Acute postoperative and cancer-related pain management : Patients experiences and perceptions in relation to health-related quality of life and the multidimensionality of pain

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

Sjuksköterskors upplevelse av smärtbehandling av äldre personeri kommunal hälso- och sjukvård

Background: Pain is a symptom that affects quality of life negatively for many people. As a person gets older, the symptoms will increase and more than 50 % of the elderly in the municipal health care is expected to have some sort of pain. This makes pain management a key question. Aim: The aim of this study was to describe what nurses perceive affect pain management for older people. Method: The study is based on interviews with 18 nurses from two municipalities in Sweden. The method used was qualitative content analysis. Results: Four categories affecting pain management were revealed: Proficiency, communication, organization and treatment strategies. Within each category three to four sub-categories were formed, such as medicine and older, documentation, work environment and pharmacological treatment. Several variations were revealed within each sub- categories. The results showed possibilities for good pain relief but the lack of tailored pain assessment tools, communication and treatment strategies tailored for older patients in pain made it difficult. The emerging theme was an unstructured organization makes it difficult to provide good pain relief. Conclusion: If evidence-based pain management strategies including pain assessment tools adapted in municipal health were developed, more patients should receive adequate pain treatment

Sjuksköterskors uppfattning om smärtbehandling och användning av riktlinjer

Aim: The aim was to identify how nurses perceive the performance of pain management and the use of guidelines for pain management. Background: Pain is one of the most common symptoms of illness for which people request health care. Patients in pain ought to be treated quickly and adequately in order to avoid developing a chronic state. Guidelines for effective pain relief are not always implemented in clinical practice. Method: A questionnaire regarding factors relevant to pain management and guidelines were designed. Findings: Of the 219 nurses who were invited, 111 (50.7%) answered the questionnaire. Thirty-one nurses responded that they used guidelines and they administered additional analgesics significantly more often when breakthrough pain occurred compared to nurses responding not using guidelines. Pain assessment is not always performed, 44 nurses agreed completely or partly that pain assessment is performed only when pain in the patient has become a problem. Forty-two nurses agreed completely or partly that there are routines in their department for treating patients with difficult pain issues. The nurses highlighted the importance of collaborating in team and having pain treatment routines. Conclusion: Pain management was perceived to be performed non-systematically and not always adapted to the individual. Guidelines were not always used

Sjuksköterskors upplevelse av smärtbehandling av äldre personeri kommunal hälso- och sjukvård

Background: Pain is a symptom that affects quality of life negatively for many people. As a person gets older, the symptoms will increase and more than 50 % of the elderly in the municipal health care is expected to have some sort of pain. This makes pain management a key question. Aim: The aim of this study was to describe what nurses perceive affect pain management for older people. Method: The study is based on interviews with 18 nurses from two municipalities in Sweden. The method used was qualitative content analysis. Results: Four categories affecting pain management were revealed: Proficiency, communication, organization and treatment strategies. Within each category three to four sub-categories were formed, such as medicine and older, documentation, work environment and pharmacological treatment. Several variations were revealed within each sub- categories. The results showed possibilities for good pain relief but the lack of tailored pain assessment tools, communication and treatment strategies tailored for older patients in pain made it difficult. The emerging theme was an unstructured organization makes it difficult to provide good pain relief. Conclusion: If evidence-based pain management strategies including pain assessment tools adapted in municipal health were developed, more patients should receive adequate pain treatment

Laborativ matematik : en studie i hur inslag av laborativ matematik i undervisningen påverkar gymnasieelevers intresse för matematik

Validerat; 20101217 (root

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 comparison of pain and health-related quality of life between two groups of cancer patients with differing average levels of pain

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