Breakthrough Pain: A Qualitative Study of Patients with Advanced Cancer in Northwest China

Background: Breakthrough pain is an extremely painful symptom that impairs quality of life in cancer patients. It negatively impacts their emotional wellbeing, physical function, and mental health. The aim of this study is to use a qualitative methodology to examine the perception of cancer patients with breakthrough pain in the Northwest of China. Methods: A semi-structured, face-to-face interview was conducted with nine cancer patients who experienced breakthrough pain; and a qualitative content analysis was performed. Results: Five themes were generated: (1) sufferings from breakthrough cancer pain, (2) hopelessness and helplessness, (3) perception of breakthrough cancer pain and analgesia, (4) strong as a Chinese, and (5) support needed from health care system. Conclusion: Although certain traditional cultural worldviews increase patients' acceptance of pain, healthcare providers need proper treatment guidelines to improve the quality of cancer patient care in Northwest China. We recommend that healthcare workers and hospital managers place cancer pain management in higher priority. Relevant pain management education programs should be provided to both healthcare providers and patients to improve their knowledge in these area. Healthcare professionals need to establish a mutual communication channel between patients and healthcare workers to meet patients' needs during breakthrough pain episodes in order to improve pain management. Nevertheless, the government and the healthcare system need to recognize the importance and urgency of palliative care services.     

Nurses' needs for education on cancer and end-of-life care

BACKGROUND: Changes in cancer and end-of-life care require frequent assessment of educational needs of nurses. METHODS: The Nurse Oncology Education Program surveyed a random sample of Texas registered nurses about their continuing education practices, level of knowledge, and educational needs. RESULTS: The 352 nurses responding to the survey primarily obtained continuing education from workshops, inservice education, and independent studies citing cost, location, content, and length of course as influencing factors. Their cancer educational needs included clinical trials, genetics, complementary therapies, and pain management. Nurses' perceptions of end-of-life needs were for physical needs, "what to expect" concerns, and transition to palliative care. CONCLUSION: These findings provide specific direction for future continuing education programs about cancer and end-of-life issues for nurses.     

Pain management skills of regional nurses caring for older people with dementia: a needs analysis

An exploratory survey of the pain management education needs of 197 nurses working with older people with dementia was undertaken in a regional area of Queensland, Australia. The analysis indicated that nurses in this setting might not have the knowledge base to manage pain effectively; and that respondents have essentially negative perceptions of the availability and appropriateness of current pain management education programs. Consistent with non-metropolitan nurses generally, respondents expressed a preference for pain management education that had a significant face-to-face component allied with ongoing mentorship and support on completion of the program. The obstacles to attending such programs were also typical of the problems facing regional and rural nurses throughout Australia. These were identified as: inability to pay for courses; lack of information on what is available; distance to travel to education; and a perceived lack of employer support due to an inability to replace those staff attending education. Positive aspects include the degree to which participants were responsive and interested in dementia pain management and their access to, and acceptance of, non-medical pain therapies. The findings suggest a definite need for a dementia pain management program for aged care nurses, specifically tailored to their needs and to the constraints of the regional practice setting.     

Strategies to build and maintain competence in pain management: Insights from a SIAARTI survey on educational needs among Italian anesthesiologists

Purpose

Fulfilling educational needs in pain management should be a lifelong process, even involving physicians board certified in pain medicine such as the anesthesiologists/pain therapists. The aim of the study was to investigate Italian anesthesiologists' self-perceived competency, confidence, and interest to attend educational programs in relation to their seniority in pain management.

Methods

SIAARTI members were sent an online questionnaire addressing the following items: education, skills (both soft and hard skills), technical expertise and engaged to participate between December 2020 and January 2021. Participants rated their competence based on the following range (no knowledge, knowledge, competence) while their agreement to attend educational courses was assessed using a 5-point Likert-type scale.

Results

Less than one in four participants declare to be dedicated to pain medicine activity with greater proportion among older (over 61 years) compared to younger ones (31–40 years). Regarding cancer and chronic noncancer pain a positive gradient of self-perceived competence has been observed in relation to seniority. In contrast, no gradient of self-perceived competence was reported about musculoskeletal and low back pain. Participants self-perceived competent in both opioid use and prevention of opioid-related adverse event while feeling less competent when managing drugs with abuse potential. The lowest competence has been observed in pediatric pain along with the lowest interest to attend educational courses. Participants were much and very much interested to education regarding cancer, noncancer, musculoskeletal, and low back pain, invasive analgesic procedures but less regarding items for which they declared less competence, such as use of pain scales, pain management in children, and use of drugs with abuse potential.

Conclusion

This work provides first evidence of a summative assessment of competency and related educational needs' profile of anesthesiologists/pain therapists thus paving the way for developing a nationwide educational program to improve chronic pain care in Italy.     

Palliative care education in the developing countries

Individuals who have experience in palliative care in wealthier countries with well-structured health systems see the palliative care needs of developing countries as forbiddingly huge. They are aware of an increasing incidence of cancer, but health delivery systems are often patchy and deficient, medications for pain management are not widely available, and cultural considerations limit opportunities to face advanced illness and focus on symptom control in terminal illness. An increasing prevalence of HIV infection compounds palliative care needs. Medical practice focuses on interventions that promise cure and earn a good reward, while nursing standards are variable and often unsatisfactory. There is a need for demonstrations of good care and effective symptom control, even if these reach only a small fraction of the needy population. On such demonstrations can be built education programs that take account of local realities, and promote attitudes, knowledge and skills capable of gradually introducing a greater professional concern and a better prospect of effective care for the dying.     

Explaining pain following cancer: a practical guide for clinicians

BackgroundPain is one of the most prevalent and debilitating symptom following cancer treatment.ObjectivesThis paper entails a practical guide for clinicians willing to apply pain neuroscience education (PNE) in this specific population, or clinical researchers willing to examine the effects of PNE in patients suffering from pain following cancer.ResultsPatient-specific information (i.e. beliefs, cognitions, pain memories, social factors) as well as identification of the dominant pain mechanism are needed to tailor the education to the specific needs and beliefs of the patient. Therapists require an in-depth understanding of pain mechanisms, the skills to explain to their patients various pain mechanisms, specific communication skills (e.g. Socratic-style dialogof education) and experience with current evidence-based biopsychosocially-driven pain management strategies for successful implementation of PNE in the clinic. Rather than purely focusing on the biomedical characteristics of pain following cancer (e.g., tissue damage due to past cancer treatment), PNE implies teaching patients about the underlying biopsychosocial mechanisms of pain. Its application is backed-up by mounting evidence supporting the effectiveness of PNE in non-cancer pain populations, and a pilot study in patients having pain following cancer.ConclusionPNE is a potential solution to improve pain outcome in cancer survivors. Further research using sufficiently powered and well-designed randomized clinical trials should be conducted to examine the potential of PNE in patients having pain following cancer.     

Palliative Care Education in the Developing Countries

Individuals who have experience in palliative care in wealthier countries with well-structured health systems see the palliative care needs of developing countries as forbiddingly huge. They are aware of an increasing incidence of cancer, but health delivery systems are often patchy and deficient, medications for pain management are not widely available, and cultural considerations limit opportunities to face advanced illness and focus on symptom control in terminal illness. An increasing prevalence of HIV infection compounds palliative care needs. Medical practice focuses on interventions that promise cure and earn a good reward, while nursing standards are variable and often unsatisfactory. There is a need for demonstrations of good care and effective symptom control, even if these reach only a small fraction of the needy population. On such demonstrations can be built education programs that take account of local realities, and promote attitudes, knowledge and skills capable of gradually introducing a greater professional concern and a better prospect of effective care for the dying.     

Establishing a cancer pain clinic in a developing country: effect of a collaborative link project with a UK cancer pain center

This paper describes a project for the establishment of a cancer pain clinic in a developing country. The project was conducted according to guidelines from the World Health Organization and utilized a link with an existing cancer pain clinic in the UK. The principal methods used for establishing the new pain clinic included: an assessment of barriers to effective cancer pain control, teaching programs for nurses and trainee doctors, educational links with a UK cancer pain clinic, and analgesic guidelines and introduction of a pain assessment tool. As a result of these interventions, a new cancer pain clinic was founded. The methods used serve as one possible model for establishing cancer pain treatment facilities in developing countries.     

Survivors of pediatric posterior fossa tumors: Cognitive outcome,intervention, and risk-based care

Adolescent and young adult survivors of posterior fossa tumors face a wide variety of functional challenges following treatment. The concept of survival needs to include plans to regularly monitor and effectively respond to those patients considered at risk for continued morbidities associated with cancer and its treatment. The nature of impairment experienced by survivors is discussed, including predominant patient- and treatment-related risk factors. A model to respond to the cognitive needs of survivors, including risk-based evaluation and intervention, is proposed. It is imperative for the success of the survivor that a team approach is taken to care. This approach must include improving the awareness and education of teachers and other education specialists who interact with this population of survivors. There is also an obligation to put forth effort in developing and validating efficacious intervention programs.     

Pain Management Needs Assessment: A Survey of Radiation Therapists at a Large Academic Comprehensive Cancer Centre

ObjectiveTo determine the knowledge of pain management among the radiation therapists (RTs) at the Odette Cancer Centre (OCC) to aid in the development of a formalized education strategy.MethodsA needs assessment survey comprising eight topics pertaining to pain management was distributed to 130 RTs at the OCC. Survey topics were ranked using a 4-point Likert scale based on preference for further education, familiarity with the topic, and relevance to practice.ResultsRTs rated topics pertaining to the undertreatment, pathophysiology, assessment, diagnosis, and treatment of pain as the most relevant topics requiring further education. RTs were most unfamiliar with topics concerning opioids and addiction, but did not find a need for further education. They also felt that breakthrough cancer pain was the most significant topic for further education.ConclusionImplementation of an educational intervention for RTs to more effectively and efficiently address pain management for their patient population is needed. Topics of most clinical relevance include: undertreatment of pain, pathophysiology of pain, assessment and diagnosis of acute and chronic pain as well as its treatment.     

Cancer pain assessment and treatment curriculum guidelines

More than 70% of patients with cancer develop significant pain at some time during their illness. Despite the general consensus that most cancer pain can be treated effectively, many patients receive inadequate treatment of their pain. One significant contributing factor is the failure of health care professionals to receive formal training in this important aspect of oncology. The Cancer Pain Assessment and Treatment Curriculum Guidelines reflect the American Society of Clinical Oncology's commitment to providing optimal pain relief to patients with cancer. These guidelines represent an effort to promote formal instruction on the assessment and treatment of cancer pain in training programs and continuing education courses. The curriculum is broad in scope and applicable to patients of all ages. The guidelines emphasize the need for (1) routine pain assessment, (2) proficiency in prescribing opioids, nonopioid analgesics, and adjuvant medications, and (3) an understanding of the potential benefits of antineoplastic, anesthetic, neurosurgical, and behavioral approaches, which often require a coordinated multidisciplinary approach. The curriculum should prove a valuable guide to those who wish further education on the optimal treatment of cancer pain.     

Barriers to effective cancer pain management: a survey of hospitalized cancer patients in Australia

The purpose of this study was to examine attitudinal barriers to effective pain management in a consecutively recruited cohort of 114 cancer patients from four Australian hospitals. When surveyed, 48% of this sample reported experiencing pain within the previous 24 hours. Of these, 56% reported this pain to be "distressing, horrible or excruciating," with large proportions indicating that this pain had affected their movement, sleep and emotional well-being. Three factors were identified as potentially impacting on patients' responses to pain-poor levels of patient knowledge about pain, low perceived control over pain, and a deficit in communication about pain. A trend for older patients to experience more severe pain was also identified. These older patients reported being more willing to tolerate pain and perceive less control over their pain. Suggestions are made for developing patient education programs and further research using concepts drawn from broader social and behavioral models.     

Pain related undergraduate teaching in medical faculties in Finland

The present questionnaire study was conducted to examine how teachers in all Finnish medical faculties have included pain teaching in their courses for undergraduate medical students. The study was planned to compare the existing education in Finland with the IASP curriculum on pain for medical schools. In 1991 and 1995 the questionnaire was sent to a total of 135 and 130 university teachers, respectively. The teachers were asked about the quantity and quality of their pain teaching. Teachers' attitudes on pain related teaching were also examined. A Finnish translation of the IASP curriculum was provided, and university teachers were asked to evaluate it and compare it with their current teaching. The educational programs of all universities were also analyzed. After completion of these surveys, representatives of teachers responsible for teaching of pain, and of medical students from all Finnish medical faculties were invited to a meeting to discuss methods for improving and developing education. Completed questionnaires were received from 107 university teachers (78%) in 1991 and from 74 (60%) in 1995. No printed curricula for pain education were found in any university and in all universities pain teaching was provided in an inconsistent way. There were differences, yet statistically non-significant, between the faculties in the pain teaching. No major differences were observed between the two questionnaires. A serious lack of teaching in psychology of pain was a general finding. University teachers were found to have positive attitudes towards developing their teaching of pain. The IASP curriculum has not been fully followed but was considered a valuable tool in planning the educational programs. The curriculum should be distributed directly to the governmental bodies of the universities, since individual university teachers are not necessarily familiar with it. Local associations may have an important role in this distribution as we have shown. This report shows the necessity of changing the attitudes of university teachers providing concrete teaching programs for pain. A multimedia package of pain containing references, video tapes and cd-discs produced by a workshop of IASP would certainly be welcome.     

Community health nursing education: where we are going and how to get there

This article discusses practical aspects of providing community health nursing (CHN) education in community-based care in partnership with a community. Changing from traditional CHN clinicals to more current models involves a shift in values and implementation of principles leading to the change. These values are: refocusing the purpose of CHN education; broad (generalist) scope of practice; problem-solving as a means of discovery; collaboration with peers, faculty, community, and service providers; and working to empower individuals, families, and the community, as well as the students themselves. Principles for developing community-based educational programs in partnership with a community are: examining and incorporating critical concepts; identifying community needs and basing activities on these needs; providing services as a means of studying the community and its problems/needs; expanding and refining services based on problems/needs and assets of the community; and maintaining services based on problems/needs and assets of the community. Each principle is discussed in a process and application format.     

Are nurses prepared to manage cancer pain? A national survey of nurses' knowledge about pain control in Taiwan

Nurses play a crucial role in cancer pain control, but little is known about how well-prepared nurses are to manage cancer pain in Taiwan. The purpose of this study was to examine the level of knowledge about pain management among Taiwanese nurses with different background characteristics and to determine the predictor(s) of nurses' pain management knowledge. Nurse subjects were recruited by a cross-sectional nationwide survey with stratified sampling from nine hospitals distributed in the four major geographic regions of Taiwan. The Nurses' Knowledge and Attitudes Survey-Taiwanese version (NKAS-T) and a background information form were used to collect the data. Of 1900 surveys distributed, 1797 valid questionnaires (94.5%) were analyzed. The average correct response rate was 50.5%, with rates ranging from 7-86% for each survey question. Results from stepwise regression showed that nurses with higher mean correct answer scores had BS or higher degrees, had received pain education at professional conferences, had more prior hours of pain education, had longer clinical care experiences, and always worked with cancer patients. Nurses who worked in intensive care units, however, had significantly lower mean correct scores. The results strongly suggest an urgent need to strengthen pain education in Taiwan. The results also provide the direction for developing pain education.     

Psychometric Evaluation of the Nurses' Cancer Pain Management Competency Scale

BackgroundThere is lack of instruments for assessing nurses' comprehensive pain management competency.AimThis study aimed to assess the psychometric properties of the Nurses' Cancer Pain Management Competency Scale and to conduct a cursory survey of the pain management educational needs/resources of nurses caring for patients with cancer pain.MethodA convenience sample of 230 Korean nurses who met the eligibility criteria completed the researcher developed the Nurses' Cancer Pain Management Competency Scale and a pain management educational needs/resources survey. The Nurses' Cancer Pain Management Competency Scale was based on the pain management core competencies identified by Fishman et al (2013). Internal consistency was assessed using Cronbach's alpha, and construct validity was examined using exploratory factor analysis with varimax rotation.ResultsCronbach's alpha of the scale was 0.89. Nurse cancer pain management competency includes four factors, which accounted for 68.44% of the variance: the context of pain management, pain assessment and measurement, management of pain, and multidimensional nature of pain. Approximately 42% of nurses had no available protocols related to cancer pain management. Nurses preferred multi-component educational modalities, including simulation-based learning.ConclusionsFindings support internal consistency reliability and content and construct validity of the Nurses' Cancer Pain Management Competency Scale that can help examine pain management competency of nurses. Adopting an evidence-based clinical cancer pain management-related protocol and multi-component training programs are needed to achieve optimal cancer pain management competency in nurses.     

Community of Inquiry Framework for Advanced Practice Nursing Students

Distance education programs are increasingly common in nursing education, and educators are challenged with creating online courses that provide students with quality learning experiences. For advanced practice nursing (APN) students, online courses need to engage students in learning while meeting their unique needs. The Community of Inquiry (COI) framework is grounded in theories of learning and teaching and is relevant for use in developing online courses for APN students. The purpose of this article is to describe the development of an online clinical practice management course for APN students using the COI framework.     

Health Policy,Health Services,and Cancer Pain Management in the New South Africa

In 1982, the World Health Organization (WHO) identified inadequate relief from cancer pain as an international health problem. WHO recommended that governments develop and implement national policies and programs for cancer pain relief. This report evaluates national health policy and the systems of health care delivery in relation to cancer pain management in the new South Africa. This field study included multiple methods of data collection: analysis of documents, field trips with participant observation in sites of care delivery, focused interviews, and in-depth interviews of key informants. The purposive sample of key informants (n = 33) represented multiple stakeholders in a variety of settings. Strengths of the developing health policy include specific recommendations related to palliative care; the shift to universal primary care; policies to support drug availability; the inclusion of morphine and codeine as essential drugs at the primary health care level; and the development of a national standard related to cancer pain management. Health services are characterized by two parallel systems of care (private and public) with numerous vestiges of the inequities of apartheid. The management of pain varies by provider and setting; major problems with access exist in the rural areas. Health services in South Africa have been plagued by inequity and inadequate resources. New health policies have set a path to ensure universal access to health care including palliative care for cancer. Their successful implementation is the next necessary step toward improving health services and alleviating the suffering of increasing numbers of individuals with cancer.