign sjukdom som ingick i studie av Breivik m fl. (6) rapporterade måttlig till svår smärta.Smärta är ett problem för ett stort antal patienter vilket kan bero på att planeringen av smärtbehandling ofta påbörjas sent i sjukdomsför-loppet och kan vara otillräcklig (7). Sjuksköterskor informerar inte alltid patienterna om smärtbehandling, trots att de anger att de gör det (8). Dessutom framkom i samma studie att de inte utför smärtbedöm-ning, inte genomför optimal smärtbehandling samt inte heller utvärde-rar given behandling. I en studie av Marinsek m fl. (9) framkom att 40% av patienter med akut buksmärta var missnöjda med sin behandling av smärta. Möjliga orsaker till detta kan vara att smärtbedömning inte gjordes på ett korrekt sätt, att utvärdering sällan genomfördes (10), och/eller att läkare (9) och sjuksköterskor (11) uppskattar att patienters smärta är av lägre intensitet än vad patienterna själva upplever. Långa väntetider för att få analgetika är också en orsak till brister i vården av patient med smärta (12). En interventionsstudie av Stalnikowicz m fl. (11) visade att utbildning av sjuksköterskor minskade diskrepansen mellan patientens och sjuksköterskans bedömning av patienters smärta vilket resulterade i att antalet patienter som fick analgetika ökade. Förutom utbildning ingick i interventionen även implementering av visuell analog skala (VAS) för bedömning och utvärdering av smärta samt införandet av protokoll för smärtbehand-ling med standardiserade riktlinjer (11). Eftersom det är sjuksköter-skor som kontinuerligt har nära kontakt med patienten är sjuksköter-skans tidiga insatser nödvändiga (7). Sjuksköterskor måste först förstå patientens smärta, sedan initiera och utvärdera effekten av behandling (13). Sjuksköterskans attityd, kunskap och erfarenhet spelar en betydande roll i detta (14). Trots att sjuksköterskornas kunskaper ökar genom utbildning så har vårdverksamhetens redan etablerade rutiner och strategier stort inflytande på vården. Det kan innebära att om sjuksköterskan inte tycker sig ha makt och möjlighet att ta självständiga beslut för att genomföra förändringar använder de inte sin kunskap som stöd i vården...
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