Outcomes. 1. Discuss a range of activities and emotional and psychological states that patients with cancer-related pain report as obstacles 2. Describe a variety of unique goals that patients with ...cancer-related pain wanted to accomplish during times of good pain control 3. Examine personal clinical pain assessment practices or research programs to reflect on goals in cancer pain management Importance. High rates of cancer pain and previously identified barriers demonstrate a gap in thorough clinical assessment of cancer pain that hinders consistent assessment of individualized pain goals and development of targeted interventions. Objectives. To answer two questions: How do patients with cancer perceive periods of good pain control, and do they do in order to maximize those periods? and What are personally meaningful activities or states for times of good pain control? Methods. Quantitative content analysis of deidentified audio recordings from 27 patients with cancer-related pain who completed four motivational interviewing interventions each to discuss functional cancer pain goals. We organized data into a priori conceptual categories: pain as an obstacle, life with controlled pain, what helped pain before, suggestions used to control pain, and patient help seeking. Unique participant behaviors, attitudes, and personal states were counted and identified categorically. Results. Based on 108 interviews, concept medians ranged from 0.5 to 3 occurrences, with the least discussed concept being patient help seeking and the most frequently discussed concept being life with controlled pain. Across the concepts, participants spoke of 1,223 examples unique to them. Conclusions. Nurses and other clinicians who are responsible for cancer pain assessment and care planning must recognize that current assessments are inadequate for the unique complexities of cancer pain experiences. A clear gap exists in the clinical assessment of meaningful cancer pain goals. Impacts. Until a measure for goals that has adequate sensitivity to capture unique patient circumstances and specificity for identifying unique goals is developed, clinicians must rely on their own skills to comprehend whether and how such factors might be barriers to effective pain management.
Evidence-based clinical practice guidelines and hospice agency policies and procedures direct nursing assessment and interventions for the care of persons with cancer-related pain. Guidelines assert ...that pain should be assessed from a holistic perspective that considers physical, psychological, social, and spiritual aspects. In addition, guidelines maintain that hospice nurses should ascertain patient goals for pain management. Assessment and documentation of goals other than pain intensity goals is an area of nursing practice that has not been developed. Without inclusion of personally meaningful goals in pain assessment instruments, such goals cannot be routinely or consistently included in the hospice care plan. To address the assessment of pain and patient goals for pain management, this scenario-based article merges theoretical knowledge about pain from concept analyses with clinical guideline recommendations. Although research is needed to develop pain goal assessment tools, nurses can use this empirically based approach for asking about goals and integrating them into the plan of care.
Cancer Pain Goals Use: A Systematic Review Ehrlich, Olga; Lackowski, Alyssa; Glover, Toni ...
Journal of pain and symptom management,
20/May , Letnik:
67, Številka:
5
Journal Article
Recenzirano
Odprti dostop
1. Participants will self-report the ability to analyze the need for multi-dimensional cancer pain goals in meeting patient pain outcomes.
2. Participants will self-report the ability to utilize ...personal pain goals appropriately as one element of a comprehensive pain assessment.
The use of goals is a key element of cancer pain assessment and treatment tailoring. To address the complex nature of cancer pain in palliative care, there is a need to assess patient goals relative to mood, activities, and function. However, our literature review demonstrates a gap in research for assessing goals other than physical pain intensity goals.
Pain is a complex symptom with physiological, psychological, social, and spiritual aspects. Best practices call for pain management to be individualized and tailored to patient goals. Current practice for goal setting is the unidimensional personal pain goal (PPG), a patient-reported numeric rating for tolerable pain intensity.
To identify pain goal utilization and interventions including or tailored to pain goals.
In this systematic literature review, we searched CINAHL, PsychInfo, and PubMed databases. Two authors independently reviewed titles, abstracts, full text, reference lists, and citations and agreed on the final sample.
Nineteen articles met inclusion criteria. Most used a PPG as an outcome measure or outcome-influencing variable. One qualitative study identified achieving personal goals as the outcome of pain management work (Adams et al., 2016); a concept analysis identified goal setting as a key attribute of pain management (Kiza & Cong, 2021); four qualitative studies identified themes of personal goals for pain management (Bahtia et al., 2014; Gibbons et al., 2013; Ehrlich et al., 2019; McPherson et al., 2014); one mixed methods study developed a patient pain management resource including a SMART goal; one pilot feasibility study used motivational interviewing to set functional pain goals (Ehrlich et al., 2021); and the remaining quantitative studies and a quality improvement project measured feasibility of assessing PPGs, correlation of PPG to other pain control variables, or comparison of achieving PPG to having controlled pain. No studies reported on correlation or efficacy testing of a non-severity-based cancer pain goal.
Until assessment tools are developed for cancer pain goals to address activities, functions, or moods that patients wish to achieve as a pain management outcome, multidimensional patient pain goals will not be consistently assessed or documented. Research is needed to develop and test cancer pain goals assessment tools to fill this gap.
Managing Suffering and Distress
Cancer pain is multidimensional and management should be individualized to patient goals. The current standard for pain goal assessment is the personal pain goal (PPG), a numeric rating for tolerable ...pain intensity. However, the PPG may not accurately capture a personally meaningful goal for tailoring pain management.
Identify how pain goals are used in cancer pain management and types of goals researched.
CINAHL, PsychInfo, and PubMed databases and manual searching were used to locate research or scholarship about cancer pain goals. Authors reviewed titles, abstracts and full text to agree on the final sample.
Sixteen articles met inclusion criteria. Study designs included: quality improvement project (1), concept analysis (1), qualitative methods (5), quantitative methods (8), and mixed methods (1). Findings included: goal setting as a key attribute of pain management; achieving personal goals as the outcome of pain management work; qualitative themes discussed personal goals related to pain management; developing a patient pain management resource including a SMART goal; using motivational interviewing to set functional pain goals; PPG assessment was feasible; and achieving PPG equated to having controlled pain when compared to the clinically important difference measure used in research (≥30%). Quantitative studies reported on PPGs only.
Currently, assessments for cancer pain goals do not include function, activities, moods, medication effects, or safety that patients wish to achieve as a pain management outcome. Development and testing of multidimensional patient pain goals assessments is warranted so that goals can be consistently assessed, documented, and personally meaningful.
Objectives Explain how motivational interviewing can be used to elicit functional pain goals. Comprehend why functional pain goals matter to patients with cancer related pain. Importance. Despite ...decades of research, high rates of moderate-to-severe cancer pain persist. Self-efficacy and feeling in control correlate with reduced pain severity and increased functionality. Functionality is associated with accomplishing important activities, or goals in persons with advanced cancers. Yet the role of functional goal setting in the context of cancer pain management has received little attention. This study tested a cognitive behavioral therapy, motivational interviewing (MI), for setting functional pain goals (FPGs). Objective(s). Pilot test feasibility and acceptability of MI for FPGs. Explore attitudinal barriers and selfefficacy. Method(s). Palliative care patients with cancerrelated pain were recruited at an ambulatory cancer center. Consented participants attended two-to-four MI sessions. A feasibility rate of at least 26 participants (41%, 90% CI, 36-60%, n¼54) completing $ 2 MI sessions was targeted. Pain attitudinal barriers and self-efficacy were explored using Barriers Questionnaire II (BQII), (possible score: 0-5) and Pain Self-Efficacy Questionnaire (PSEQ) (possible score 0-60). Low barriers scores indicate acceptance of pain management interventions and low PSEQ scores indicate high attention to pain relieving. Results. Of 115 participants invited, 54 enrolled, 36 (66%) completed $ 2 sessions. Total session usage was 64%, with a 5% withdrawal rate after $ 1 MI session. Withdrawal reasons included fatigue, relocation, and hospice admission. Median time from first to second session was three weeks (range 1-12), with a median time from first to last session of nine weeks (range 1-22). 52% completed all 4 sessions and 88% reported FPGs. Mean overall scores were: 1) BQII ¼ 1.7, low, and 2) PSEQ ¼ 34, moderate. Conclusion(s). MI is a feasible and acceptable method for setting FPGs. Although low barriers scores and moderate self-efficacy scores may have been related to access to palliative care, the sample was small to be conclusive. Relationships between MI, FPG setting, pain barriers and self-efficacy require further research. Impact. New pilot data has been generated for the study of FPGs and in cancer pain management.
High rates of pain impede quality of life for persons with advanced cancer. Research has identified barriers to cancer pain control. Little has been written, however, about the unique motivating ...goals and individual pain management behaviors of persons with cancer-related pain.
To describe motivating factors and pain management behaviors used.
Quantitative content analysis.
Outpatient palliative care Participants: 27 persons with cancer pain.
We analyzed deidentified audio recordings from participants who had completed motivational interviewing interventions to discuss functional pain goals. We organized data into a priori conceptual categories: (1) Pain as an Obstacle, (2) Life with Controlled Pain, (3) What Helped Pain Before, (4) Suggestions Used to Control Pain, and (5) Patient Help-Seeking. Unique behaviors, attitudes, and personal states were counted and organized categorically.
Medians for discussed concepts ranged from 0.5-3 occurrences across a sample of 108 interviews. The least discussed concept was Help-Seeking and the most frequently discussed was Controlled Pain based on personal motivations.
Current cancer pain assessment tools do not capture the unique complexities of cancer pain motivating behaviors, or personal functional goals, and thus hinder nurses’ capacity to provide tailored care across patient encounters. Until a measure with specificity to capture unique patient goals is developed, nurses must rely on their own skills to comprehend if and how motivating factors could benefit individual cancer pain management plans.
Persons with advanced cancers experience high rates of pain. Nursing interventions for pain, which are tailored to the individual patient, may support motivation to engage in self-management and ...should include setting of realistic functional goals. For patients with advanced cancer, functional pain goals include personally important activities, measurable across clinical encounters. However, limited evidence exists regarding nursing assessment of functional pain goals. To address this gap, we piloted use of a motivational interviewing intervention. Motivational interviewing is a clinical technique for clarifying goals and related impediments, such as cognitive and emotional factors underlying pain management behaviors.
Pilot feasibility testing.
Palliative care patients with cancer-related pain completed up to four intervention sessions, the Pain Self-Efficacy Questionnaire, and an author-developed acceptability questionnaire. Feasibility success was determined by 60% of participants completing at least two interventions. Fidelity to the intervention was assessed using the Motivational Interviewing Skills for Healthcare Encounters tool.
Sixty-seven percent completed two interventions. Participants reported that interventions were helpful, worthwhile, and recommended. Mean pain self-efficacy scores (0-60 possible) rose from 31.5 (SD = 11.2) at intervention 1 to 35.5 (SD = 13) after intervention 4. Intervention fidelity was maintained.
Participants were willing to engage in multiple motivational interviewing conversations focused on pain management behaviors related to functional goals. Based on these findings about motivational interviewing for functional goals and patient willingness to set them, these conversations may have a place in clinical care as an element of pain assessment and intervention tailoring.
Since 2021, some state legislators have passed laws that limit what public institutions can teach about discrimination. The number of these laws, also called gag orders, is increasing despite a ...national outcry against racism, homophobia and transphobia, and other forms of discrimination. Many nursing and other professional healthcare organizations have recognized and published statements decrying racism in healthcare and calling for an increased focus on health disparities and advancing health equity. Similarly, national research institutions and private grant funders are funding health disparities research. Nursing and other faculty in higher education, however, are being gagged by laws and executive orders which prevent them from teaching and conducting research about historic and contemporary health disparities. This commentary seeks to highlight the immediate and long-term impact of academic gag orders and to encourage action in opposition of such legislation. Supported by professional codes of ethics and discipline-specific education, we present concrete activities readers can use to address gag order legislation and in doing so, protect patient and community health outcomes.
•A number of recent state laws forbid teaching about discrimination and racism.•These gag order laws put nursing faculty at risk for funding cuts and job loss.•Student impacts include violation of the right to essential nursing knowledge.•New nurse graduates in affected states will be unable to address health inequities.
Background:
Qualitative pain research for hospice patients with cancer and their caregivers involves recruiting and retaining participants with multiple vulnerabilities and ethical and logistical ...challenges. These have been reported for studies of individuals or dyads. However, there are no reports of the related challenges and outcomes where the sampled population was a hospice triad.
Objectives:
Qualitative research about pain management for home hospice patients with cancer contributes rich descriptive data and such studies are critical to improving cancer pain outcomes. We describe the ethical and pragmatic challenges we faced in a study of the hospice caring triad, operationalized as the patient, family caregiver, and nurse; how our study design anticipated them; and related outcomes.
Results:
We found that having an established relationship with the hospice agency at which we recruited participants, clearly identifying potential participants at the onset of hospice care, practice using a recruitment script, patient recruitment of caregivers, establishing rapport, and participants determining when interviews should end helped us recruit and retain our sample. We were unable to accrue our anticipated triad sample, partially because of nurse gatekeeping and the condition at admission of patient participants who enrolled but had physical decline or died prior to written consent.
Conclusions:
Although researchers will always face challenges to enrolling individuals and groups in cancer pain studies, with careful study design, recruitment, and retention planning and research team-participant engagement, it is possible to gather a robust corpus of qualitative data.
