A theory-based educational intervention targeting nurses' attitudes and knowledge concerning cancer-related pain management: A study protocol of a quasi-experimental design

<p>Abstract</p> <p>Background</p> <p>Pain is one of the most frequent problems among patients diagnosed with cancer. Despite the availability of effective pharmacological treatments, this group of patients often receives less than optimal treatment. Research into nurses' pain management highlights certain factors, such as lack of knowledge and attitudes and inadequate procedures for systematic pain assessment, as common barriers to effective pain management. However, educational interventions targeting nurses' pain management have shown promise. As cancer-related pain is also known to have a negative effect on vital aspects of the patient's life, as well as being commonly associated with problems such as sleep, fatigue, depression and anxiety, further development of knowledge within this area is warranted.</p> <p>Methods/design</p> <p>A quasi-experimental study design will be used to investigate whether the implementation of guidelines for systematic daily pain assessments following a theory-based educational intervention will result in an improvement in knowledge and attitude among nurses. A further aim is to investigate whether the intervention that targets nurses' behaviour will improve hospital patients' perception of pain. Data regarding nurses' knowledge and attitudes to pain (primary outcome), patient perception regarding pain (secondary outcome), together with socio-demographic variables, will be collected at baseline and at four weeks and 12 weeks following the intervention.</p> <p>Discussion</p> <p>Nursing care is nowadays acknowledged as an increasingly complicated activity and "nursing complexity is such that it can be seen as the quintessential complex intervention." To be able to change and improve clinical practice thus requires multiple points of attack appropriate to meet complex challenges. Consequently, we expect the theory-based intervention used in our quasi-experimental study to improve care as well as quality of life for this group of patients and we also envisage that evidence-based guidelines targeting this patient group's pain will be implemented more widely.</p> <p>Trial Registration Number</p> <p>ClinicalTrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT01313234">NCT01313234</a></p

Pilot study evaluating a brief mindfulness intervention for those with chronic pain: study protocol for a randomized controlled trial.

BACKGROUND: The burden of chronic pain is a major challenge, impacting the quality of life of patients. Intensive programmes of mindfulness-based therapy can help patients to cope with chronic pain but can be time consuming and require a trained specialist to implement. The self-management model of care is now integral to the care of patients with chronic pain; home-based interventions can be very acceptable, making a compelling argument for investigating brief, self-management interventions. The aim of this study is two-fold: to assess the immediate effects of a brief self-help mindfulness intervention for coping with chronic pain and to assess the feasibility of conducting a definitive randomized controlled trial to determine the effectiveness of such an intervention. METHODS/DESIGN: A randomized controlled pilot study will be conducted to evaluate a brief mindfulness intervention for those with chronic pain. Ninety chronic pain patients who attend hospital outpatient clinics will be recruited and allocated randomly to either the control or treatment group on a 1:1 basis using the computer-generated list of random numbers. The treatment group receives mindfulness audios and the control group receives audios of readings from a non-fiction book, all of which are 15 minutes in length. Immediate effects of the intervention are assessed with brief psychological measures immediately before and after audio use. Mindfulness, mood, health-related quality of life, pain catastrophizing and experience of the intervention are assessed with standardized measures, brief ratings and brief telephone follow-ups, at baseline and after one week and one month. Feasibility is assessed by estimation of effect sizes for outcomes, patient adherence and experience, and appraisal of resource allocation in provision of the intervention. DISCUSSION: This trial will assess whether a brief mindfulness-based intervention is effective for immediately reducing perceived distress and pain with the side effect of increasing relaxation in chronic pain patients and will determine the feasibility of conducting a definitive randomized controlled trial. Patient recruitment began in January 2015 and is due to be completed in June 2016. TRIAL REGISTRATION: ISRCTN61538090 Registered 20 April 2015

Relationship between self-reported pain sensitivity and pain after total knee arthroplasty: a prospective study of 71 patients 8 weeks after a standardized fast-track

Berit T Valeberg,1 Lise H H&oslash;vik,2 Kari H Gjeilo3&ndash;6 1Faculty of Nursing, Oslo and Akershus University College of Applied Sciences, Oslo, 2Clinic of Anaesthesia and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, 3Department of Cardiothoracic Surgery, 4Department of Cardiology, 5National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital, Trondheim University Hospital, 6Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway Background and purpose: This was a prospective cohort study assessing data from 71 adult patients undergoing total knee arthroplasty (TKA) following a standardized fast-track program between January and July 2013. The objective was to examine the relationship between self-rated pain sensitivity, as measured by the Pain Sensitivity Questionnaire (PSQ), and postoperative pain after TKA. Methods: The baseline questionnaires, PSQ and Brief Pain Inventory, were given to the patients for self-administration at the presurgical evaluation (1&ndash;2&nbsp;weeks prior to surgery). The follow-up questionnaire, Brief Pain Inventory, was administered at the first follow-up, 8&nbsp;weeks after surgery. Results: A statistically significant association was found between average preoperative pain and average pain 8&nbsp;weeks after surgery (P=0.001). The PSQ-minor was statistically significantly associated with average pain only for patients younger than 70&nbsp;years (P=0.03). Interpretation: This is the first study to examine the relationship between pain sensitivity measured by PSQ and postoperative pain in patients after TKA. We found that a lower score on the PSQ-minor was statistically significantly associated with patients&rsquo; pain 8&nbsp;weeks after TKA surgery, but only for younger patients. Further research is needed to explore whether the PSQ could be a useful screening tool for patients&rsquo; pain sensitivity in clinical settings. Keywords: postoperative pain, pain sensitivity, pain sensitivity questionnaire, total knee arthroplast

Qualidade de vida relacionada à saúde, antes e seis meses após a revascularização do miocárdio Calidad de vida relacionada con la salud antes y seis meses después de la revascularización miocárdica Health-related quality of life before and six months after coronary artery bypass graft surgery

A cirurgia de revascularização do miocárdio (CRM) visa melhorar a qualidade de vida relacionada à saúde (QVRS), aliviar sintomas e aumentar a sobrevida. Objetivou-se comparar a QVRS antes e seis meses após CRM e avaliar a sua relação com idade, sexo, escolaridade e estado civil. Estudo descritivo e longitudinal que utilizou o SF-36 para avaliar a QVRS. Entre os 54 sujeitos, 53,7% eram homens, 66,7% casados, com idade média de 57,3+9,7 anos e 5,7+4 anos de escolaridade. Após a CRM as médias dos domínios do SF-36 variaram de 62 a 74,2 sendo o intervalo anterior de 17,1 a 58,1. Homens apresentaram melhor avaliação da QVRS antes e após a CRM do que as mulheres, mas as diferenças foram estatisticamente significantes apenas para Estado geral de saúde e Dor. Não se constatou associação entre QVRS, escolaridade e estado civil. Concluiu-se que a CRM melhorou a QVRS dos participantes.<br>La cirugía de revascularización del miocardio (CRVM) busca ofrecer una mejor calidad de vida relacionada con la salud (CVRS), aliviar los síntomas de angina y aumentar la sobrevida. Los objetivos foi comparar la CVRS antes y seis meses después de la CRVM y evaluar su relación con la edad, sexo, escolaridad y estado civil. Estudio descriptivo y longitudinal, que utilizó el SF-36 para evaluar la CVRS. Entre los 54 participantes, 53,7% eran hombres, 66,7% casados, con edad media de 57,3+9,7 años y 5,7+4 años de escolaridad. Después de la CRVM las medias de los dominios del SF-36 variaron de 62 a 74,2 siendo el intervalo anterior de 17,1 a 58,1. Hombres presentaron mejor evaluación de CVRS antes e después de la CRVM que las mujeres, entretanto las diferencias fueron estadísticamente significativas sólo para Estado General de salud y Dolor. No se encontró asociación entre CVRS, escolaridad y estado civil. Las conclusión es que la CRVM mejoró la CVRS de los participantes.<br>Coronary artery bypass grafting (CABG) surgery aims at offering a better health-related quality of life (HRQL), relieving symptoms and increasing survival .The objectives were to compare HRQL before CABG and six months after it and to evaluate its relation concerning participants' age, sex, schooling and marital status. Descriptive and longitudinal study, which used the SF-36 to evaluate HRQL. Among the 54 subjects, 53,7% were men, 66,7% of them were married, their average age was of 57,3+9,7 and their schooling of 5,7+4. After CABG, the scores of the domains of the SF-36 varied from 62 to 74,2 being the previous interval from 17,1 to 58,1. Men showed a better evaluation towards HRQL before and after CABG than women, but the differences were only statistically significant for General Health and Bodily pain. No association between HRQL, schooling and marital status was stated. In conclusion, the CABG improved participants' HRQL