Development of Nursing Practice Scale of Cancer Pain Management and Examination of Reliability and Validity

The aims of this study were (1) to develop and validate the scale to measure evidence-based nursing practice in cancer pain management and (2) to identify associated factors. We developed potential items based on the 2014 version of Japanese Clinical Guidelines for Cancer Pain Management and administered anonymous questionnaire for 189 oncology nurses in a designated cancer center. We conducted a re-test to test reliability.167 nurses participated in the study. As a result of item analysis and exploratory factor analysis, we developed a nursing practice scale of cancer pain management and its shortened version. This scale consists of 1 domain 50 items The Cronbach’s α coefficient showing internal consistency was 0.98 (shortened version 0.88). The intra-class correlation coefficient of reliability was 0.52 (shortened version 0.77). Concurrent validity was confirmed by the correlation between the total score of the whole scale and the total score of the practice of palliative care, knowledge, difficulty, self-confidence scale. We concluded that this scale was valid and reliable. Factors related to the nursing practice of cancer pain management were years of experience in cancer nursing, opportunities of postgraduate education, and satisfaction with postgraduate education. This scale can be used for evaluation of daily clinical practice and practice evaluation after educational efforts such as cancer pain nursing training.

Can we dream of an integrated pain management app for cancer patients?

The cancer burden continues to grow globally, exerting tremendous physical, emotional, and financial strain on individuals, families, communities, and health systems. The number of health-related mobile applications (apps) is increasing rapidly. We searched for pain apps specific for cancer patients on App Store for iOS devices and Google Play for Android devices. An integrated pain management app (IPMA) is the need of the hour, which will not only provide a platform to users to assess their pain scores but also assess other associated symptoms and can provide a step-wise assessment to their symptomatology. This can offset the patient burden in the outpatient pain clinic and reduce the number of follow-up visits by addressing common concerns that can be tackled easily at home

The pharmaceutical care in the good pain management ward / 中国药学杂志

OBJECTIVE: To evaluate the effect of pharmaceutical care on establishing "the good pain management ward" in hospital, therefore, improving treatment level and elevating the management experience of cancer pain. METHODS: Retrospective analysis method was used to evaluate the effect of pharmaceutical care on establishing "the good pain management ward" through analyzing the DDDs of anticancer drugs, reasonable rate of prescriptions and changes of pharmaceutical care in a chemotherapy department of polyclinic from 2011 to 2015. RESULTS: In contrast the establishment of the good pain management ward before and after, there was a remarkable difference in the DDDs constituent ratio of the three-step analgesic ladder drugs (P<0.05). And usage rate of adjunctive drug was increased; moreover, reasonable rate of prescriptions was significantly improved (P<0.05). CONCLUSION: Pharmaceutical care could effectively promote the reasonable and normative ability of cancer drug use and management in establishing "the good pain management ward".

Practice and Role of Clinical Pharmacists in Cancer Pain Management / 中国药房

OBJECTIVE:To explore the role of clinical pharmacists in cancer pain management. METHODS:The cases were presented to investigate the content and method of clinical pharmacists participating in cancer pain management. RESULTS:The clinical pharmacists could provide professional analgesic recommendations and participated in the formulation of individual analge-sic plan. By carrying out pharmaceutical care and patient education,clinical pharmacists could find potential medication risk,cor-rected medication errors and improved patient compliance. By carrying out patient family members training,clinical pharmacists could help to strengthen patient support system and improve cancer pain management effectiveness. CONCLUSIONS:Clinical phar-macists participating in cancer pain management can promote rational use of analgesics,guarantee the safety of drug use,and im-prove cancer pain management.

Patient-Related Barriers to Cancer Pain Management – A Prospective Cross Sectional Study in a Tertiary Hospital

Effective management of cancer pain is often hampered by patients’ lack of knowledge regarding cancer pain management and other barriers related to ethnicity and religious beliefs. This cross sectional study was performed to determine the patient-related barriers to effective cancer pain management. One hundred patients receiving cancer pain management were studied. Inclusion criteria were: patients over the age of 18 years, able to communicate, with known diagnosis of cancer, experiencing persistent pain for the past two weeks. A modified version of the Barriers Questionnaire II (BQ-II) was used and a modified Brief Pain Inventory was used to assess the pain profile. Barriers such as, patient’s attitude and beliefs, communication skills and fear of side effects of pain medication were determined, given a score and the summation was recorded as the total patient related barriers score. Overall, 85% of respondents achieved more than 40% pain relief and the 72 of 100 patients reported low patient related barrier scores of 6 or less. Nevertheless, the main patient related barriers were: fear of tolerance to opioids (51%), ethnicity (p=0.003) and religious beliefs (p=0.002) which constituted the major components of the patient-related barriers score. Ethnicity and religious beliefs had significant influence on patient-related barriers score suggesting the need of further investigation into this area. In order to achieve a comprehensive view, other barriers to effective cancer pain management such as those related to the health systems and healthcare providers need to be assessed together.

The current state of patient education for opioids by doctors, nurses and pharmacists, and evaluation of a pamphlet

The first step of cancer medical treatment is to eliminate anxiety about opioids. It is recommended to use printed matter in the "Guideline for Cancer Pain Management" edited by Japanese Society of Palliative Medicine,but few medical professionals actually use it. We developed the Opioids' pamphlet designed by Aichi Prefectural Society of Hospital Pharmacists; abbreviated OPA. This pamphlet is little burdened for readers; focusing on eliminating anxiety about opioids. Evaluation of the utility of the OPA and the actual conditions of patient education about the use of opioids by medical professionals were investigated, since there have been no reports on these issues. A questionnaire survey was conducted in hospitals with more than 150 beds in Aichi Prefecture. It targeted doctors, pharmacists and nurses who were practicing palliative care using opioids. There were many pharmacists and nurses who had been consulted about opioids, and most of the consultations were about addiction. 60% of pharmacists and 30% of nurses voluntarily performed patient education. Awareness of the guideline for of cancer pain management was low. OPA, which was reviewed based on the guideline, was applicable to 99% of the cases where the nurses were consulted. Its size and contents were highly acclaimed. Therefore, OPA is extremely valuable in clinical practice. Palliat Care Res 2009; 4(1): 214-227

Knowledge and Attitudes of Family Physician and Oncologist toward Cancer Pain Management in Korea

BACKGROUND: Two representative groups of family physicians and oncologists were surveyed concerning their knowledge and attitudes toward cancer pain management (CPM). METHODS: A questionnaire, designed to assess knowledge (13 items) and attitudes (6 items) toward CPM, was sent to 2,200 members of Korean Association of Family Medicine and 800 members of Korean Cancer Association. RESULTS: Three hundreds and eighty eight family physicians (17.6%) and one hundred and forty seven oncologists (18.4%) responded and completed the questionnaire. They had inadequate knowledge toward CPM, especially, chance of respiratory depression, tolerance to adverse effect, ceiling effect, risk of addiction, and use of adjuvants. Most of the physicians had positive attitude toward importance of CPM, best judge of pain severity, and priority of CPM but had negative attitude toward concerns about potential problem of addiction and earlier prescription of maximum dose of opioid. Family physicians displayed more lack of knowledge about CPM in 9 of 13 items and more negative attitudes toward 4 of 6 items. Adjustment for demographic characteristics and experiences in cancer patients with pain showed that while family physicians had poor knowledge of tolerance to confusion, they had more adequate knowledge on the effect of antidepressant and had positive attitude towards best judge of pain severity and priority of CPM. Poor knowledge about CPM was rated by 66.3% of physicians as the most important barrier to adequate CPM. CONCLUSION: These findings that most of the physicians had poor knowledge and negative view toward CPM suggest a continuous need for comprehensive education program focused on CPM for physicians.

Nurses' Knowledge about and Attitude toward Cancer Pain Management: A Survey from Korean Cancer Pain Management Project / 성인간호학회지

PURPOSE: This study was conducted to examine the nurses' knowledge about and attitude toward cancer pain management. METHOD: Study subjects of this retrospective cross-sectional survey study were 343 nurses sampled conveniently in a tertiary teaching hospital in Seoul. Seven measurement tools were used to collect data on demographic data, knowledge about and attitude toward cancer pain management, barrier to cancer pain management, knowledge about and concerns for the opioid use, and professional education of cancer pain management. RESULT: Nurses showed knowledge deficit when their knowledge on the cancer pain management and the opiod use was evaluated using two case scenarios and the 15-item questionnaire respectively. Ninety-five percent of the nurses believed that cancer pain management is a major problem. However, inadequate staff knowledge of pain management was rated as the single most important barrier to adequate pain management by 20.4% of nurses. Only 10.9% and 23.2% of the nurses replied that nursing school's education and professional education in cancer pain management respectively, were adequate. CONCLUSION: This study confirms the existence of knowledge deficits and attitudinal barriers among Korean nurses that can impede cancer pain manage- ment. This study suggests a need for professional education for nurses on cancer pain management.