Kreftpasienters barrierer mot smertebehandling

Bakgrunn: Ulike faktorer hos helsepersonell, pasienten selv eller i rammefaktorene kan forklare mangelfull smertelindring hos kreftpasienter. Hos pasientene kan barrierer for optimal smertebehandling være tilbakeholdenhet med å rapportere smerte og å følge anbefalte smerteregimer. Dette kan forklares med feiloppfatninger, misforståelser eller manglende kunnskap om smerte og smertebehandling. For eksempel redsel for avhengighet, toleranse og bivirkninger eller at smerte er en uunngåelig del av sykdommen. Hensikt: Å beskrive pasientrelaterte barrierer i forhold til smerte og smertebehandling i et utvalg av norske kreftpasienter. Og undersøke om barrierer for smertebehandling påvirker pasientenes smerteintensitet og smertens påvirkning på funksjon. Metode: Studien er en beskrivende tverrsnittsundersøkelse med 217 polikliniske kreftpasienter som har smerter og/eller bruker smertestillende medikamenter hvor barriere mot smerte og smertebehandling undersøkes ved hjelp av barriereskjema (NBQ–II). Hovedresultat: De spørsmål som reflekterer de høyeste barrierene for smertebehandling er spørsmål om avhengighet, toleranse, monitorere symptomer i forhold til egen helsetilstand, nye smerter og redsel for enkelte bivirkninger som døsighet. Konklusjon: Polikliniske kreftpasienter rapporterer en del barrierer for smertebehandling og må kanskje få en mer individualisert informasjon om smerte og smertebehandling for å bedre smertebehandlingen.Background: Numerous professional, patient, and system barriers contribute to the under-treatment of pain in cancer patients. Patients may, for example, be reluctant to report pain and to use available analgesics. This reluctance is often based on erroneous beliefs or misconceptions about pain and pain medication and includes factors such as fears of addiction and tolerance, fear of side-effects, and a belief that pain is an inevitable component of the disease. Objectives: To investigate patient-related barriers to pain management in a sample of outpatients with cancer and investigate whether barriers influence patients pain intensity and pain interference with function. Method: The study is a cross-sectional descriptive study with a convenient sample of 217 cancer patients self-reporting pain and/or using analgesics assessing barriers to pain and pain management using the Norwegian version of the Barriers Questionnaire (NBQ–II). Results: Questions reflecting the highest barriers were concerns about addiction, tolerance and about the pain-medications’ ability to prevent knowledge about new pain and changes in their health. With regard to side-effects of pain medication, the highest reported level on NBQ–II was on the items concerning drowsiness. Conclusion: Out-patients with cancer still have barriers to pain management and may need more individualized information and follow-up by health personnel in order to enhance pain management. Keyword: cancer pain, patients’ barriers, pain management, outpatient

The Relationships between Mood Disturbances and Pain, Hope, and Quality of Life in Hospitalized Cancer Patients with Pain on Regularly Scheduled Opioid Analgesic

Objective: The study purposes were to describe the percentage of patients in one of four mood groups (i.e., neither anxiety nor depression [NEITHER], only anxiety [ANX], only depression [DEP], both anxiety and depression [BOTH]) and to evaluate how differences in mood states are related to pain, hope, and quality of life (QOL). Methods: Oncology inpatients (n=225) completed Brief Pain Inventory, Herth Hope Index (HHI), and the European Organization for Research and Treatment of Cancer Core QOL Questionnaire-C30. Research nurses completed Symptom Severity Checklist, Karnofsky Performance Status score, and medical record reviews. Data were analyzed using x^2, Kruskal-Wallis, one-way analyses of variance (ANOVAs), and analyses of covariance (ANCOVA). Results: Thirty-two percent of patients were categorized in the NEITHER group, 12% in the ANX group, 12% in the DEP group, and 44% in the BOTH group. Younger patients and women were more likely to be in the BOTH group. While only minimal differences were found among the mood groups on pain intensity scores, patients in the NEITHER group in general, reported lower pain interference scores than those in the other three groups. Significant differences were found in HHI scores between the patients in the NEITHER group and the BOTH group. In addition, patients with both mood disorders reported significantly poorer QOL scores. Conclusions: Because 44% of the patients had both anxiety and depression, clinicians need to evaluate patients for the co-occurrence of these two symptoms, evaluate its impact on pain management, hope, and QOL, and develop appropriate interventions to manage these symptoms

Health care providers underestimate symptom intensities of cancer patients: A multicenter European study

<p>Abstract</p> <p>Background</p> <p>Many patients with advanced cancer depend upon health care providers for symptom assessment. The extent of agreement between patient and provider symptom assessments and the association of agreement with demographic- and disease-related factors was examined.</p> <p>Methods</p> <p>This cross-sectional study included 1933 patient-health care provider dyads, from 11 European countries. Patients reported symptoms by using the four-point scales of the European Organization of Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) version 3, and providers used corresponding four-point categorical scales. Level of agreement was addressed at the group level (Wilcoxon Signed-Rank test), by difference scores (provider score minus patient score), at the individual level (Intraclass Correlation Coefficients, ICCs) and visually by Bland-Altman plots. Absolute numbers and chi-square tests were used to investigate the relationship between agreement and demographic-, as well as disease-related factors.</p> <p>Results</p> <p>The prevalence of symptoms assessed as moderate or severe by patients and providers, respectively, were for pain (67 vs.47%), fatigue (71 vs. 54%), generalized weakness (65 vs. 47%), anorexia (47 vs. 25%), depression (31 vs. 17%), constipation (45 vs. 30%), poor sleep (32 vs. 21%), dyspnea (30 vs. 16%), nausea (27 vs. 14%), vomiting (14 vs. 6%) and diarrhea (14 vs. 6%). Symptom scores were identical or differed by only one response category in the majority of patient-provider assessment pairs (79-93%). Providers underestimated the symptom in approximately one of ten patients and overestimated in 1% of patients. Agreement at the individual level was moderate (ICC 0.38 to 0.59). Patients with low Karnofsky Performance Status, high Mini Mental State-score, hospitalized, recently diagnosed or undergoing opioid titration were at increased risk of symptom underestimation by providers (all p < 0.001). Also, the agreement was significantly associated with drug abuse (p = 0.024), provider profession (p < 0.001), cancer diagnosis (p < 0.001) and country (p < 0.001).</p> <p>Conclusions</p> <p>Considerable numbers of health care providers underestimated symptom intensities. Clinicians in cancer care should be aware of the factors characterizing patients at risk of symptom underestimation.</p

Characterization of Mycobacterium bovis from Humans and Cattle in Namwala District, Zambia

Tuberculosis remains a major public health problem in Zambia. While human to human transmission of Mycobacterium tuberculosis is of major importance in driving the tuberculosis epidemic, the impact of Mycobacterium bovis transmission from infected cattle is largely unknown. This cross-sectional study aimed at molecular characterization of M. bovis in humans and cattle. A total of 100 human sputum samples and 67 bovine tissues were collected and analyzed for the presence of mycobacteria. Of 65 human samples that harbored acid fast bacteria (AFB), 55 isolates were obtained of which 34 were identified as M. tuberculosis and 2 as M. bovis. AFB-positive bovine samples (n=67) yielded 47 mycobacterial isolates among which 25 were identified as M. bovis and no M. tuberculosis was found. Among the M. bovis isolates, spoligotyping revealed a high homogeneity in genotypes circulating in Namwala district. Human and cattle isolates shared identical MIRU-VNTR genotypes, suggesting that transmission between the two hosts may occur. Therefore, this study has documented zoonotic TB in human patients in Namwala district of Zambia. However, further molecular epidemiological studies in the study area are recommended

A multicenter international prospective study of the validity and reliability of a COVID-19-specific health-related quality of life questionnaire

Purpose: To develop and validate a health-related quality of life (HRQoL) questionnaire for patients with current or previous coronavirus disease (COVID-19) in an international setting. Methods: This multicenter international methodology study followed standardized guidelines for a four-phase questionnaire development. Here, we report on the pretesting and validation of our international questionnaire. Adults with current or previous COVID-19, in institutions or at home were eligible. In the pretesting, 54 participants completed the questionnaire followed by interviews to identify administration problems and evaluate content validity. Thereafter, 371 participants completed the revised questionnaire and a debriefing form to allow preliminary psychometric analysis. Validity and reliability were assessed (correlation-based methods, Cronbach’s α, and intra-class correlation coefficient). Results: Eleven countries within and outside Europe enrolled patients. From the pretesting, 71 of the 80 original items fulfilled the criteria for item-retention. Most participants (80%) completed the revised 71-item questionnaire within 15 min, on paper (n = 175) or digitally (n = 196). The final questionnaire included 61 items that fulfilled criteria for item retention or were important to subgroups. Item-scale correlations were > 0.7 for all but nine items. Internal consistency (range 0.68–0.92) and test–retest results (all but one scale > 0.7) were acceptable. The instrument consists of 15 multi-item scales and six single items. Conclusion: The Oslo COVID-19 QLQ-W61© is an international, stand-alone, multidimensional HRQoL questionnaire that can assess the symptoms, functioning, and overall quality of life in COVID-19 patients. It is available for use in research and clinical practice. Further psychometric validation in larger patient samples will be performed.publishedVersio

Health-related quality of life issues, including symptoms, in patients with active COVID-19 or post COVID-19; a systematic literature review

Purpose This systematic review was performed to identify all relevant health-related quality of life (HRQoL) issues associated with COVID-19. Methods A systematic literature search was undertaken in April 2020. In four teams of three reviewers each, all abstracts were independently reviewed for inclusion by two reviewers. Using a pre-defined checklist of 93 criteria for each publication, data extraction was performed independently by two reviewers and subsequently compared and discussed. If necessary, a third reviewer resolved any discrepancies. The search was updated in February 2021 to retrieve new publications on HRQoL issues including issues related to the long-term consequences of COVID-19. Results The search in April 2020 identified 3342 potentially relevant publications, and 339 publications were selected for full-text review and data extraction. We identified 75 distinct symptoms and other HRQoL issues categorized into 12 thematic areas; from general symptoms such as fever, myalgia, and fatigue, to neurological and psychological issues. The updated search revealed three extra issues experienced during active disease and long-term problems with fatigue, psychological issues and impaired cognitive function. Conclusion This first comprehensive systematic review provides a detailed overview of the wide range of HRQoL issues experienced by patients with COVID-19 throughout the course of the disease. It demonstrates the devastating impact of the disease and provides critically important information for clinicians, to enable them to better recognize the disease and to provide knowledge important for treatment and follow-up. The results provided the foundation for the international development of a COVID-19 specific patient-reported HRQoL questionnaire

Health-related quality of life in patients with COVID-19; international development of a patient-reported outcome measure

Background We aimed to create a questionnaire to assess the health-related quality of life including functioning, symptoms, and general health status of adult patients with current or previous COVID-19. Here, we report on Phase I and II of the development. Methods Internationally recognized methodology for questionnaire development was followed. In Phase I, a comprehensive literature review was performed to identify relevant COVID-19 issues. Decisions for inclusion, exclusion, and data extraction were completed independently in teams of two and then compared. The resulting issues were discussed with health care professionals (HCPs) and current and former COVID-19 patients. The input of HCPs and patients was carefully considered, and the list of issues updated. In Phase II, this updated list was operationalized into items/questions. Results The literature review yielded 3342 publications, 339 of which were selected for full-text review, and 75 issues were identified. Discussions with 44 HCPs from seven countries and 52 patients from six countries showed that psychological symptoms, worries, and reduced functioning lasted the longest for patients, and there were considerable discrepancies between HCPs and patients concerning the importance of some of the symptoms. The final list included 73 issues, which were operationalized into an 80-item questionnaire. Conclusion The resulting COVID-19 questionnaire covers health–related quality of life issues relevant to COVID-19 patients and is available in several languages. The next steps include testing of the applicability and patients’ acceptability of the questionnaire (Phase IIIA) and preliminary psychometric testing (Phase IIIB)

Measuring physiotherapy performance in patients with osteoarthritis of the knee: A prospective study

<p>Abstract</p> <p>Background</p> <p>Patients with knee osteoarthritis [OA] are commonly treated by physiotherapists in primary care. Measuring physiotherapy performance is important before developing strategies to improve quality. The purpose of this study was to measure physiotherapy performance in patients with knee OA by comparing clinical practice to evidence from systematic reviews.</p> <p>Methods</p> <p>We developed a data-collection form and invited all private practitioners in Norway [n = 2798] to prospectively collect data on the management of one patient with knee OA through 12 treatment session. Actual practice was compared to findings from an overview of systematic reviews summarising the effect of physiotherapy interventions for knee OA.</p> <p>Results</p> <p>A total of 297 physiotherapists reported their management for patients with knee OA. Exercise was the most common treatment used, provided by 98% of the physiotherapists. There is evidence of high quality that exercise reduces pain and improves function in patients with knee OA. Thirty-five percent of physiotherapists used acupuncture, low-level laser therapy or transcutaneous electrical nerve stimulation. There is evidence of moderate quality that these treatments reduce pain in knee OA. Patient education, supported by moderate quality evidence for improving psychological outcomes, was provided by 68%. Physiotherapists used a median of four different treatment modalities for each patient. They offered many treatment modalities based on evidence of low quality or without evidence from systematic reviews, e.g. traction and mobilisation, massage and stretching.</p> <p>Conclusion</p> <p>Exercise was used in almost all treatment sessions in the management of knee OA. This practice is desirable since it is supported by high quality evidence. Physiotherapists also provide several other treatment modalities based on evidence of moderate or low quality, or no evidence from systematic reviews. Ways to promote high quality evidence into physiotherapy practice should be identified and evaluated.</p

The effects of age on health-related quality of life in cancer populations: A pooled analysis of randomized controlled trials using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 involving 6024 cancer patients.

Cancer incidence increases exponentially with advancing age, cancer patients live longer than in the past, and many new treatments focus on stabilizing disease and HRQOL. The objective of this study is to examine how cancer affects patients' HRQOL and whether their HRQOL is age-dependent.Data from 25 EORTC randomized controlled trials was pooled. EORTC QLQ-C30 mean scores for the cancer cohort and five general population cohorts were compared to assess the impact of cancer on patients' HRQOL. Within the cancer cohort, multiple linear regressions (two-sided level P-value = 0.05 adjusted for multiple testing.) were used to investigate the association between age and HRQOL, adjusted for gender, WHO performance status (PS), distant metastasis and stratified by cancer site. A difference of 10 points on the 0-100 scale was considered clinically important.Cancer patients generally have worse HRQOL compared to the general population, but the specific HRQOL domains impaired vary with age. When comparing the cancer versus the general population, young cancer patients had worse financial problems, social and role functioning, while the older cancer groups had more appetite loss. Within the cancer cohort, HRQOL was worse with increasing age for physical functioning and constipation, and better with increasing age for social functioning, insomnia and financial problems (all p < 0.05).HRQOL is impaired in cancer patients compared to the general population, but the impact on specific HRQOL domains varies by age. Within the cancer population, some HRQOL components improve with age while others deteriorate. Optimal care for older cancer patients should target HRQOL domains most relevant to this population