Objective: To identify non-pharmacological strategies in the control of pain and
dyspnea, in patient with oncological disease, in acute care.
Methodology: Question in PI[C]O format was used and search at EBSCO
(MEDLINE with Full TEXT; CINAHL, Plus with Full Text; British Nursing Index)
retrospectively from 2009 to 2015. We included also guidelines by reference
entities: Oncology Nursing Society (2011) National Comprehensive Cancer
Network and Cancer Care Ontario, resulting in a total of 15 articles.
Results: The gold standard for an adequate symptom control is a systematized
assessment. Non-pharmacological measures: psycho-emotional support,
hypnosis, counseling/training/ instruction, therapeutic adherence, music therapy,
massage, relaxation techniques, telephone support, functional and respiratory reeducation
increase health gains.
Conclusion: The control of oncologic pain and dyspnea require a comprehensive
and multimodal approach

Fonseca, C

Lopes, M. J.

Mendes, F

Parreira, P.

Ramos, A.

Tavares, AP

Repositório Científico da Universidade de Évora

Nursing & Care Open Access JournalControl of Pain and Dyspnea in Patients with Oncologic Disease in Acute Care: Non-Pharmacological InterventionsSubmit Manuscript | http://medcraveonline.comIntroductionGlobally, more than 14 million new cases of cancer will occur each year and the number of people with this disease expected to triple by 2030, as a result of survival [1,2]. Survivors continue to experience significant limitations, compared to those without a history of cancer [3]. The presence of symptoms persists permanently, resulting from the direct adverse effects of cancer, treatment, exacerbation and/ or onset of new ones, associated with recurrence or second tumor [4,5].Pain, dyspnea, fatigue, emotional distress arise simultaneously and are interdependent. In this way, the term cluster symptoms comes to light when two or more symptoms are interrelated, since they can share the same etiology and produce a cumulative effect on the person’s functioning [6]. Richards et al. [7] found that patients with a high prevalence of pain were more likely to be treated with high-dose pain relief than those who did not. The incidence of pain at the onset of the disease pathway is estimated at 50% and is increased to approximately 75% at advanced stages, which means that the survivor does not experience it only as an immediate treatment outcome [6]. In an advanced stage of the oncological disease, dyspnea is one of the symptoms that assumes particular relevance, often arises associated with pain (about 45%), represented a cluster symptoms inducer of greater anxiety and fatigue. That is responsible for the demand for health care, so it is fundamental a serious investment in their control [8]. The objective of this systematic review of the literature is to identify non-pharmacological strategies in the control of pain and dyspnea, of the patients with oncological disease, in acute care.Research StrategyWe formulated a question in PI[C]O format: What are the non-pharmacological strategies (Intervention) for the control of pain and dyspnea (Outcomes) in the patients with oncology (Population) in acute care (Setting)? The electronic database used was based on EBSCO (MEDLINE with Full TEXT; CINAHL, Plus with Full Text, British Nursing Index), and descriptors were searched in the following order: [guideline OR guideline OR evidence based practice OR randomized controlled trial] AND [symptoms control OR dyspnea OR tachypnea OR Cheyne-stokes respiration OR respiratory symptoms OR chronic pain OR cancer pain OR [oncology nursing OR emergency care OR palliative care]. The descriptors were searched, retrospectively from 2009 until 2015, resulting in a total of 12 articles. Inclusion criteria include the guidelines emitted by reference entities in the Oncology Nursing Society, National Comprehensive Cancer Network [9,10] and Cancer Care Ontario. Exclusion criteria included all articles with unclear methodology, repeated in both databases (N =3), aged less than 18 years and with a date prior to 2009. In total, a total of 15 articles. As show the Figure 1.To assure its applicability in the clinical context, only levels of evidence considered of high quality, that is, up to 2a, like shows the Table 1, were acceptable. Volume 2 Issue 3 - 2017  1Ph.D student, Hospital of Medium Tejo, Portugal2Department of Nursing, Univerisity of Coimbra, Portugal3Department of Nursing, University of Évora, Portugal*Corresponding author: César Fonseca, Department of Nursing, Univerisity of Coimbra, Portugal, Email: Received: January 12, 2017 | Published: February 13, 2017Research ArticleNurse Care Open Acces J 2017, 2(3): 00036AbstractObjective: To identify non-pharmacological strategies in the control of pain and dyspnea, in patient with oncological disease, in acute care.Methodology: Question in PI[C]O format was used and search at EBSCO (MEDLINE with Full TEXT; CINAHL, Plus with Full Text; British Nursing Index) retrospectively from 2009 to 2015. We included also guidelines by reference entities: Oncology Nursing Society (2011) National Comprehensive Cancer Network and Cancer Care Ontario, resulting in a total of 15 articles.Results: The gold standard for an adequate symptom control is a systematized assessment. Non-pharmacological measures: psycho-emotional support, hypnosis, counseling/training/ instruction, therapeutic adherence, music therapy, massage, relaxation techniques, telephone support, functional and respiratory re-education increase health gains.Conclusion: The control of oncologic pain and dyspnea require a comprehensive and multimodal approach.Keywords: Oncologic pain; Dyspnea; Nursing interventions; Acute care; Music therapy; Symptom; British nursingCitation: Ramos A, Tavares AP, Lopes M, Mendes F, Parreira P, et al. (2017) Control of Pain and Dyspnea in Patients with Oncologic Disease in Acute Care: Non-Pharmacological Interventions. Nurse Care Open Acces J 2(3): 00036. DOI: 10.15406/ncoaj.2017.02.00036Control of Pain and Dyspnea in Patients with Oncologic Disease in Acute Care: Non-Pharmacological Interventions2/5Copyright:©2017 Ramos et al.ResultsTable 1: Review results.ResultsAssessment of Oncologycal PainUsing self-assessment tools [11,12]Wong-Baker Faces ScaleNumbers Evaluation ScaleQualitative ScaleEdmonton Symptom Assessment ScaleSummary of Pain InventoryUsing hetero-evaluation tools [11,12] Assessment of Pain in Advanced DementiaObserver ScaleScale Behavioral Pain ScaleEvaluate the characteristics of oncologic pain [5,6,11-16]IntensityFrequencyType of pain (somatic, visceral, neuropathic or mixed)Location and / or presence of irradiationDuration of pain and pattern of pain (continuous / end of dose / irruptive)Relieving and exacerbating factorsResponse to current and rescue analgesic regimenExistence of other associated symptomsInterference in daily living activitiesEvaluate psycho-emotional state [11,12]Degree of concern with the diseaseDegree of anxietyPrevious diagnosis of depression and / or personality disordersPresence of suicidal ideationPresence of spiritual concernsTo ascertain the existence of other comorbidities and / or additive behaviors [11,12]To verify the performance of previous or current oncological treatments [11,12]To perform a comprehensive analysis of the etiology of oncologic pain with analytical and imaginary findings [12]Non-pharmacological treatment of cancer painIndividualization of nursing care [8,11,14,17,18]Inclusion of the significant person in the therapeutic plan [8,11,14,17]Psycho-emotional support [18]Counseling / education for health self-management / health literacy [6,12,17-19] Phone follow-up [12]Telephone assistence [12]Newsletter, with analgesic scheme included [12]Relaxing techniques and guided image [12]Transcutaneous Electrical Stimulation [12]Therapeutic Massage, Heat / Hot Application [12]Music Therapy [18]Nurse as case manager in therapeutic adherence [12,18]Citation: Ramos A, Tavares AP, Lopes M, Mendes F, Parreira P, et al. (2017) Control of Pain and Dyspnea in Patients with Oncologic Disease in Acute Care: Non-Pharmacological Interventions. Nurse Care Open Acces J 2(3): 00036. DOI: 10.15406/ncoaj.2017.02.00036Control of Pain and Dyspnea in Patients with Oncologic Disease in Acute Care: Non-Pharmacological Interventions3/5Copyright:©2017 Ramos et al.Appreciation of DyspneaUse the acronym O,P,Q,R,S, T,U e V10Onset: Beginning, frequency and durationProvoking / Palliating: factors of relief and exacerbationQuality descriptionRegion / Radiation: association with other symptomsSeverity: intensityTreatment: therapeutic regimen, efficacy and adverse effectsUnderstanding: Understanding the etiology attributedValues: objective in control of dyspneaEvaluate the psycho-emotional state [1]To evaluate the existence of other comorbidities [1]Using assessment tools that include dyspnea: Edmonton Symptom Assessment Scale, Clinical Anxiety and Depression Scale - HADS, Modified Dyspnea Index (MDI) [1]Screening of the sub treated causes of dyspnea, requiring pericardiocentesis, pelurodesis, thoracentesis, bronchofibroscopy, transfusion support or antibiotic therapy [20]Non-Pharmacological StrategiesControl and Dissociation of Respiratory Times [8,20]Effective assisted cough training [8,20]Positioning to reduce respiratory work [8,20]Application of facial cold to stimulate the trigeminal nerve [1,20]Consider the need to adopt healthy lifestyles [8]Psycho-emotional support [1,8,20] Management of anxiety of the person / caregiver / family, with exploration of the meaning of dyspnea for the person, illness and life expectancy [1,8,20]Relaxing and visualization exercises [1,8,20,21] Consider adjustment of nutritional and water habits [8]Education for self-management of the therapeutic regimen [8]Referral to other health services / professionals: pain unit, functional and respiratory rehabilitation, palliative care, mental and psychiatric health [1,8,21]Discussion The assessment of pain is considered the first step towards effective pain control, which includes self-assessment tools that enable a more measurable dimension, where the person’s speech is the gold standard in data collection. The characteristics of pain are influenced by the psycho-emotional state, the activities of daily living, the existence of other comorbidities and/or additive behaviors. The performance of previous or current oncological treatments, analytical and imaging data were related to the etiology of pain. This aspect is considered fundamental in a comprehensive analysis of the person with cancer pain [10,22-24]. The non-pharmacological strategies are the person-centered care, which emphasizes the individualization and inclusion of a significant person that increases health outcomes. Directed interventions for counseling, education for self-management, training/instruction, telephone follow-up, health literacy and nurses as case manager, with interconnection with other health professionals and health services increase therapeutic adherence and satisfaction with care [18,22,24,25]. Therapeutic massage, hot and/or cold application, positioning, hypnosis, transcutaneous electrical nerve stimulation and music therapy are considered measures that improve the affectivity of medication regimen [25].In the evaluation of dyspnea, the literature suggests the use of the acronym O,P,Q,R,S,T,U and V to better evaluate its characteristics: (onset) frequency, provoking factors of relief and exacerbation, (Quality) description of the dyspnea sensation, (region/radiation) the existence of other symptoms simultaneously, (severity) intensity of dyspnea, (Treatment) medication used for its control, efficacy and adverse effects, (Understanding) dyspnea on human living, (Values) the level Citation: Ramos A, Tavares AP, Lopes M, Mendes F, Parreira P, et al. (2017) Control of Pain and Dyspnea in Patients with Oncologic Disease in Acute Care: Non-Pharmacological Interventions. Nurse Care Open Acces J 2(3): 00036. DOI: 10.15406/ncoaj.2017.02.00036Control of Pain and Dyspnea in Patients with Oncologic Disease in Acute Care: Non-Pharmacological Interventions4/5Copyright:©2017 Ramos et al.of acceptable/desirable dyspnea intensity for the person. The instruments to be included in its assessment are: the Edmonton System Assessment Scale, Clinical Anxiety and Depression Scale - HADS, Modified Dyspnea Index (MDI) and Numerical Rating Scale (NRS) for breathlessness, Modified Borg and Chronic Respiratory Questionnaire [26]. The etiology of dyspnea should be carefully investigated to determine the need for other complementary techniques for its relief.Non-pharmacological strategies aimed at functional and respiratory rehabilitation, cold application, adoption of healthy lifestyles, education for self-management /counseling, psycho-emotional support and relaxation/ visualization exercises in anxiety control and referral to others health professionals/ services allow better control of dyspnea [27,28].ConclusionPain is experienced by most cancer patients, and the incidence tends to increase in the more advanced stages of the disease. Dyspnea also appears as the main symptom, but arises mainly in the more advanced phases of the disease and frequently associated with pain. With regard to the control of pain and dyspnea, its assessment is paramount and fundamental through the use of appropriate scales. Non-pharmacological techniques should be person-centered in order to individualize the nurse’s intervention. Its use in conjunction with pharmacological measures increases the effectiveness of the treatments bringing benefits to the patient in terms of pain and dyspnea control, but also proves to be beneficial in the control of anxiety and fatigue. Teamwork among health professionals allows better control of symptoms, increases adherence to the therapeutic regimen and satisfaction with health care.Figure 1: Research and selection process of articles, from 2009 to 2015.Citation: Ramos A, Tavares AP, Lopes M, Mendes F, Parreira P, et al. (2017) Control of Pain and Dyspnea in Patients with Oncologic Disease in Acute Care: Non-Pharmacological Interventions. Nurse Care Open Acces J 2(3): 00036. DOI: 10.15406/ncoaj.2017.02.00036Control of Pain and Dyspnea in Patients with Oncologic Disease in Acute Care: Non-Pharmacological Interventions5/5Copyright:©2017 Ramos et al.References 1. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, et al. (2013) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136 (5): E359-E358.2. WHO (2014) Global battle against cancer won’t be won with treatment alone--effective prevention measures urgently needed to prevent cancer crises. Cent Eur J Public Health 22(1): 23-28.3. Zucca A, Boyes A, Linden W, Girgs A (2012) All’s well that ends well? Quality of life and physical symptoms clusters in long-term cancer survivors across cancer types. J Pain Symptom Manage 43(4): 720-731.4. Sun V, Borneman T, Piper B, Koczywas M, Ferrel B (2008) Barriers to pain assessment and management in cancer survivorship. J Cancer Suviv 2(1): 65-71.5. Brant J, Beck S, Dudley W, Cobb P, Pepper G, et al. (2011) Symptom trajectories in post treatment cancer survivors. Cancer Nurs 31(1): 67-77.6. Cleeland C, Sloan J (2010) Assessing the symptoms of cancer using patient-reported outcomes (ASCPRO): searching for standards. J Pain Symptom Manage 39(6): 1077-1085.7. Richards C, Gisondi M, Chang C, Courtney M, Engel K, et al. (2011) Palliative care symptom assessment for patients with cancer in the emergency department: validation of the screen for palliative and end-of-life care needs in the emergency department instrument. J Palliat Med 14(6): 757-764.8. Dong S, Butow P, Costa D, Lovell M, Aga M (2014) Symptom clusters in patients with advanced cancer: a systematic review of observational studies. J Pain Symptom Manage 48(3):411-450.9. National Comprehensive Cancer Network. (2011) NCCN guidelines palliative care. Washington: National Comprehensive Cancer Network.1110. National Comprehensive Cancer Network (2014) NCCN clinical practice guidelines in oncology: adult cancer pain. Washington: National Comprehensive Cancer Network.11. Farquhar M, Prevost A, McCrone P, Higginson I, Gray J, et al. (2011) Study Protocol: Phase III single-blinded fast-track pragmatic randomised controlled trial of a complex intervention for breathlessness in advanced disease. Trials 12(130): 1-11.12. Heidenreich A, Bastian P, Bellmunt J, Bolla M, Joniau S, et al. (2013) Guidelines on prostate cancer. Netherlands: European Association of Urology.13. Bharkta H, Marco C (2014) Pain management: association with patient satisfaction among emergency department patients. J Emerg Med 46(4): 456-464.14. Caraceni A, Hanks G, Kaasa S, Bennett M, Brunelli C, et al. (2012) Use of opioid analgesic in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol 13(2): e58-68.15. Choi M, Kim H, Chung S, Ahn M, Yoo J, et al. (2014) Evidence-based practice for pain management for cancer patients in an acute care setting. Int J Nurs Pract 20(1): 60-69.16. LeBlanc T, Abernethy A (2014) Building the palliative care evidence base: lessons from a randomized controlled trial of oxygen vs. room air for refractory dyspnea. J Natl ComprCancNetw 12(7): 989-992.17. Dale O, Moksnes K, Kaasa S (2010) European Palliative Care Research Collaborative pain guidelines: opioid switching to improve analgesia or reduce side effects: a systematic review. Palliat Med 25(5): 494-503.18. Jarzyana D, Jungquist C, Pasero C, Willens J, Nisbet A, et al. (2011) American society for pain management nursing guidelines on monitoring for opioid-induced sedation and respiratory depression. Pain Manag Nurs 12(3): 118-145.19. Doran D (2003) Nursing-sensitive outcomes: state of the science. Jones and Bartlett, USA.20. Fielding F, Sanford T, Davis M (2013) Achieving effective control in cancer pain: a review of current guidelines. Int J Palliat Nurs 19(12): 584-591.21. Guyatt G, Oxman A, Visit G, Regina k,Yngve FY, et al. (2008) GRADE: an emerging consensus on rating quality of evidence and stregth of recommendations. BMJ 336(7650): 924-926.22. Ripamonti C, Santini D, Maranzo E, Berti M, Roila F (2012) Management of cancer pain: ESMO clinical practice guidelines. Ann Oncol 23: 139-154.23. Yamaguchi T, Shima Y, Morita T, Hosoya M, Matoba M (2013) Clinical guidelines for pharmacological management of cancer pain: the Japanese Society of Palliative Medicine recommendations. Jpn J Clin Oncol 43(9): 896-909.24. Wengström Y, Geerling J, Rustoen T (2014) European Oncology Nursing Society breakthrough cancer pain guidelines. Eur J Oncol Nurs 18: 127-131.25. Vallerand A, Musto S, Polomano R (2011) Nursing’s role in cancer pain management. Curr Pain Headache Rep 15: 250-262.26. Raymond V, Bak K, Kiteley C, Martelli Reid L, Poling M, et al. (2010) Symptom management guide-to-practice: dyspnea. Canada: Cancer Care Ontario.27. DiSalvo WM, Joyce MM, Tyson LB, Culkin AE, Mackay K (2012) Putting evidence into practice: evidence-based interventions for cancer-related dyspnea. Clin J Oncol Nurs 12(2): 341-352.28. Zeppetella G (2010) Opioids for the management of breakthrough cancer pain in adults: A systematic review undertaken as part of an EPCRC opioid guidelines project. Palliat Med 25(5): 516-524.

Control of Pain and Dyspnea in Patients with Oncologic Disease in Acute Care: Non-Pharmacological Intervention

http://dspace.uevora.pt/rdpc/bitstream/10174/22889/1/947bd517da673fe7b411d2303b36c087622a.pdf

Control of Pain and Dyspnea in Patients with Oncologic Disease in Acute Care: Non-Pharmacological Intervention

Abstract

Similar works

Full text

Available Versions

Repositório Científico da Universidade de Évora