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Wang Y, Hu C, Hu J, Liang Y, Zhao Y, Yao Y, Meng X, Xing J, Wang L, Jiang Y, Xiao X. Investigating the risk factors for nonadherence to analgesic medications in cancer patients: Establishing a nomogram model. Heliyon 2024; 10:e28489. [PMID: 38560243 PMCID: PMC10981129 DOI: 10.1016/j.heliyon.2024.e28489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
Objective The substantial prevalence of nonadherence to analgesic medication among individuals diagnosed with cancer imposes a significant strain on both patients and healthcare resources. The objective of this study is to develop and authenticate a nomogram model for assessing nonadherence to analgesic medication in cancer patients. Methods Clinical information, demographic data, and medication adherence records of cancer pain patients were gathered from the Affiliated Hospital of Chengde Medical University between April 2020 and March 2023. The risk factors associated with analgesic medication nonadherence in cancer patients were analyzed using the least absolute selection operator (LASSO) regression model and multivariate logistic regression. Additionally, a nomogram model was developed. The bootstrap method was employed to internally verify the model. Discrimination and accuracy of the nomogram model were evaluated using the Concordance index (C-index), area under the receiver Operating characteristic (ROC) curve (AUC), and calibration curve. The potential clinical value of the nomogram model was established through decision curve analysis (DCA) and clinical impact curve. Results The study included a total of 450 patients, with a nonadherence rate of 43.33%. The model incorporated seven factors: age, address, smoking history, number of comorbidities, use of nonsteroidal antiinflammatory drugs (NSAIDs), use of opioids, and PHQ-8. The C-index of the model was found to be 0.93 (95% CI: 0.907-0.953), and the ROC curve demonstrated an AUC of 0.929. Furthermore, the DCA and clinical impact curves indicate that the built model can accurately predict cancer pain patients' medication adherence performance. Conclusions A nomogram model based on 7 risk factors has been successfully developed and validated for long-term analgesic management of cancer patients.
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Affiliation(s)
- Ying Wang
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - ChanChan Hu
- Department of Oncology, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Junhui Hu
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Yunwei Liang
- Department of Oncology, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Yanwu Zhao
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Yinhui Yao
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Xin Meng
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Jing Xing
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Lingdi Wang
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Yanping Jiang
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Xu Xiao
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
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Zhang Y, Long W, Wang H, Wang J, Tang C, Ma J, Zhong J. Pain catastrophising in Chinese patients with breast cancer during postoperative chemotherapy: a qualitative study. BMJ Open 2023; 13:e076362. [PMID: 37714673 PMCID: PMC10510868 DOI: 10.1136/bmjopen-2023-076362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE To investigate the pain catastrophising in patients with breast cancer during postoperative chemotherapy. METHODS Objective sampling method was used to select patients with breast cancer who underwent breast surgery and received chemotherapy in a third-class hospital of Wuhan from October to December 2022 through semi-structured interview. The interview data were sorted out and analysed by content analysis method. RESULTS A total of 11 patients were interviewed and five categories were summarised: (1) Physical memory of pain; (2) the special meaning of time; (3) disease treatment and prognosis; (4) interpersonal communication and coping; (5) personal behaviour and growth. CONCLUSION Patients with breast cancer have adverse pain experience during postoperative chemotherapy. The evaluation and screening of psychological variables such as pain catastrophising should be strengthened to provide new ideas for pain management.
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Affiliation(s)
- Yanting Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Wenjia Long
- Department of Prosthetic and Orthopedic Services, Hubei Province Rehabilitation Assistive Technology Center, Wuhan, Hubei, China
| | - Hongying Wang
- Department of Thyroid and Breast Surgery，Sterile Supply Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jingyi Wang
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Chen Tang
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jing Ma
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jun Zhong
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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Abstract
BACKGROUND Adherence to prescribed analgesics for patients seriously ill with cancer pain is essential for comfort. OBJECTIVE The objective of this study was to determine the analgesic adherence in seriously ill patients with cancer and its association with clinical and demographic characteristics. METHODS This is a cross-sectional study. At home, 202 patients with cancer (mean age, 59.9 ± 14.2 years; 58% female, 48% Black, and 42% White) admitted to hospice/palliative care completed measures on a pen tablet: PAIN Report It, Symptom Distress Scale, mood state item, Pittsburgh Sleep Quality Index item, and Pain Management Index. RESULTS The mean current pain intensity was 4.4 ± 2.9, and the mean worst pain in the past 24 hours was 7.2 ± 2.7. More than one-half of participants were not satisfied with their pain level (54%) and reported their pain was more intense than they wanted to tolerate for 18 hours or longer in the last 24 hours (51%). Only 12% were not prescribed analgesics appropriate for the intensity of their pain. Adherence rates were variable: nonsteroidal anti-inflammatory drugs (0.63 ± 0.50), adjuvants (0.93 ± 0.50), World Health Organization step 2 opioids (0.63 ± 0.49), and step 3 opioids (0.80 ± 0.40). With setting/clinical/demographic variables in the model, dose intervals of less than 8 hours were associated with less adherence ( P < .001). CONCLUSION Little progress has been made toward improving analgesic adherence even in settings providing analgesics without cost. Research focused on targeting analgesic dose intervals and barriers not related to cost is needed. IMPLICATION FOR PRACTICE Dose intervals of 8 hours or longer were significantly associated with higher adherence rates; therefore, use of longer-acting analgesics is one strategy to improve pain control at the end of life.
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Vanneste L, Lefebvre T, Tack L, Van Eygen K, Cool L, Schofield PA, Boterberg T, De Rijdt T, Verhaeghe A, Verhelle K, Debruyne PR. Pain medication adherence in patients with cancer: a pragmatic review. PAIN MEDICINE 2021; 23:782-798. [PMID: 33502510 DOI: 10.1093/pm/pnab010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Adherence to pain medication in patients with cancer is crucial for successful pain therapy. This review aimed to investigate: the rate of adherence, which factors influence adherence, whether adherence differs in diverse patient populations, whether there are methods to improve adherence, and the relationship between adherence and pain relief. METHODS This review was performed following the PRISMA guidelines. MEDLINE/Pubmed, Embase, Web Of Science, Cochrane and ClinicalTrials.gov were searched. All types of studies investigating adherence of patients with cancer, factors influencing adherence, and methods to improve adherence to pain medication were included. They were first screened on title and abstract and thereafter on full text. Selected articles were subjected to a quality assessment according to the PRISMA checklist. From included articles, study characteristics and outcomes were extracted. RESULTS Out of 795 articles, 18 were included. Different methods were used to measure adherence, which led to adherence rates ranging from 8.9% to 82.0%. White Americans and men were found to be more adherent than African Americans and women. Due to various barriers, adherence is often suboptimal. Fear of addiction, physiological and harmful effects, tolerance, and disease progression are common concerns. Interventions, such as pain education booklets, pain consults, and specialised nurses, may be beneficial to increase the adherence. Lower adherence rates were associated with lower pain relief. CONCLUSION Adherence of cancer patients to pain medication is suboptimal. Health care workers should focus on barriers to increase the adherence in order to obtain a better pain relief.
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Affiliation(s)
- Lorenz Vanneste
- Hospital Pharmacy, General Hospital Groeninge, Kortrijk, Belgium.,Department of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium.,Faculty of Pharmaceutical Sciences, Catholic University Leuven, Leuven, Belgium
| | - Tessa Lefebvre
- Department of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium.,Department of Radiotherapy and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Laura Tack
- Department of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium.,Department of Radiotherapy and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Koen Van Eygen
- Department of Haematology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Lieselot Cool
- Department of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | | | - Tom Boterberg
- Department of Radiotherapy and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Thomas De Rijdt
- Hospital Pharmacy, University Hospitals Leuven, Leuven, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, Catholic University Leuven, Leuven, Belgium
| | - Anne Verhaeghe
- Hospital Pharmacy, General Hospital Groeninge, Kortrijk, Belgium
| | - Katy Verhelle
- Hospital Pharmacy, General Hospital Groeninge, Kortrijk, Belgium
| | - Philip R Debruyne
- Department of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium.,Positive Ageing Research Institute (PARI), Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
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Mercadante S, Adile C, Tirelli W, Ferrera P, Penco I, Casuccio A. Barriers and Adherence to Pain Management in Advanced Cancer Patients. Pain Pract 2020; 21:388-393. [PMID: 33200548 DOI: 10.1111/papr.12965] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Abstract
AIM To assess patients' barriers to pain management and analgesic medication adherence in patients with advanced cancer. METHODS This was a prospective cross-sectional study in patients with advanced cancer receiving chronic opioid therapy. Age, gender, cancer diagnosis, Karnofsky level, and educational status were recorded. The Brief Pain Inventory (BPI), Edmonton Symptom Assessment Scale (ESAS), Memorial Delirium Assessment Scale (MDAS), Barriers Questionnaire II (BQ-II), Medication Adherence Rating Scale (MARS), and Hospital Anxiety and Depression Scale (HADS) were the measurement instruments used. RESULTS One-hundred-thirteen patients were analyzed. The mean age was 68 (±13) years, and 59 (52%) were male. The mean Karnofsky status was 51.4 (standard deviation [SD] 11.5). The mean score for BQ-II items was 1.77 (SD 0.7). The BQ-II score was independently related to the HADS-Depression score (P = 0.033) and the total HADS score (P = 0.049). Negative side-effects and attitudes toward psychotropic medication globally prevailed among MARS items. These items were independently associated with gender (P = 0.030), pain (P = 0.003), and depression (P = 0.047). CONCLUSION Barriers to pain management were mild. Psychological factors such as depression were the main factor associated with barriers. Poor adherence to analgesic medication was mostly manifested as negative side-effects and attitudes toward psychotropic medication, was more frequent observed in females, and was associated with the ESAS items pain and depression.
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Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center for Pain Relief and Palliative/Supportive Care, La Maddalena Cancer Center Palermo, Palermo, Italy
| | - Claudio Adile
- Main Regional Center for Pain Relief and Palliative/Supportive Care, La Maddalena Cancer Center Palermo, Palermo, Italy
| | | | - Patrizia Ferrera
- Main Regional Center for Pain Relief and Palliative/Supportive Care, La Maddalena Cancer Center Palermo, Palermo, Italy
| | | | - Alessandra Casuccio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
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The Relation Between Patients' Beliefs About Pain Medication, Medication Adherence, and Treatment Outcome in Chronic Pain Patients: A Prospective Study. Clin J Pain 2020; 35:941-947. [PMID: 31513057 DOI: 10.1097/ajp.0000000000000760] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Nonadherence to prescribed pain medication is common in chronic noncancer pain patients. Beliefs about pain medication have been reported to be associated with nonadherence behavior in cross-sectional studies. The aim of this study was to prospectively investigate the relationship between patients' beliefs about pain medication and their medication adherence and treatment outcome. METHODS Chronic noncancer pain patients completed a baseline questionnaire including the 47-item Pain Medication Attitudes Questionnaire, consisting of 7 subscales with regards to beliefs on prescribed medication. After 11 weeks, medication underuse and overuse were assessed by self-report. In addition, patient satisfaction with regards to the effect of prescribed pain medication and satisfaction as regards prescribed medication and care, and the burden of side effects were assessed. RESULTS A total of 133 participants completed the baseline questionnaire, and 99 patients completed the follow-up questionnaire. Concerns over side effects at baseline were positively associated with underuse and the presence of side effects after 11 weeks. The perceived need was positively associated with overuse, whereas concerns over addiction were negatively associated with overuse. Concerns over tolerance were negatively associated with patient satisfaction with medication effects after 11 weeks. Concerns over tolerance and mistrust in the prescribing doctor were negatively associated with satisfaction about medication and care. CONCLUSION Attitudes and concerns toward pain medication are associated with adherence patterns and outcome parameters. To improve medication adherence and therapy outcome, patient beliefs about pain medication should be taken into account by providing tailored education, adequate follow-up, or alternate therapy.
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Tsay SL, Wang JY, Lee YH, Chen YJ. Fear of recurrence: A mediator of the relationship between physical symptoms and quality of life in head and neck cancer patients. Eur J Cancer Care (Engl) 2020; 29:e13243. [PMID: 32510671 DOI: 10.1111/ecc.13243] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 02/12/2020] [Accepted: 04/16/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Head and neck cancer (HNC) patients suffer from symptoms and fear of recurrence (FoR), which both affect their quality of life (QoL). Based on a self-regulation model, the purpose of the study was to examine patients' FoR as a mediator of the relation between symptoms and QoL, and to identify which symptoms may trigger FoR. METHODS A cross-sectional study was conducted, using convenience sampling. Structured questionnaires were used to collect data at a medical centre in Northern Taiwan. The analytic methods included descriptive statistics, structural equation modelling and linear regression. RESULTS A total of 103 participants were recruited. Patients experienced a medium level of symptom severity and QoL but a moderate to high level of FoR. Symptom severity, FoR and QoL were significantly correlated. FoR was a significant partial mediator between symptom severity and QoL. The significant factors of the overall FoR and the subscale of health worry were "pain in general" and "pain in the mouth, throat or neck." "Pain in general" was a significant factor for the subscale of cancer worry. CONCLUSIONS This theory-driven study supports a mediation model of FoR among HNC patients and provides a more comprehensive understanding of the antecedents and consequences of FoR.
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Affiliation(s)
| | - Ju-Yi Wang
- Department of Nursing, Tri-Service Hospital, Taipei, Taiwan
| | - Yun-Hsiang Lee
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Ju Chen
- Department of Nursing, Da-Yeh University, Changhua, Taiwan
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Chatterjee A, Thota RS, Ramanjulu R, Ahmed A, Bhattacharya D, Salins N, Jain P, Bhatnagar S. Indian Society for Study of Pain, Cancer Pain Special Interest Group Guidelines, for the Diagnosis and Assessment of Cancer Pain. Indian J Palliat Care 2020; 26:164-172. [PMID: 32874029 PMCID: PMC7444567 DOI: 10.4103/0973-1075.285691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The Indian Society for Study of Pain (ISSP), Cancer Pain Special Interest Group (SIG) guidelines, for the diagnosis and assessment of cancer pain in adults provide a structured, step-wise approach which will help to improve the management of cancer pain and to provide the patients with a minimally acceptable quality of life. The guidelines have been developed based on the available literature and evidence, to suit the needs of patient population and situations in India. A questionnaire based on the key elements of each sub draft addressing certain inconclusive areas where evidence was lacking, was made available on the ISSP website and circulated by E-mail to all the ISSP and Indian Association of Palliative Care (IAPC) members. We recommend that a comprehensive pain assessment of all the patients should be conducted before initiating treatment. The patients should be educated about all the available pain control interventions. For assessing cancer pain, unidimensional tools such as Numeric Rating Scale, Visual Analog Scale, and Visual Rating Scale should always be used routinely. Patients with cancer pain should routinely be screened for distress and other psychological disorders, using the Patient Health Questionnaire-9. The most reliable assessment of pain is patients' self-reporting.
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Affiliation(s)
- Aparna Chatterjee
- Department of Anaesthesiology, Critical Care and Pain, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Raghu S Thota
- Department of Anaesthesiology, Critical Care and Pain, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Raghavendra Ramanjulu
- Department of Pain and Palliative Care, Cytecare Hospital, Bengaluru, Karnataka, India
| | - Arif Ahmed
- Department of Anaesthesia, Critical Care and Pain Management, CK Birla Hospital for Women, Gurugram, Haryana, India
| | - Dipasri Bhattacharya
- Department of Anaesthesiology, Critical Care and Pain, R. G. Kar Medical College, Kolkata, West Bengal, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Parmanand Jain
- Department of Anaesthesiology, Critical Care and Pain, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Kan E, Mustafa S, Chong WW, Premakumar CM, Mohamed Shah N. Relationship Between Adherence to Opioid Analgesics and Pain Beliefs Among Patients with Cancer Pain at Tertiary Care Hospitals in Malaysia. Patient Prefer Adherence 2020; 14:1411-1419. [PMID: 32848370 PMCID: PMC7429214 DOI: 10.2147/ppa.s255289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/20/2020] [Indexed: 12/18/2022] Open
Abstract
CONTEXT Pain is a common and distressing symptom among cancer patients. Opioid analgesics are the mainstay of cancer pain management, and adequate adherence plays an important role in achieving good pain control. PURPOSE To determine the level of adherence to opioid analgesics in patients with cancer pain and to identify factors that may influence the adherence. PATIENT AND METHODS This was a cross-sectional study conducted from March to June 2018 at two tertiary care hospitals in Malaysia. Study instruments consisted of a set of validated questionnaires; the Medication Compliance Questionnaire, Brief Pain Inventory and Pain Opioid Analgesic Beliefs─Cancer scale. RESULTS A total of 134 patients participated in this study. The patients' adherence scores ranged from 52-100%. Factors with a moderate, statistically significant negative correlation with adherence were negative effect beliefs (rs= -0.53, p<0.001), pain endurance beliefs (rs = -0.49, p<0.001) and the use of aqueous morphine (rs = -0.26, p=0.002). A multiple linear regression model on these predictors resulted in a final model which accounted for 47.0% of the total variance in adherence (R2 = 0.47, F (7, 126) = 15.75, p<0.001). After controlling for other variables, negative effect beliefs were the strongest contributor to the model (β = -0.39, p<0.001) and uniquely explained 12.3% of the total variance. CONCLUSION The overall adherence to opioid analgesics among Malaysian patients with cancer pain was good. Negative effects beliefs regarding cancer pain and opioids strongly predicted adherence.
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Affiliation(s)
- Elaine Kan
- Pharmacy Department, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suzana Mustafa
- Pharmacy Department, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia
| | - Wei Wen Chong
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Chandini Menon Premakumar
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Correspondence: Noraida Mohamed Shah Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur50300, MalaysiaTel +60 3 9289 8038 Email
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Ma X, Lu Y, Yang H, Yu W, Hou X, Guo R, Wang Y, Zhang Y. Relationships between patient-related attitudinal barriers, analgesic adherence and pain relief in Chinese cancer inpatients. Support Care Cancer 2019; 28:3145-3151. [PMID: 31701270 DOI: 10.1007/s00520-019-05082-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/16/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate patient-related attitudinal barriers and identify associated factors in Chinese cancer inpatients receiving opioids and to explore relationships between patient-related attitudinal barriers, analgesic adherence and pain relief. METHODS A cross-sectional study was conducted. A total of 146 participants completed face-to-face surveys, including information about demographics, the Barriers Questionnaire-Chinese (BQ-C), analgesic adherence, average pain and breakthrough pain in the past 24 h. The Mann-Whitney U test and Kruskal-Wallis test were performed to test the differences in the attitudinal barrier scores between the adherence and nonadherence groups, the complete and incomplete pain relief groups and the groups based on demographics. RESULTS The majority of participants in this study were men (67.8%), over half of all participants were less than 60 years old, gastrointestinal cancer (47.3%) was the most common diagnosis and 59 (40.4%) acquired comprehensive pain education from the last discharge guidance procedure. The total BQ-C mean (SD) score was 1.61 ± 0.94. A total of 87 (59.6%) patients with cancer pain were completely relieved. Most of the patients (73.3%) completely took analgesics by orders. There was no significant difference in the total BQ-C score between the adherence group and the nonadherence group (P > 0.05), but the difference was significant between the complete pain relief group and the incomplete pain relief group (P < 0.05). CONCLUSION The findings of this study support unsatisfactory pain management and moderate analgesic adherence for Chinese inpatients. It is suggested that patient-related attitudinal barriers do not play an undermining role in pain management by negatively affecting patients' analgesic adherence. Conversely, patients' beliefs are more likely to be shaped by under treatment rather than as a cause.
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Affiliation(s)
- Xiaoxiao Ma
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Yuhan Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China.
| | - Hong Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Wenhua Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Xiaoting Hou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Renxiu Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Yun Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Yaru Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
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Wright EM, El-Jawahri A, Temel JS, Carr A, Safren SA, Park ER, Pirl WF, Bruera E, Traeger L. Patient Patterns and Perspectives on Using Opioid Regimens for Chronic Cancer Pain. J Pain Symptom Manage 2019; 57:1062-1070. [PMID: 30831237 PMCID: PMC6557123 DOI: 10.1016/j.jpainsymman.2019.02.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 01/24/2023]
Abstract
CONTEXT With increasing attention to the undertreatment of cancer pain in parallel with concerns about opioid misuse, little is known about how patients with advanced cancer adhere to opioid regimens for chronic cancer pain. OBJECTIVES We explored patient approaches to managing chronic cancer pain with long-acting opioids. METHODS In a multimethods study at an academic medical center, adult patients with chronic cancer pain (n = 17) used electronic pill caps to record adherence to prescribed long-acting opioid regimens. After eight weeks, patients viewed their adherence records and completed a semistructured interview about their opioid use. With a framework approach, we coded interview data (Kappa >0.95) and identified themes in how patients perceived and used opioids to manage cancer pain. RESULTS Patients (59% female; 94% non-Hispanic white; median age = 65 years) felt grateful about pain benefit from opioids yet concerned about opioid side effects and addiction/tolerance. Main reasons for nonadherence included both intentional decisions (e.g., skipping doses) and unintentional barriers (e.g., missing doses due to inconsistent sleep schedules). Overall, patients set their own opioid adherence goals and developed routines to achieve them. Residual pain varied and was not consistently linked with opioid adherence. CONCLUSION Patients commonly felt conflicted about using prescribed long-acting opioids to manage cancer pain due to concurrent perceptions of their risks and benefits, and they set their own parameters for opioid-taking practices. Intentional and unintentional deviations from prescribed opioid schedules highlight the need to enhance adherence communication, education, and counseling, to optimize the use of long-acting opioids as a component of cancer pain management.
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Affiliation(s)
- Emily M Wright
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Alaina Carr
- Department of Psychology, University of Colorado Denver, Denver, Colorado, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Elyse R Park
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - William F Pirl
- Harvard Medical School, Boston, Massachusetts, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Lara Traeger
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
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12
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Cancer pain management needs and perspectives of patients from Chinese backgrounds: a systematic review of the Chinese and English literature. Palliat Support Care 2018; 16:785-799. [DOI: 10.1017/s1478951517001171] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AbstractObjectiveMore than half of all cancer patients experience unrelieved pain. Culture can significantly affect patients’ cancer pain-related beliefs and behaviors. Little is known about cultural impact on Chinese cancer patients’ pain management. The objective of this review was to describe pain management experiences of cancer patients from Chinese backgrounds and to identify barriers affecting their pain management.MethodA systematic review was conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they reported pain management experiences of adult cancer patients from Chinese backgrounds. Five databases were searched for peer-reviewed articles published in English or Chinese journals between1990 and 2015. The quality of included studies was assessed using Joanna Briggs Institution's appraisal tools.ResultsOf 3,904 identified records, 23 articles met criteria and provided primary data from 6,110 patients. Suboptimal analgesic use, delays in receiving treatment, reluctance to report pain, and/or poor adherence to prescribed analgesics contributed to the patients’ inadequate pain control. Patient-related barriers included fatalism, desire to be good, low pain control belief, pain endurance beliefs, and negative effect beliefs. Patients and family shared barriers about fear of addiction and concerns on analgesic side effects and disease progression. Health professional–related barriers were poor communication, ineffective management of pain, and analgesic side effects. Healthcare system–related barriers included limited access to analgesics and/or after hour pain services and lack of health insurance.Significance of resultsChinese cancer patients’ misconceptions regarding pain and analgesics may present as the main barriers to optimal pain relief. Findings of this review may inform health interventions to improve cancer pain management outcomes for patients from Chinese backgrounds. Future studies on patients’ nonpharmacology intervention-related experiences are required to inform multidisciplinary and biopsychosocial approaches for culturally appropriate pain management.
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Meghani SH, Knafl GJ. Salient concerns in using analgesia for cancer pain among outpatients: A cluster analysis study. World J Clin Oncol 2017; 8:75-85. [PMID: 28246587 PMCID: PMC5309716 DOI: 10.5306/wjco.v8.i1.75] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 12/01/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To identify unique clusters of patients based on their concerns in using analgesia for cancer pain and predictors of the cluster membership.
METHODS This was a 3-mo prospective observational study (n = 207). Patients were included if they were adults (≥ 18 years), diagnosed with solid tumors or multiple myelomas, and had at least one prescription of around-the-clock pain medication for cancer or cancer-treatment-related pain. Patients were recruited from two outpatient medical oncology clinics within a large health system in Philadelphia. A choice-based conjoint (CBC) analysis experiment was used to elicit analgesic treatment preferences (utilities). Patients employed trade-offs based on five analgesic attributes (percent relief from analgesics, type of analgesic, type of side-effects, severity of side-effects, out of pocket cost). Patients were clustered based on CBC utilities using novel adaptive statistical methods. Multiple logistic regression was used to identify predictors of cluster membership.
RESULTS The analyses found 4 unique clusters: Most patients made trade-offs based on the expectation of pain relief (cluster 1, 41%). For a subset, the main underlying concern was type of analgesic prescribed, i.e., opioid vs non-opioid (cluster 2, 11%) and type of analgesic side effects (cluster 4, 21%), respectively. About one in four made trade-offs based on multiple concerns simultaneously including pain relief, type of side effects, and severity of side effects (cluster 3, 28%). In multivariable analysis, to identify predictors of cluster membership, clinical and socioeconomic factors (education, health literacy, income, social support) rather than analgesic attitudes and beliefs were found important; only the belief, i.e., pain medications can mask changes in health or keep you from knowing what is going on in your body was found significant in predicting two of the four clusters [cluster 1 (-); cluster 4 (+)].
CONCLUSION Most patients appear to be driven by a single salient concern in using analgesia for cancer pain. Addressing these concerns, perhaps through real time clinical assessments, may improve patients’ analgesic adherence patterns and cancer pain outcomes.
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14
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Oldenmenger WH, Sillevis Smitt PAE, de Raaf PJ, van der Rijt CCD. Adherence to Analgesics in Oncology Outpatients: Focus on Taking Analgesics on Time. Pain Pract 2016; 17:616-624. [DOI: 10.1111/papr.12490] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/10/2016] [Accepted: 06/07/2016] [Indexed: 02/04/2023]
Affiliation(s)
- Wendy H. Oldenmenger
- Department of Medical Oncology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
| | | | - Pleun J. de Raaf
- Department of Medical Oncology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
| | - Carin C. D. van der Rijt
- Department of Medical Oncology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
- Netherlands Comprehensive Cancer Organisation; Utrecht The Netherlands
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15
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McWilliams DF, Walsh DA. Factors predicting pain and early discontinuation of tumour necrosis factor-α-inhibitors in people with rheumatoid arthritis: results from the British society for rheumatology biologics register. BMC Musculoskelet Disord 2016; 17:337. [PMID: 27515300 PMCID: PMC4982340 DOI: 10.1186/s12891-016-1192-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/29/2016] [Indexed: 11/10/2022] Open
Abstract
Background We examined pain levels in 2 cohorts assembled from the British Society for Rheumatology Biologics Register (BSRBR), and investigated which factors predicted Bodily Pain scores and discontinuation of TNFα-inhibitors. Method Data were retrieved from BSRBR-RA databases for up to 1 year after commencing TNFα-inhibitors (n = 11995) or being treated with non-biologic therapies (n = 3632). Bodily Pain scores were derived from the Short Form-36 (SF36) questionnaire and norm-transformed to allow comparison with UK population averages. Discontinuation data were from physician reports. Other data, including 28-joint disease activity score (DAS28) measurements, were from clinical examination, interview, medical records and self-report questionnaires. DAS28-P was derived as the proportion of DAS28 attributed to patient-reported factors (tender joint count and visual analogue score). Missing baseline variables from both cohorts were imputed into 20 replicate datasets. Odds ratios (OR) and adjusted OR were calculated for higher than median pain within each cohort. Results Participants reported moderate to severe pain at baseline, and pain scores remained >1SD worse than normal population standards at 1 year, even when disease activity responded to treatment. Baseline pain was associated with DAS28-P, worse physical function, worse mental health, and DAS28. After logistic regression, independent predictors of higher than median pain at follow up were baseline Bodily Pain score, higher DAS28-P, worse physical function or mental health and co-morbidities. Higher age, male gender, and higher BMI were additional independent predictors of higher pain in participants who received TNFα-inhibitors. Baseline pain was also one of the predictors of discontinuation of the first TNFα-inhibitor within 1 year, as were female gender, current smoking, co-morbidities, extra-articular manifestations and worse function. Conclusion Pain persists in people with treated RA, even in those for whom inflammation responds to treatment. Worse pain outcomes are predicted by factors different to those typically found to predict inflammatory disease activity in other studies. Worse pain at baseline also predicts discontinuation of TNFα-inhibitors. Improved pain management should complement inflammatory disease suppression in RA. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1192-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel F McWilliams
- Arthritis UK Pain Centre, Academic Rheumatology, University of Nottingham, Nottingham, UK. .,Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK.
| | - David A Walsh
- Arthritis UK Pain Centre, Academic Rheumatology, University of Nottingham, Nottingham, UK.,Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK
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16
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Lee BO, Liu Y, Wang YH, Hsu HT, Chen CL, Chou PL, Hsu WC. Mediating Effect of Family Caregivers' Hesitancy to Use Analgesics on Homecare Cancer Patients' Analgesic Adherence. J Pain Symptom Manage 2015; 50:814-21. [PMID: 26297852 DOI: 10.1016/j.jpainsymman.2015.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/19/2015] [Accepted: 07/06/2015] [Indexed: 02/08/2023]
Abstract
CONTEXT Family caregivers play an increasingly critical role in cancer patients' symptom management as the number of cancer patients receiving home care grows. However, there is a lack of research measuring the impact of the family caregivers' hesitancy to use analgesics on analgesic adherence and the resulting influence on patient pain intensity. OBJECTIVES To examine whether family caregivers' hesitancy to use analgesics is a mediator that influences patient adherence and investigate how analgesic regimen adherence affects pain intensity. METHODS This study used a cross-sectional and descriptive design. One hundred seventy-six patient-family caregiver dyads (N = 352) were recruited from one local hospital in southern Taiwan. Instruments included the Short Version of the Barriers Questionnaire-Taiwan, the Morisky Medication Adherence Measure-Taiwan, the Brief Pain Inventory-Chinese, and demographic and illness questionnaires. A one-way analysis of variance and post hoc comparisons were performed to assess the influence of analgesic regimen adherence on pain intensity. Sobel tests were used to examine mediating effects. RESULTS Family caregivers' hesitancy to use analgesics was a significant mediator between patient barriers to use analgesics and patient analgesic regimen adherence (P < 0.0001). Patients with low and moderate adherence levels reported significantly higher levels of pain severity (F = 3.83, P < 0.05). CONCLUSION This study showed that family caregivers' hesitancy to use analgesics was a significant mediator associated with their hesitancy to use analgesics and the patients' analgesic adherence. It is important for health care providers to consider family caregivers' hesitancy to use analgesics when attempting to improve adherence to pain management regimens in clinical practice.
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Affiliation(s)
- Bih-O Lee
- Department of Nursing, Chang Gung University of Science and Technology, Chia-Yi Campus, Taiwan, Republic of China
| | - Yi Liu
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Yi-Hsien Wang
- Research Center for Nonlinear Analysis & Optimization, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Hsin-Tien Hsu
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Chien-Liang Chen
- Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan, Republic of China
| | - Pi-Ling Chou
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
| | - Wen-Chung Hsu
- Institute of Human Resource Management, National Sun Yat-sen University, Kaohsiung, Taiwan, Republic of China
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17
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Dhingra L, Lam C, Chen J. Adherence to the analgesic regimen is a major problem among Chinese-American oncology outpatients. J Pain Symptom Manage 2015; 49:e4-6. [PMID: 25640277 DOI: 10.1016/j.jpainsymman.2015.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 11/26/2014] [Accepted: 01/05/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA.
| | | | - Jack Chen
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA
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18
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Wang TJ, Chang CF, Lou MF, Ao MK, Liu CC, Liang SY, Wu SFV, Tung HH. Biofeedback Relaxation for Pain Associated With Continuous Passive Motion in Taiwanese Patients After Total Knee Arthroplasty. Res Nurs Health 2014; 38:39-50. [DOI: 10.1002/nur.21633] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Tsae-Jyy Wang
- Professor; Department of Nursing; National Taipei University of Nursing and Health Science; Taipei Taiwan ROC
| | - Ching-Fen Chang
- Lecturer; Department of Nursing; National Taipei University of Nursing and Health Science; Taipei Taiwan ROC
| | - Meei-Fang Lou
- Associate Professor; Department of Nursing; National Taiwan University; Taipei Taiwan ROC
| | - Man-Kuan Ao
- Director of Orthopedics Department; Cheng Hsin General Hospital; Taipei Taiwan ROC
| | - Chiung-Chen Liu
- Nurse Practitioner; Department of Nursing and Department of Pediatrics; Tri-Service General Hospital; No.325 Chenggong Rd. Sec. 2, Neihu District Taipei 114 Taiwan ROC
| | - Shu-Yuan Liang
- Associate Professor; Department of Nursing; National Taipei University of Nursing and Health Science; Taipei Taiwan ROC
| | - Shu-Fang Vivienne Wu
- Associate Professor; Department of Nursing; National Taipei University of Nursing and Health Science; Taipei Taiwan ROC
| | - Heng-Hsing Tung
- Professor; Department of Nursing; National Taipei University of Nursing and Health Science; Taipei Taiwan ROC
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19
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20
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Rhee YO, Kim E, Kim B. Assessment of pain and analgesic use in African American cancer patients: factors related to adherence to analgesics. J Immigr Minor Health 2013; 14:1045-51. [PMID: 22367628 DOI: 10.1007/s10903-012-9582-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study describes pain experience, analgesic use and barriers to pain control in African American cancer patients (N = 116). The overall adherence rate of analgesics was 46%. Constipation and nausea were the most commonly cited side effects of analgesics. Eighty-seven percent of patients reported concern about addiction to analgesics. Patients who believed their doctor needed to focus on curing illness rather than on controlling pain tended to comply with analgesic prescriptions (r = 0.20, p < 0.05). Patients with concerns that analgesics may cause confusion were less likely to take any type of analgesics (r = -0.16, p < 0.05). The study confirms that a patient's perceived barriers influence their decision to take analgesics, and also suggests that African American cancer patients may benefit from education that prevents misconceptions about analgesic use.
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Affiliation(s)
- Young O Rhee
- College of Pharmacy, University of Illinois, Chicago, IL, USA
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21
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Concerns About Pain and Prescribed Opioids in Taiwanese Oncology Outpatients. Pain Manag Nurs 2013; 14:336-342. [DOI: 10.1016/j.pmn.2011.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 08/11/2011] [Accepted: 08/12/2011] [Indexed: 11/17/2022]
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22
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Liang SY, Wang TJ, Wu SF, Chao TC, Chuang YH, Tsay SL, Tung HH, Lee MD. Gender Differences Associated with Pain Characteristics and Treatment in Taiwanese Oncology Outpatients. Asian Pac J Cancer Prev 2013; 14:4077-82. [DOI: 10.7314/apjcp.2013.14.7.4077] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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23
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Lee YH, Liao YC, Liao WY, Shun SC, Liu YC, Chan JC, Yu CJ, Yang PC, Lai YH. Anxiety, depression and related factors in family caregivers of newly diagnosed lung cancer patients before first treatment. Psychooncology 2013; 22:2617-23. [PMID: 23893960 DOI: 10.1002/pon.3328] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 05/10/2013] [Accepted: 05/10/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to (i) explore the prevalence and levels (severity) of anxiety and depression in family caregivers (FCs) of patients newly diagnosed with advanced lung cancer (stage IIIb or IV) before first treatment, and (ii) identify the factors related to FCs' anxiety and depression. METHODS For this cross-sectional study, 106 patient-FC dyads were recruited from a medical center in northern Taiwan. FCs' anxiety and depression were measured using the self-report Hospital Anxiety and Depression Scale, and FCs' ability to manage patients' symptoms was assessed using the Self-Efficacy in Symptom Management Scale. FCs' risks for anxiety and depression were separately identified using two multivariate logistic regression models. RESULTS This study found two major results. First, before patients' first treatment, 50.9% and 32.1% of FCs were at risk for anxiety and depression, respectively. FCs' overall mean anxiety and depression scores were 7.7 (SD = 4.7) and 6.1 (SD = 4.5), respectively. Second, both FCs' anxiety and depression were significantly related to four factors: caring for another sick family member, younger age, having pain problems, and lower self-efficacy in managing symptoms. CONCLUSION Family caregivers of patients newly diagnosed with advanced lung cancer had anxiety and depression before the patients' first treatment. We strongly suggest developing and testing interventions to reduce FCs' psychological distress and enhance their quality of life, thus ensuring better quality of patient care.
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Affiliation(s)
- Yun-Hsiang Lee
- National Taiwan University, School of Nursing, College of Medicine, Taipei, Taiwan
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24
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Nguyen LMT, Rhondali W, De la Cruz M, Hui D, Palmer L, Kang DH, Parsons HA, Bruera E. Frequency and predictors of patient deviation from prescribed opioids and barriers to opioid pain management in patients with advanced cancer. J Pain Symptom Manage 2013; 45:506-16. [PMID: 22940562 PMCID: PMC3856203 DOI: 10.1016/j.jpainsymman.2012.02.023] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 02/25/2012] [Accepted: 02/28/2012] [Indexed: 12/16/2022]
Abstract
CONTEXT Approximately 80% of patients with advanced cancer report pain and receive opioids. Information is limited about deviations from prescribed opioid doses and barriers to pain control, but poor opioid adherence has been reported in 49%-70% of patients. OBJECTIVES To evaluate the frequency and severity of self-reported opioid deviation and barriers to opioid pain management in outpatients with advanced cancer. METHODS We surveyed 198 patients and collected pain scores (0-10), prescribed opioid dose, confidential patient-reported opioid prescription dose and intake (as long as there was no severe opioid deviation), barriers to pain management (Barriers Questionnaire-II [BQ-II]) scores, and adherence scores. Opioid deviation was defined as <70% or >130% of the prescribed dose. RESULTS Median patient age was 55 years; 91 (46%) were female. Median pain intensity and morphine equivalent daily dose were 4 (interquartile range=3-7) and 120mg (interquartile range=45-270mg), respectively. Prescribed and patient-reported prescribed doses were highly correlated for regular (r=0.90, P<0.001) and regular plus breakthrough opioid intake (r=0.94, P<0.001). Nineteen (9.6%) patients deviated. Deviation was more frequent in males (P=0.039) and nonwhites (P=0.0270). Nonwhite patients had higher scores on the BQ-II than white patients (P=0.038). Low adherence scores were significantly associated with higher BQ-II scores (1.99±0.80) for lower motivation score vs. 1.61±0.77 for higher score, P=0.007; and 2.13±0.79 for lower knowledge score vs. 1.57±0.72 for higher score, P=0.001. CONCLUSION Very few patients reported dose deviations, which were mostly toward lower dose. More research is necessary to better characterize the frequency and predictors of opioid deviation in this population.
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Affiliation(s)
- Linh M T Nguyen
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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25
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Liang SY, Chen KP, Tsay SL, Wu SF, Chuang YH, Wang TJ, Tung HH, Cheng SF. Relationship Between Belief about Analgesics, Analgesic Adherence and Pain Experience in Taiwanese Cancer Outpatients. Asian Pac J Cancer Prev 2013; 14:713-6. [DOI: 10.7314/apjcp.2013.14.2.713] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Koller A, Miaskowski C, De Geest S, Opitz O, Spichiger E. A systematic evaluation of content, structure, and efficacy of interventions to improve patients' self-management of cancer pain. J Pain Symptom Manage 2012; 44:264-84. [PMID: 22871509 DOI: 10.1016/j.jpainsymman.2011.08.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 08/05/2011] [Accepted: 09/01/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT Cancer pain continues to be extensively undertreated, despite established guidelines. Although the efficacy of interventions that support patients' self-management of cancer pain has been demonstrated in several studies, the most effective components of these interventions remain unknown. OBJECTIVES The purpose of this review of experimental and quasi-experimental studies was to systematically describe the structure and content components, as well as the efficacy of various components, of interventions designed to improve patients' self-management of cancer pain. METHODS A systematic review of the literature was done that supplemented the 2009 meta-analysis of Bennett et al. Intervention components were categorized using content analysis. The intervention components were compared based on their calculated largest effect sizes (ESs) within each study (i.e., Hedges G(u) for between-group differences in pain intensity scores). RESULTS Based on 34 publications (i.e., 24 interventions), seven structure and 16 content components were identified. In 11 studies with statistically significant ESs, the largest ES within each study ranged from -1.87 to -0.44, which represented clinically meaningful effects. No single component was found to have a discernable influence on ES. CONCLUSION This analysis provides researchers and clinicians with a detailed overview of the various structural and content components, as well as various combinations that were tested in intervention studies to improve cancer pain management. However, because of a variety of limitations, the most efficacious intervention components or combination of components remain to be determined in future studies.
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Affiliation(s)
- Antje Koller
- Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland
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27
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Yuxiang L, Lingjun Z, Lu T, Mengjie L, Xing M, Fengping S, Jing C, Xianli M, Jijun Z. Burn patients' experience of pain management: a qualitative study. Burns 2011; 38:180-6. [PMID: 22079543 DOI: 10.1016/j.burns.2011.09.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 09/02/2011] [Accepted: 09/02/2011] [Indexed: 11/27/2022]
Abstract
Pain is a major problem after burns and researchers continue to report that pain from burns remains undertreated. The inadequate pain control results in adverse sequalae physically and psychologically in the burn victims. A better understanding of a burn patient's experience is important in identifying the factors responsible for undertreated pain and establishing effective pain management guidelines or recommendation in the practice of pain relief for burn injuries. This study sought to explore and describe the experience that patients have about pain related to burn-injury during hospitalization. Semi-structured interviews were conducted on eight patients with moderate to severe pain from burn injuries recruited from a Burn Centre in Northwest China. Data was collected by in-depth interviews and qualitative description after full transcription of each interview. Analysis involved the identification of themes and the development of a taxonomy of patients' experience of burn pain and its management. Three themes were indentified: (1) patients' experience of pain control, (2) patients' perception on burn pain management, and (3) patients' expectation of burn pain management. Findings from this study suggested that patients experience uncontrolled pain both physically and psychologically which may serve as an alert for awareness of health professionals to recognize and establish a multidisciplinary pain management team for burn victims, including surgeons, critical care specialists, anesthesiologists, nurses, psychologists, and social workers to accomplish safe and effective strategies for pain control to reach an optimal level of pain management in burn patients. It also provides insights and suggestions for future research directions to address this significant clinical problem.
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Affiliation(s)
- Li Yuxiang
- Department of Nursing, Changhai Hospital, Second Military Medical University, Shanghai, China
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28
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Arria AM, Garnier-Dykstra LM, Caldeira KM, Vincent KB, O'Grady KE. Prescription analgesic use among young adults: adherence to physician instructions and diversion. PAIN MEDICINE (MALDEN, MASS.) 2011; 12:898-903. [PMID: 21539698 PMCID: PMC3117100 DOI: 10.1111/j.1526-4637.2011.01107.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To understand the extent to which medication adherence was related to diversion of prescription analgesics. DESIGN Cross-sectional analyses of data from the College Life Study, a prospective study of young adults. SETTING Participants were originally sampled as incoming first-time first-year college students from one large public university in the Mid-Atlantic United States. PARTICIPANTS One hundred ninety-two young adults aged 21-26 who were prescribed an analgesic to treat acute pain in the past year. OUTCOME MEASURE Diversion of prescription analgesics. The study tested two competing hypotheses: 1) individuals who skip doses (under-users) are at greatest risk for diversion because they have leftover medication; and 2) individuals who over-use their prescriptions (over-users) are at greatest risk for diversion, perhaps because of a general propensity to engage in deviant behavior. RESULTS Fifty-eight percent followed physician's instructions regarding their prescription analgesic medication; 27% under-used their prescribed medication and 16% over-used their prescribed medication. Twenty-seven percent of the total sample diverted their medication, with over-users being the most likely to divert (63%). Holding constant demographic characteristics and perceived harmfulness of nonmedical use, over-users were almost five times as likely as adherent users to divert analgesic medications (P < 0.05). CONCLUSIONS Further research is needed to better understand the relationship between adherence and diversion. If these findings are replicated, physicians who are involved in pain management for acute conditions among young adults should take steps to monitor adherence and reduce diversion of prescription analgesics.
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Affiliation(s)
- Amelia M Arria
- Center on Young Adult Health and Development, Department of Family Science, University of Maryland School of Public Health, College Park, Maryland, USA.
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Prescribed opioids adherence among Taiwanese oncology outpatients. Pain Manag Nurs 2011; 14:155-60. [PMID: 23972866 DOI: 10.1016/j.pmn.2011.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 02/09/2011] [Accepted: 02/15/2011] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to evaluate adherence to prescribed opioids in Taiwanese oncology outpatients and to examine the associations between various demographic and medical characteristics and prescribed opioids adherence. Ninety-two outpatients who had taken prescribed opioid analgesics for cancer-related pain at least once in the past week participated in this study. Patients were asked to recall the dose of each opioid analgesic that they had taken in the past 24 hours. Mean adherence rates were calculated for analgesic adherence. For mean adherence rates, all opioid analgesics were converted to morphine equivalents. The results of this study reveal a priority issue of poor opioid analgesic adherence. The adherence rate of 63.6% for the around-the-clock opioid analgesics in this study is well below acceptable levels. Also, an adherence rate of 30.9% for the as-needed opioid analgesics is very low. This study identified that women tend to be less adherent to their prescribed opioid analgesic regimen than men. Findings of this study suggest that to improve pain control, efforts to promote patients' opioid regimen adherence should be given high priority. Clinicians should be particularly aware that there may be some gender difference in adherence to prescribed opioid analgesics. There is a need for better programmatic efforts to improve analgesic adherence.
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Colorectal surgery patients' pain status, activities, satisfaction, and beliefs about pain and pain management. Pain Manag Nurs 2011; 14:184-192. [PMID: 24315241 DOI: 10.1016/j.pmn.2010.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 12/02/2010] [Accepted: 12/08/2010] [Indexed: 11/20/2022]
Abstract
This study describes surgical colorectal cancer patients' pain levels, recovery activities, beliefs and expectations about pain, and satisfaction with pain management. A convenience sample of 50 adult inpatients who underwent colorectal surgery for cancer participated. Patients were administered the modified American Pain Society Patient Outcome Questionnaire on postoperative day 2 and asked to report on their status in the preceding 24 hours. Patients reported low current (mean 1.70) and average (mean 2.96) pain scores but had higher scores and greater variation for worst pain (mean 5.48). Worst pain occurred mainly while turning in bed or mobilizing, and 25% of patients experienced their worst pain at rest. Overall, patients expected to have pain after surgery and were very satisfied with pain management. Patients with worst pain scores >7 reported interference with recovery activities, mainly general activity (mean 5.67) and walking ability (mean 5.15). These patients were likely to believe that "people can get addicted to pain medication easily" (mean 3.39 out of 5) and that "pain medication should be saved for cases where pain gets worse" (mean 3.20 out of 5). These beliefs could deter patients from seeking pain relief and may need to be identified and addressed along with expectations about pain in the preoperative nursing assessment.
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Liang SY, Li CC, Wu SF, Wang TJ, Tsay SL. The prevalence and impact of pain among Taiwanese oncology outpatients. Pain Manag Nurs 2011; 12:197-205. [PMID: 22117751 DOI: 10.1016/j.pmn.2010.10.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 10/17/2010] [Accepted: 10/18/2010] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to report the prevalence and impact of pain among Taiwanese oncology outpatients who had experienced moderate pain. Ninety-two cancer outpatients in two teaching hospitals in the Taipei area of Taiwan were enrolled in a descriptive cross-sectional study. Outpatients aged ≥18 years who had been prescribed opioid analgesics for cancer-related pain completed the Brief Pain Inventory-Chinese questionnaire. Results of this study highlighted an important issue: undertreatment of cancer pain in the Taiwanese outpatients. Patients in this study reported that in the preceding 24 hours they had experienced a mean worst pain of 6.91 (SD 2.06, range 0-10). The average pain intensity in the preceding 24 hours was 5.21 (SD 1.69, range 0-10). Around 50% of the patients had pain most of the time and 25% of the patients had pain all of the time. In the preceding 24 hours the average pain relief experienced was 62.6% (SD 22.2%, range 0%-100%). Only 10.9% of patients experienced good pain relief (defined as 90%-100% of pain relief in the past 24 hours), whereas 45.7% experienced poor pain relief (defined as 0%-60% of pain relief in the past 24 hours). The mean pain interference with the patients' daily activities was 5.69 (SD 2.33, range 0-10). The findings of this study indicate the need for better programmatic efforts to improve relief of cancer pain in Taiwanese outpatients.
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Affiliation(s)
- Shu-Yuan Liang
- School of Nursing, National Taipei University of Nursing and Health Science, Taipei, Taiwan
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Lee W, Yan YY, Jensen MP, Shun SC, Lin YK, Tsai TP, Lai YH. Predictors and Patterns of Chronic Pain Three Months after Cardiac Surgery in Taiwan. PAIN MEDICINE 2010; 11:1849-58. [DOI: 10.1111/j.1526-4637.2010.00976.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Fishbain DA, Bruns D, Disorbio JM, Lewis JE, Gao J. Variables Associated with Self-Prediction of Psychopharmacological Treatment Adherence in Acute and Chronic Pain Patients. Pain Pract 2010; 10:508-19. [DOI: 10.1111/j.1533-2500.2010.00371.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Blamey R, Jolly K, Greenfield S, Jobanputra P. Patterns of analgesic use, pain and self-efficacy: a cross-sectional study of patients attending a hospital rheumatology clinic. BMC Musculoskelet Disord 2009; 10:137. [PMID: 19903350 PMCID: PMC2777148 DOI: 10.1186/1471-2474-10-137] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 11/10/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many people attending rheumatology clinics use analgesics and non-steroidal anti-inflammatories for persistent musculoskeletal pain. Guidelines for pain management recommend regular and pre-emptive use of analgesics to reduce the impact of pain. Clinical experience indicates that analgesics are often not used in this way. Studies exploring use of analgesics in arthritis have historically measured adherence to such medication. Here we examine patterns of analgesic use and their relationships to pain, self-efficacy and demographic factors. METHODS Consecutive patients were approached in a hospital rheumatology out-patient clinic. Pattern of analgesic use was assessed by response to statements such as 'I always take my tablets every day.' Pain and self-efficacy (SE) were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Arthritis Self-Efficacy Scale (ASES). Influence of factors on pain level and regularity of analgesic use were investigated using linear regression. Differences in pain between those agreeing and disagreeing with statements regarding analgesic use were assessed using t-tests. RESULTS 218 patients (85% of attendees) completed the study. Six (2.8%) patients reported no current pain, 26 (12.3%) slight, 100 (47.4%) moderate, 62 (29.4%) severe and 17 (8.1%) extreme pain. In multiple linear regression self efficacy and regularity of analgesic use were significant (p < 0.01) with lower self efficacy and more regular use of analgesics associated with more pain.Low SE was associated with greater pain: 40 (41.7%) people with low SE reported severe pain versus 22 (18.3%) people with high SE, p < 0.001. Patients in greater pain were significantly more likely to take analgesics regularly; 13 (77%) of those in extreme pain reported always taking their analgesics every day, versus 9 (35%) in slight pain. Many patients, including 46% of those in severe pain, adjusted analgesic use to current pain level. In simple linear regression, pain was the only variable significantly associated with regularity of analgesic use: higher levels of pain corresponded to more regular analgesic use (p = 0.003). CONCLUSION Our study confirms that there is a strong inverse relationship between self-efficacy and pain severity. Analgesics are often used irregularly by people with arthritis, including some reporting severe pain.
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Affiliation(s)
- Ruth Blamey
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Utne I, Miaskowski C, Bjordal K, Paul SM, Jakobsen G, Rustøen T. Differences in the use of pain coping strategies between oncology inpatients with mild vs. moderate to severe pain. J Pain Symptom Manage 2009; 38:717-26. [PMID: 19775862 DOI: 10.1016/j.jpainsymman.2009.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 02/25/2009] [Accepted: 04/01/2009] [Indexed: 11/28/2022]
Abstract
The purposes of this study were to determine a clinically significant cutpoint for worst pain and to evaluate for differences in the use of pain coping strategies between oncology inpatients with mild (i.e., worst pain intensity scores of <or=4) compared with moderate to severe (i.e., worst pain intensity scores of >4) pain based on results of the cutpoint analysis. Oncology inpatients in pain (n=224) completed the Coping Strategies Questionnaire (CSQ), the Brief Pain Inventory, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Fifty-six percent had moderate to severe pain. Patients in the moderate to severe pain group had significantly poorer Karnofsky Performance Status scores (P=0.04) and significantly lower ratings of overall health (P<0.0001). No differences were found between the two pain groups on any of the subscales of the CSQ, except catastrophizing (P<0.0001). Compared with the mild pain group, patients in the moderate to severe group scored significantly higher on this subscale. In addition, patients in the moderate to severe group used more passive coping strategies (P=0.02). Except for catastrophizing, the number and types of pain coping strategies used by this sample of hospitalized patients do not appear to be influenced by their pain intensity scores. Finally, when the CSQ scores of these hospitalized oncology patients were compared with those found in previous studies of oncology outpatients and patients with chronic noncancer pain, the scores were similar.
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Affiliation(s)
- Inger Utne
- Faculty of Nursing, Oslo University College, Oslo, Norway.
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Abstract
The experience of pain pervades the physical and psychosocial domains of a patient's existence. It has a concrete underpinning in the form of an injury or disease process, yet subjective responses to pain sensations are psychosocial processes that influence the experience of pain and the capacity to cope with it. Anticipation of pain is one of the key fears associated with cancer, and uncontrolled pain strips away morale and quality of life. The interacting biopsychosocial dimensions are important areas for consideration in the comprehensive, skillful approach to assessment and treatment of cancer pain. This article addresses the interactive relationships between pain and mood using the biopsychosocial model as a heuristic for assessment.
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Affiliation(s)
- Margaret S Wool
- Psychiatry and Human Behavior, Brown University, Providence, RI 02906, USA.
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Edrington J, Sun A, Wong C, Dodd M, Padilla G, Paul S, Miaskowski C. Barriers to pain management in a community sample of Chinese American patients with cancer. J Pain Symptom Manage 2009; 37:665-75. [PMID: 19004613 PMCID: PMC2688466 DOI: 10.1016/j.jpainsymman.2008.04.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2007] [Revised: 04/07/2008] [Accepted: 04/09/2008] [Indexed: 11/16/2022]
Abstract
Barriers to cancer pain management can contribute to the undertreatment of cancer pain. No studies have documented barriers to cancer pain management in Chinese American patients. The purposes of this study in a community sample of Chinese Americans were to: describe their perceived barriers to cancer pain management; examine the relationships between these barriers and patients' ratings of pain intensity, pain interference with function, mood disturbances, education, and acculturation level; and determine which factors predicted barriers to cancer pain management. Fifty Chinese Americans with cancer pain completed the following instruments: Brief Pain Inventory (BPI), Karnofsky Performance Status (KPS) Scale, Barriers Questionnaire (BQ), Hospital Anxiety and Depression Scale (HADS), Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA), and a demographic questionnaire. The mean total BQ score was in the moderate range. The individual barriers with the highest scores were: tolerance to pain medicine; time intervals used for dosage of pain medicine; disease progression; and addiction. Significant correlations were found between the tolerance subscale and least pain (r=0.380) and the religious fatalism subscale and average pain (r=0.282). These two subscales were positively correlated with anxiety and depression levels: (tolerance: r=0.282, r=0.284, respectively; religious fatalism: r=0.358, r=0.353, respectively). The tolerance subscale was positively correlated with pain interference (r=0.374). Approximately 21% of the variance in the total BQ score was explained by patients' education level, acculturation score, level of depression, and adequacy of pain treatment. Chinese American cancer patients need to be assessed for pain and perceived barriers to cancer pain management to optimize pain management.
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Affiliation(s)
- Janet Edrington
- School of Nursing, University of California at San Francisco, California, USA.
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Liang SY, Yates P, Edwards H, Tsay SL. Factors influencing opioid-taking self-efficacy and analgesic adherence in Taiwanese outpatients with cancer. Psychooncology 2009; 17:1100-7. [PMID: 18314911 DOI: 10.1002/pon.1326] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM Although research has suggested that medication adherence rates are lower than what is needed to achieve optimal pain control, the role of patient beliefs and attitudes in influencing opioid adherence has rarely been examined. Perceived self-efficacy is reported to be an important construct in predicting and enhancing adherence behaviour. The purpose of this study was to explore the relationship between opioid-taking self-efficacy, opioid beliefs, adherence behaviours, and pain experience amongst Taiwanese cancer outpatients. METHOD The cross-sectional study included 92 oncology outpatients in two teaching hospitals in the Taipei area of Taiwan. The research instruments included the Opioid-Taking Self-Efficacy Scale-Cancer (OTSES-CA), the Pain Opioid Analgesic Beliefs Scale-Cancer (POABS-CA), opioid adherence, and the Brief Pain Inventory-Chinese (BPI-Chinese). RESULTS Opioid-taking self-efficacy demonstrated a significant positive relationship with patients' opioid adherence (r=0.22, p<0.05) and pain relief (r=0.35, p<0.01), while also demonstrating a significant positive correlation with worst pain (r=0.25, p<0.05). In addition, the more negative beliefs regarding opioids the patient had, the worse their adherence to around the clock analgesic regimen (r=-0.30, p<0.01). Multivariate analysis identified opioid-taking self-efficacy continued to have a significant independent influence on opioid adherence and pain relief, after controlling for key demographic variables. Self-efficacy accounted for 4% (R(inc) (2)=0.04, p=0.043) of the variance and opioid beliefs accounted for 8% (R(inc) (2)=0.08, p=0.007) of the variance in opioid adherence. Multivariate analysis also identified that opioid-taking self-efficacy accounted for 11% (R(inc) (2)=0.11, p=0.001) of the variance in pain relief, but opioid beliefs did not continue to have an independent effect for this outcome. CONCLUSIONS The study highlights the potential importance of a patient's self-efficacy beliefs in adherence to medication and key pain outcomes.
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Affiliation(s)
- Shu-Yuan Liang
- Department of Nursing, National Taipei College of Nursing, Taipei, Taiwan.
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Lai YH, Guo SL, Keefe FJ, Tsai LY, Shun SC, Liao YC, Li IF, Liu CP, Lee YH. Multidimensional Pain Inventory-Screening Chinese version (MPI-sC): psychometric testing in terminal cancer patients in Taiwan. Support Care Cancer 2009; 17:1445-53. [PMID: 19242731 DOI: 10.1007/s00520-009-0597-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 02/02/2009] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cancer pain is identified as a multidimensional experience, but relatively few brief instruments are available for assessing the complex pain-related experiences of terminal cancer patients in Taiwan. The purposes of this study were to (1) translate and examine the feasibility and psychometric characteristics of the eight-item Multidimensional Pain Inventory-Screening Chinese (MPI-sC) when used with patients having terminal cancer and (2) apply the MPI-sC to examine multidimensional pain-related experiences of terminal cancer patients in Taiwan. MATERIALS AND METHODS The MPI-sC was tested in 106 terminal cancer inpatients at a hospice setting in Taipei. RESULTS The results showed that the MPI-sC has satisfactory face and content validity, feasibility, acceptable internal consistency reliability (overall Cronbach's alpha of 0.75), and overall support of theoretical assumptions. However, instead of the four-factor structure of the original instrument, we found a three-factor structure (with pain intensity and pain interference merged into one factor) that explained 76.73% of the variance. Close to half the patients (48.1%) had considerable levels of pain interference, and a majority (72.6%) reported not having control in life based on the cut-point of MPI-sC categorization. CONCLUSION Our results support the brief MPI-sC as a feasible and valid tool for assessing and representing multidimensional pain experiences in terminal cancer patients. The MPI-sC could help clinicians and researchers assess the complex multidimensional pain experiences of terminal cancer patients, including Chinese-speaking cancer populations.
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Affiliation(s)
- Yeur-Hur Lai
- Department of Nursing, College of Medicine, National Taiwan University, 1 Jen-Ai Rd., Sec. 1, Taipei, 100, Taiwan.
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Oldenmenger WH, Sillevis Smitt PAE, van Dooren S, Stoter G, van der Rijt CCD. A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: a critical appraisal. Eur J Cancer 2009; 45:1370-80. [PMID: 19201599 DOI: 10.1016/j.ejca.2009.01.007] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 01/06/2009] [Indexed: 01/31/2023]
Abstract
The aim of this paper is to identify the major barriers hindering adequate pain management and critically review interventions aiming to overcome them. We searched relevant literature on PubMed published between January 1986 and April 2007. The most frequently mentioned barriers for both patients and professionals were knowledge deficits, inadequate pain assessment and misconceptions regarding pain. Four interventions were identified: patient education, professional education, pain assessment and pain consultation. These interventions were never combined in multidisciplinary study protocols. Most RCTs included small groups of patients and reported no power analysis. Studies on professional education and pain assessment did not evaluate patients' outcomes. In 5 of 11 RCTs on patient education, pain intensity decreased statistically significantly. In two RCTs on pain consultation, patients' pain decreased statistically significantly, although the adequacy of pain treatment did not change. In conclusion, international guidelines on multidisciplinary interventions in pain management are partly substantiated by clinical trials.
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Affiliation(s)
- Wendy H Oldenmenger
- Department of Medical Oncology, Erasmus MC, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands
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Jacobsen R, Møldrup C, Christrup L, Sjøgren P, Hansen OB. The Danish version of the Medication Adherence Report Scale: Preliminary Validation in Cancer Pain Patients. Pain Pract 2009; 9:1-7. [DOI: 10.1111/j.1533-2500.2008.00245.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prevalence rates for and predictors of self-reported adherence of oncology outpatients with analgesic medications. Clin J Pain 2008; 24:627-36. [PMID: 18716502 DOI: 10.1097/ajp.0b013e31816fe020] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Inadequate adherence with an analgesic regimen may be a reason why oncology patients experience unrelieved pain. However, only a limited number of studies have evaluated the prevalence rates for adherence and no studies have attempted to determine predictors of adherence in patients with cancer pain. On the basis of concepts from the Health Belief Model, the purposes of this study were to describe oncology outpatients' level of adherence with an analgesic regimen and to evaluate the direct and indirect effects of selected demographic variables, pain characteristics, barriers to pain management, and self-efficacy (SE) on adherence with an analgesic regimen. METHODS A descriptive, cross-sectional study recruited outpatients from oncology clinics in a large, tertiary referral cancer hospital in Norway. A sample of 174 oncology outpatients completed a demographic questionnaire, the Brief Pain Inventory, 2 self-reported adherence measures, the Barriers Questionnaire, and a SE questionnaire. RESULTS Only 41% of the patients were adherent with their analgesic regimen. In the regression analysis, 29.9% of the variance in adherence was explained. Higher adherence scores were associated with male sex, and also lower SE for physical function scores, higher average pain intensity scores, higher pain relief scores, and the use of strong opioid analgesics. CONCLUSIONS Improvements in pain management may occur if clinicians routinely assessed patients' level of adherence with their analgesics regimen.
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Tsai YF, Chu TL, Lai YH, Chen WJ. Pain experiences, control beliefs and coping strategies in Chinese elders with osteoarthritis. J Clin Nurs 2008; 17:2596-603. [DOI: 10.1111/j.1365-2702.2008.02306.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jacobsen R, Møldrup C, Christrup L, Sjøgren P. Patient-related barriers to cancer pain management: a systematic exploratory review. Scand J Caring Sci 2008; 23:190-208. [PMID: 18785917 DOI: 10.1111/j.1471-6712.2008.00601.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this review was to systemically explore the current evidence regarding patient-related barriers to cancer pain management to find new areas that might be important for better understanding of patient barriers' phenomenon. The method used in this study was a computerised literature search, carried out in Cochrane Library, Medline (through PubMed), Web of Science and EMBASE databases for the period 1994-2005. Thirty-seven studies, dealing with cognitive, sensory and affective patient-related barriers, as well as studies, describing patients' pain communication and their adherence to analgesic regimen were included and analysed. The dominant part of articles studied cognitive patient-related barriers to cancer pain management, while affective, sensory barriers, as well as pain communication and pain medication adherence were studied in much less extend. However, the findings from different studies regarding relationships between cognitive barriers and pain intensity were not consistent. On the contrary, the quality of pain communication was consistently found to be not satisfactory in some key areas. The associations between more expressed attitudinal as well as sensory barriers and less optimal adherence were also consistent. In conclusions suggestion for the new research areas on patient-related barriers to cancer pain management are made. Firstly, further research is needed to differentiate the role of cognitive, affective and sensory factors with respect to their impact on pain relief, pain communication and medication adherence. Besides that, validated instruments to assess patients' pain communication and adherence to analgesic regimen are lacking.
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Affiliation(s)
- Ramune Jacobsen
- Department of Pharmacology and Pharmacotherapy, Section for Social Pharmacy, The Faculty of Pharmaceutical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Opioid-taking self-efficacy amongst Taiwanese outpatients with cancer. Support Care Cancer 2008; 20:199-206. [PMID: 18461371 DOI: 10.1007/s00520-008-0451-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Accepted: 04/03/2008] [Indexed: 10/22/2022]
Abstract
GOALS The purpose of this study was to describe the level of opioid-taking self-efficacy amongst Taiwanese outpatients with cancer pain, and to examine the associations between various demographic and medical characteristics and opioid-taking self-efficacy. MATERIALS AND METHODS This was a cross-sectional study. Ninety-two outpatients who had taken prescribed opioid analgesics for cancer related pain in the past 1 week completed the Opioid-Taking Self-Efficacy Scale-CA (OTSES-CA). Details of the medical characteristics were obtained from the patients' medical record. MAIN RESULTS Results show patients in this study were moderately confident of being able to perform many of the key tasks associated with effective opioid-taking. However, for many key behaviours relating to tailoring medication regimens, acquiring help and managing treatment-related concerns, only around one third to slightly more than two fifths reported high confidence. Individuals with lower levels of education and who were experiencing more side effects from opioids reported lower confidence in taking their analgesics. CONCLUSIONS The results of this study suggest it is important to understand how patients perceive their ability to perform key tasks associated with effective opioid-taking, to effectively tailor educational and supportive interventions. Patients with lower levels of education and with side effects of opioids may be at risk of lower self-efficacy, requiring particular attention.
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Oldenmenger WH, Echteld MA, de Wit R, Sillevis Smitt PAE, Stronks DL, Stoter G, van der Rijt CCD. Analgesic adherence measurement in cancer patients: comparison between electronic monitoring and diary. J Pain Symptom Manage 2007; 34:639-47. [PMID: 17703909 DOI: 10.1016/j.jpainsymman.2007.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Revised: 01/22/2007] [Accepted: 02/02/2007] [Indexed: 01/01/2023]
Abstract
Adherence to analgesics in cancer patients has scarcely been studied. In this study, the Medication Event Monitoring System (MEMS) and medication diaries were compared with respect to feasibility and adherence measurements. Forty-six outpatients with nociceptive pain caused by cancer were asked to use MEMS for their analgesics and to record their medication usage in a diary for four weeks. Seventy-nine percent of the patients used MEMS for the full four-week period; 70% did so for the diary. The majority of patients were satisfied with both MEMS and diary. Adherence data assessed by MEMS and diary were comparable. Patients used the amount of analgesics adequately (taking adherence: 87%) but took them irregularly (timing adherence: 53%). Subgroup analyses in patients using single and multiple analgesic regimens confirmed the comparable suitability of both methods. MEMS and a medication diary are equally useful for analgesic adherence measurement in cancer patients with pain.
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Affiliation(s)
- Wendy H Oldenmenger
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands.
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Enting RH, Oldenmenger WH, Van Gool AR, van der Rijt CCD, Sillevis Smitt PAE. The effects of analgesic prescription and patient adherence on pain in a dutch outpatient cancer population. J Pain Symptom Manage 2007; 34:523-31. [PMID: 17664055 DOI: 10.1016/j.jpainsymman.2007.01.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 01/11/2007] [Accepted: 01/13/2007] [Indexed: 12/01/2022]
Abstract
Insufficient awareness of cancer pain, including breakthrough pain, inadequate analgesic prescriptions, and nonadherence contribute to inadequate cancer pain management. There are insufficient data about the contribution of each of these factors. In a cross-sectional survey among 915 adult cancer outpatients, pain was assessed by the Brief Pain Inventory. Breakthrough pain was defined as a worst pain intensity rated as "7 or more" and an average pain intensity rated as "6 or less" in patients on "around-the-clock" (ATC) analgesics. The Pain Management Index (PMI) was calculated to measure the quality of treatment. Adherence was considered inadequate when below 100% of the dose prescribed. Pain was present in 27% of patients. Worst pain was rated as moderate in 26%, and as severe in 54%. Breakthrough pain was present in 45% of patients with ATC medication. The PMI indicated inadequate treatment in 65% of patients. The proportions of patients adherent to ATC analgesics varied from 59% (tramadol) to 91% (Step 3 opioids). The management of cancer pain will benefit most from improving analgesic prescriptions and patient adherence.
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Affiliation(s)
- Roelien H Enting
- Department of Neuro-Oncology, Daniel den Hoed Cancer Center, Erasmus University Medical Center, Rotterdam, The Netherlands
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