Overcoming barriers to cancer pain management: an institutional change model

The Agency for Health Care Policy and Research Pain Guidelines of 1994 recognized pain as a critical symptom that impacts quality of life (QOL). The barriers to optimum pain relief were classified into three categories: patient, professional, and system barriers. A prospective, longitudinal clinical trial is underway to test the effects of the "Passport to Comfort" innovative intervention on pain and fatigue management. This article reports on preintervention findings related to barriers to pain management. Cancer patients with a diagnosis of breast, lung, colon, or prostate cancer who reported a pain rating of >/=4 were accrued. Subjects completed questionnaires to assess subjective ratings of overall QOL, barriers to pain management, and pain knowledge at baseline and at one- and three-month evaluations. A chart audit was conducted at one month to document objective data related to pain management. The majority of subjects had moderate (4-6 on a 0-10 numeric rating scale) pain at the time of accrual. Patient barriers to pain management existed in attitudes and knowledge regarding addiction, tolerance, and not being able to control pain. Subjects who were currently receiving chemotherapy were reluctant to communicate their pain with health care professionals. Professional and system barriers were focused around screening, documentation, reassessment, and follow-up of pain. Lack of referrals to supportive care services for patients was also noted. Several well-described patient, professional, and system barriers continue to hinder efforts to provide optimal pain relief. Phase II of this initiative will attempt to eliminate these barriers using the "Passport" intervention to manage cancer pain.     

Overcoming barriers to diabetes control in geriatrics

Introduction: Diabetes mellitus is approaching epidemic proportions in most countries and has captured the attention of physicians at local, national and global levels. The elderly population remains at a higher risk for diabetes mellitus ( 1 ), and the disease poses unique concerns for geriatricians, primary care physicians, nurses and specialised pharmacists who provide care to the elderly. Glycaemic control, geriatric‐related syndromes and cardiovascular risk factors considerably affect the elderly patient’s functional status and life expectancy ( 2 ). Geriatric syndromes may include polypharmacy, chronic pain, injurious falls, cognitive impairment, urinary incontinence and depression. Higher rates of premature death; functional disability; and chronic illnesses, such as hypertension, cerebrovascular accidents, dementia and coronary artery disease, often affect elderly diabetic patients. Discussion: Collaborative efforts are continually needed to allocate and maximise utilisation of resources to help empower older adults with diabetes to overcome barriers to disease management. Healthcare providers are increasingly challenged by the complexity of problems that face old patients, and must therefore be prepared to assess and treat diabetes mellitus within the milieu of many geriatric‐related chronic illnesses. Healthcare providers must tailor individualised treatment methods, with the ultimate goal of not only achieving laboratory norms but also improving the quality of life for this vulnerable population. Conclusion: There is a need for extra care and overcoming barriers to diabetes control in old patients as a dynamic and a continuous task that needs coordination of healthcare systems and professionals at all levels of care.     

Overcoming barriers to hypertension control in African Americans

Barriers to blood pressure control exist at the patient, physician, and system levels. We review the current evidence for interventions that target patient- and physician-related barriers, such as patient education, home blood pressure monitoring, and computerized decision-support systems for physicians, and we emphasize the need for more studies that address the effectiveness of these interventions in African American patients.     

Current status of pain management in China: an overview

China is a large country with a huge population.It is estimated that 1.8 million patients suffer initially from cancer and 1.4 million patients die from it each year in Mainland China. Cancer ranks as the primary reason for death among the common diseases in cities and the second in rural areas.The management of pain is still a critical issue in the care of patients both with cancer and non-cancer pain. A national survey suggested that the fear of addicting patients was still a major barrier for medical professionals in prescribing opioid analgesics. The major reasons for poor management or negative factors of pain relief came from patients' own reasons including their over-concern about addiction to opioid analgesics, their reluctance to report pain and their resistance to use opioid analgesics. Oral long-acting opioids are the most commonly used drugs for third ladder pain management. With policy support from the government, the consumption of morphine for medical purposes has increased significantly for the first time in recent Chinese history as this new cancer pain relief policy has been developed in the country. As a result, the three-step analgesic ladder of the World Health Organization (WHO) has been gradually accepted by medical personnel and patients.Although pain management has been improved since the WHO's strategy of the three-step approach was implemented in China, variations still exist in different regions of the Mainland. Currently the three main aspects of work on pain measurement are going to be undertaken including (1) continuous support from government policy; (2) consistent education and training; and (3) better availability of drugs for medical use throughout the whole country.     

Hypertension in patients with diabetes. Overcoming barriers to effective control

The management of diabetic hypertension poses special problems for the medical community. Although patient adherence is often a major barrier to successful management, physicians' beliefs and prejudices also negatively impact treatment. In addition, healthcare organizations need to provide better support to physicians who feel isolated in their efforts to manage diabetic hypertension. Reductions of morbidity and mortality are achievable goals but require aggressive treatment and improved adherence if they are to be reached.     

Diabetes management: an update

The diabetic diet is no longer as rigid as it once was. Oral hypoglycemic agents continue to have a place in management, and the declining cost of human insulin makes it an increasingly attractive option. Home glucose testing is the preferred monitoring method, and its use is becoming more common. Regardless of the management method used, close control offers the potential benefit of fewer diabetic complications but also presents increased hazards from hypoglycemia.     

Patient-related barriers to pain management: the Icelandic Barriers Questionnaire II

The Barriers Questionnaire-II (BQ-II) is used to evaluate eight attitudinal barriers to cancer pain management. The purpose of this study was to evaluate the psychometric properties of the Icelandic BQ-II (IBQ-II). Icelandic adults (n=244) completed the IBQ-II, the Brief-Pain-Inventory, and demographic questions. Half the responders were male (52%), and 42.8% had pain on the day of data collection. Participants had a mean (SD) age of 34.73 (11.78) years and education of 15.08 (3.69) years. Factor analysis of the IBQ-II supported three factors. The alpha was 0.90. The mean (SD) IBQ-II total score was 2.32 (0.78), on a scale of 0 to 5, with higher scores indicating stronger barriers. IBQ-II total scores were inversely related to education (r=-0.21; P<0.01), and positively related to least pain (r=0.24; P<0.05), average pain (r=0.23; P<0.05), and pain interference with life activities (r=0.22; P<0.05) for those who had pain. There is support for reliability, validity, and feasibility of the IBQ-II.     

Airway management in trauma: an update

This article reviews the more recent theoretic and practical information that pertains to airway management in the trauma setting. This is followed by a presentation of the newer airway devices that may be advantageous in the management of the airway in trauma as well as a discussion of other devices, techniques, or maneuvers that are useful in the trauma setting but may be underused. Each clinician needs to be knowledgeable about the various airway options and then, based on one's own particular skills and resources, construct an airway management algorithm that works best for him or her. Each clinician needs to be knowledgeable about the various airway options, and then, based on the clinician's particular skills and resources, construct an airway management algorithm that works best.     

Attitudinal barriers to cancer pain management in the Icelandic population

The purpose of this study was to evaluate attitudinal barriers to cancer pain management in a random sample of 1,284 adults drawn from a national registry. Data were collected with a postal survey, and 599 (46.6%) surveys were completed. Barriers were evaluated with the Icelandic Barriers Questionnaire-II. The mean (SD) age of respondents was 45.28 (17.14) years, and 55.8% were women. Their mean (SD) length of education was 13.81 (4.27) years. Approximately half (55.6%) had personal experience of cancer; of those, 95.7% had a relative or a close friend so diagnosed, and in addition, 33 (10%) had been diagnosed themselves. The mean (SD) Icelandic Barriers Questionnaire-II score was 2.16 (0.77) on a scale of 0 to 5, with higher scores indicating stronger attitudinal barriers. Education was inversely related to barriers, and age was inversely related to 1 specific barrier (fatalistic beliefs). Those who had personal experience of cancer had lower barriers than those who did not. There seem to be substantial attitudinal barriers to cancer pain management among the general population of Iceland, and stronger than previously described in the United States. This points to the importance of addressing barriers among lay people because these barriers may interfere with good pain management practices.     

Overcoming the barriers to using information systems

AIM: To identify any barriers to the use of information technology by community nurses, such as poor access, insufficient time and a lack of appropriate skills. METHODS: Literature review and questionnaire. RESULTS: The study showed that a large majority of community nurses had access to IT. However, sharing facilities and varying clinical systems meant that, with the exception of e-mail, they made infrequent use of the applications provided. CONCLUSION: Despite some access difficulties, community nurses have a positive attitude to IT and would like to receive more training.