Randomized clinical trial to evaluate a cancer pain self-management intervention for outpatients.

Objective Unrelieved pain is common in patients with advanced cancer. Although psychoeducational interventions were found to decrease pain, effects were moderate. The purpose of this study was to evaluate the efficacy of a pain self-management intervention compared with usual care and to explore participants' experiences with pain management and study participation. Methods A multicenter randomized controlled trial design with post-trial interviews was used. Outpatients with cancer pain and their family caregivers were recruited from three Swiss university hospitals. The intervention group (IG) received the six-week intervention consisting of education, skills building, and nurse coaching. The control group (CG) received usual care. Outcome variables were analyzed using multilevel models. Interpretive description guided the qualitative study part. Results Twenty-one patients with advanced cancer and seven family caregivers completed the study. The group x time effect showed a statistically significant decrease in average pain (P ​= ​0.04), but no significant group x time effect for worst pain (P ​= ​0.06). Pain scores, pain-related knowledge, Pain Management Index, self-efficacy, and performance status improved in the IG (P ​< ​0.05). Almost all of the interviewed participants perceived the pain management diary, tailored intervention sessions, and weekly support as useful. None experienced study participation as burdensome. Conclusions This study was the first to test the efficacy of a psychoeducational cancer pain self-management intervention in a German-speaking context, with most patients receiving palliative care. Clinicians can recommend the use of pain management diaries. Tailoring interventions to an individual's situation and dynamic pain trajectory may improve patients' pain self-management. Registration number This study has been registered via ClinicalTrials.gov: NCT02713919.https://clinicaltrials.gov/ct2/show/NCT02713919?term=NCT02713919&amp;draw=2&amp;rank=1

Spiritualität und Behandlung: Die Perspektive von Patienten mit chronischen Schmerzen

Background: Chronic pain affects all aspects of human life, which raises spiritual questions that should be included within the framework of multimodal care. Objectives: We investigated the perspective of patients with chronic pain around spiritual concerns and their potential integration into care. Materials and methods: We conducted five focus group interviews and two small group interviews. In total, 42 patients with chronic pain in outpatient or inpatient pain care at the time of the study participated. The interviews were transcribed and thematically analyzed. Results: Three themes emerged: (1) Chronic pain permeates the entity of a person's existence. (2) Spiritual resources are potentially supportive in living with chronic pain. (3) Patients appreciate the opportunity to engage with health care professionals in a dialog that encompasses spiritual concerns. For participants, these concerns have considerable relevance. In many cases participants associated them with religious convictions, but not exclusively. They often related feeling that their pain experience was dismissed. Conclusion: Finding strategies for effectively dealing with chronic pain represents a turning point in life. Open discussion with health care professionals that allow for spiritual issues facilitates this process. == Hintergrund: Chronischer Schmerz betrifft alle menschlichen Lebensdimensionen und wirft auch spirituelle Fragen auf, die im Rahmen eines multimodalen Behandlungsmodells berücksichtigt werden sollten. Ziel der Arbeit: Wir untersuchten die Perspektive von Patienten mit chronischen Schmerzen zu spirituellen Themen und deren möglicher Integration in den Behandlungsprozess. Material und Methoden: Es wurden fünf Fokusgruppen- und zwei Kleingruppeninterviews an fünf Studienzentren durchgeführt. Daran nahmen 42 Patienten mit chronischen Schmerzen teil, die aktuell in ambulanter oder stationärer Schmerzbehandlung waren. Die Interviews wurden transkribiert und einer thematischen Analyse unterzogen. Ergebnisse: Drei Themen traten hervor: 1. Chronischer Schmerz durchdringt die gesamte menschliche Existenz. 2. Spirituelle Ressourcen stellen eine Möglichkeit im Umgang mit chronischen Schmerzen dar. 3. Patienten ist es ein Anliegen, mit Fachpersonen in einen Dialog treten zu können, der auch für spirituelle Themen offen ist. Diese haben aus Sicht der Teilnehmenden große Relevanz. Sie verknüpften sie vielfach, aber nicht ausschließlich mit religiösen Überzeugungen. Häufig wurde geschildert, in der Schmerzerfahrung nicht ernst genommen zu werden. Diskussion: Strategien für einen effektiven Umgang mit chronischem Schmerz zu finden, stellt einen Wendepunkt im Leben dar. In diesem Prozess unterstützt ein offener Dialog mit Fachpersonen, der auch spirituellen Themen Rechnung trägt

Including the Spiritual Dimension in Multimodal Pain Therapy. Development and Validation of the Spiritual Distress and Resources Questionnaire (SDRQ)

Context: Valid instruments for assessing spiritual resources and distress in pain therapy are scarce. The Spiritual Distress and Resources Questionnaire (SDRQ) was developed to fill this gap. Goals: The objective of this study was to investigate the SDRQ's psychometric properties. Methods: We presented the SDRQ to 219 patients with chronic pain conditions and examined its measurement properties, namely reliability and structural, convergent and discriminant validity. To investigate test–retest reliability, the SDRQ was presented a second time to a subsample of 58 randomly selected participants. Results: Factor analysis required a grouping of the 22 SDRQ items into four subscales: spiritual distress, spiritual coping, immanence and transcendence, the latter two representing spiritual resources. Cronbach's alpha was high for spiritual distress (0.93), transcendence (0.85), and immanence (0.81) while it was somewhat lower but still satisfactory for spiritual coping (0.70). The construct validity of the SDRQ was shown by correlations with established measures in the field. Higher levels of spiritual distress were associated with signs of more severe illness, such as emotional distress and pain intensity. Conclusion: The results from this study suggest that the SDRQ is an easy-to-use, reliable and valid screening instrument for assessing spiritual distress, spiritual resources and spiritual coping in patients with chronic pain. The SDRQ has the potential to be used with patients suffering from other chronic diseases and to disseminate the palliative approach to pain treatment to other areas of medicine

Long-term outcomes of stroke rehabilitation:patients and informal caregivers

Patiënten profiteren van betere begeleiding na beroerte Na een beroerte hebben mensen vaak levenslang zorg nodig. Dat leidt tot een zware belasting van het zorgstelsel en van mantelzorgers. Des te belangrijker is het dat patiënten zo goed mogelijk herstellen, niet alleen tijdens, maar ook na de revalidatie in een kliniek. Heike Geschwindner en collega-onderzoeker Horst Rettke gingen voor 287 patiënten in meerdere revalidatiecentra in Duitstalig Zwitserland na in hoeverre zij eerder gestelde revalidatiedoelen na drie jaar wisten te bereiken. Ook onderzochten ze hoe mantelzorgers (vaak de partner of naaste familie) in deze periode de zorg voor de patiënten ervoeren. Geschwindner en Rettke promoveren op dezelfde dag op dit onderzoek. Geschwindner en Rettke ontdekten dat de revalidatiedoelen die de patiënten in het revalidatiecentrum formuleerden weliswaar vaak gehaald werden, maar dat re-integratie in de maatschappij vervolgens vaak maar ten dele lukt. Volgens de onderzoekers komt dat omdat de focus in het revalidatiecentrum op lichamelijk, en daarna pas op geestelijk herstel ligt. Juist cognitieve functies, zoals communicatievaardigheden, zijn essentieel om goed te kunnen re-integreren. De promovendi stellen daarom dat aan cognitief herstel meer aandacht zou moeten worden besteed. Ook ontdekten Geschwinder en Rettke dat mantelzorgers de zorg voor een partner of familielid minder belastend vonden, naarmate ze het gevoel hadden de situatie meester te zijn en een structurele bijdrage te kunnen leveren aan verder herstel. Wel concludeerden ze dat mantelzorgers wat dat betreft nog beter op hun taak voorbereid kunnen worden.

Exploring learning processes associated with a cancer pain self-management intervention in patients and family caregivers: A mixed methods study.

AIM Explore learning processes associated with a psychoeducational pain selfmanagement intervention. BACKGROUND Self-management of cancer pain is challenging for patients and their family caregivers (FCs). While psychoeducational interventions can support them to handle these tasks, it remains unclear how learning processes are hampered or facilitated. METHODS A convergent parallel mixed methods design with qualitative data collection embedded in a randomized controlled trial (RCT) was used. Outpatients with cancer and FCs were recruited from three Swiss university hospitals. The six-week intervention consisted of education, skills building, and nurse coaching. Quantitative data on pain management knowledge and self-efficacy were analyzed using multilevel models. Patients and FCs were interviewed post-RCT regarding their learning experiences. Qualitative data analysis was guided by interpretive description. Finally, quantitative and qualitative data were integrated using case level comparisons and a meta-matrix. RESULTS Twenty-one patients and seven FCs completed this study. The group-by-time effect showed increases in knowledge (p = 0.035) and self-efficacy (p = 0.007). Patients' and FCs' learning through experience was supported by an intervention nurse, who was perceived as competent and trustworthy. After the study, most intervention group participants felt more confident to implement pain self-management. Finally, data integration showed that declining health hampered some patients' pain self-management. CONCLUSIONS Competent and trustworthy nurses can support patients' and FCs' pain self-management by providing individualized interventions. Using a diary, jointly reflecting on the documented experiences, and addressing knowledge deficits and misconceptions through the use of academic detailing can facilitate patients' and FCs' learning of critical skills

Comparing perspectives: patients’ and health care professionals’ views on spiritual concerns and needs in chronic pain care - a qualitative study

Background: The spiritual aspect of care is an often neglected resource in pain therapies. The aim of this study is to identify commonalities and differences in chronic pain patients’ (CPP) and health care professionals’ (HCP) perceptions on the integration of spiritual care into multimodal pain therapy. Methods: We conducted a qualitative exploratory study with 42 CPPs and 34 HCPs who were interviewed in 12 separate groups in five study centres specialising in chronic pain within German-speaking Switzerland. The interviews were transcribed and subjected to a qualitative content analysis. Findings were generated by juxtaposing and analysing the statements of (a) HCP about HCP, (b) HCP about CPP, (c) CPP about HCP, and (d) CPP about CPP. Results: Views on spiritual concerns and needs in chronic pain care can be described in three distinct dimensions: function (evaluating the need / request to discuss spiritual issues), structure (evaluating when / how to discuss spiritual issues) and context (evaluating why / under which circumstances to discuss spiritual issues). CPPs stress the importance of HCPs recognizing their overall human integrity, including the spiritual dimension, and would like to grant spiritual concerns greater significance in their therapy. HCPs express difficulties in addressing and discussing spiritual concerns and needs with chronic pain patients. Both parties want clarification of the context in which the spiritual dimension could be integrated into treatment. They see a need for greater awareness and training of HCPs in how the spiritual dimension in therapeutic interactions might be addressed. Conclusions: Although there are similarities in the perspectives of HCPs and CPPs regarding spiritual concerns and needs in chronic pain care, there are relevant differences between the two groups. This might contribute to the neglect of the spiritual dimension in the treatment of chronic pain