Pain, Pain Management and Need of Pain Relief Support among Patients with Cervical Cancer Undergoing High-Dose-Rate Brachytherapy

This descriptive study investigated pain, pain management, and the need for pain-relief support, among 63 patients with cervical cancer undergoing high-dose-rate (HDR) brachytherapy at the Division of Therapeutic Radiology in a southern Thailand hospital. Data were collected using a validated questionnaire at 4 time-points during treatment: before insertion, during applicator insertion in-bed, waiting and HDR brachytherapy insertion, and applicator removal. The questionnaires consisted of 4 parts: demographic and health-related data form, pain record with numeric rating scale, open-ended questionnaire regarding pain management, and an open-ended questionnaire covering the need for pain-relief support. The mean age of the subjects was 51 years. They were all diagnosed with stage 1-3 cervical cancer. Moderate to severe pain was reported for each in-bed applicator insertion, with =6.00±2.12 to =6.43±2.15. Pain decreased during the waiting period (=4.51±2.37 to = 4.87±1.99), and at applicator removal (=3.37±1.78 to = 3.80±1.46). Nearly all patients (98%) received one gram of paracetamol orally 30 minutes before the HDR procedure. Several methods were used to relieve the pain. The most common methods were deep breathing, endurance, and prayer. In addition, during the in-bed waiting and applicator-removal periods, pelvic muscle relaxation was used prominently. Throughout the steps in the treatment procedure, across 4 time-points, the subjects reported need for pain-relief support from healthcare personnel. They requested the doctors’ use the applicators gently, provide sufficient local anesthetic, and provide effective pain medication. They wanted the nurses to provide psychological support by gentle touch and dialog, in a caring manner. They indicated similar support needs from other personnel.                 Patients with cervical cancer undergoing HDR brachytherapy experienced moderate to severe pain at all 4 time-points. This indicated that current pain-control practices, using only paracetamol, may be inadequate. The patients had tried to manage their pain themselves, and had requested additional support from physicians, nurses, and other personnel. These findings might inform improvements in the quality care of care for patients with cervical cancer undergoing high-dose-rate brachytherapy. (Thai Cancer J 2010;30:4-17)

The Effect of Fatigue Management Combining Yoga Program Among Cancer Patients Receiving Radiotherapy

This quasi-experimental research aimed to examine the effect of fatigue management combining yoga program in cancer patients receiving radiotherapy. Subjects were patients attending at the regional cancer center in southern Thailand. They were sequentially assigned into one of three groups. The subjects of each group were matched according to gender, age, cancer disease, treatment, amount of radiation dose, and level of fatigue before the intervention. The first 20 subjects were assigned to the control group, who received the standard care. The second 20 subjects were in experimental group 1 and received fatigue management program. The third 20 subjects were in experimental group 2 and received treatment similar to the experimental group 1 plus yoga practice. Data were collected using a demographic data form and the Fatigue Questionnaire. The experimental instruments consisted of videotapes, handbooks, poster, and pamphlet regarding fatigue management and yoga practice. The data were analyzed and presented using percentage, mean, standard deviation, chi-square, and Repeated Measures ANOVA. The results revealed that subjects in experimental group 2 reported fatigue scores at post intervention significantly lower than subjects in experimental group 1 and those in the control group (F = 63.71, p \< .01). These findings indicate that the fatigue management combining yoga program is helpful in reducing the level of fatigue. Implementing fatigue management combining yoga program is highly recommended. Family members should also be encouraged to participate in yoga practice. This program should be further tested with other groups of cancer patients such as those who receive chemotherapy.

Perception of Thai Nursing Students and Faculty’s Competence toward Caring for Culturally Diverse Clients

This descriptive study aimed to examine the culturally competence perception of Thai nursing students and faculty for caring diverse clients. A convenience sample of 121 second year, 107 fourth year of baccalaureate students, and 42 faculty members at Faculty of Nursing, Prince of Songkla University was recruited to measure using Cultural Care Completence Scale-Thai composed of Cultural Knowledge Test and Self-Cultural Competence Test. Focus group discussions were also conducted as additional method. The questionairre was exmained content validity by experts. The reliability of Cultural Knowledge Test was obtained by discrimination index of .73 and point biserial correlation ranged from .3 - .8. The Cronbach’s alpha of Self-Cultural Competence Test was .89. Data were analyzed using descriptive statistic and simple content analysis. Findings revealed that majority of the second year students (81.1%) and the fourth year students (71.5%) perceived their culturally competence at the level of cultural aware, however majority of the faculty (58.8%) perceived their culturally competence at the level ot cultural competence. The perception of the cultural skill was the highest mean score of the second year students, the fourth year students, and faculty (X¯ = 17.72, S.D. = 1.835; X¯= 17.99, S.D. = 2.146 and X¯= 18.95, S.D. = 2.501 respectively), and the perception of the cultural knowledge was the lowest mean score of the second year sudents, the fourth year students, and faculty (X¯ = 9.38, S.D. = 2.499; X¯ = 9.96, S.D. = 2.244, and X¯ = 9.93 , S.D. = 2.908 respectively). The results suggest that teaching and delivering culturally competence care are challenging and requiring further studies to develop an effective model by using richness of the clinical setting with real-world clients and their cultural needs.

Barriers to Pharmacological Management of Cancer Pain: A Comparison of Beliefs Between Patients and Caregivers

The purposes of this study were to describe beliefs which were considered to be barriers to pharmacological management of cancer pain and to compare such beliefs between Thai patients with cancer and their caregivers. A total of 97 dyads of patients with cancer and their caregivers participated in this study, from the inpatient department of three regional hospitals and the regional cancer center in southern Thailand. The instruments consisted of the demographic questionnaire, Pain NRS and the Barriers Questionnaire-ll (BQ-ll). Collected data were analyzed using descriptive statistics, independent t-test, and ANOVA. The results revealed that the mean barriers total score of patients and caregivers was at a moderate level. The three barriers with the highest scores were: fear of tolerance, fear of addiction, and concern that analgesics may block one’s ability to monitor illness symptoms. There was no significant difference between barrier scores perceived by patients and caregivers. There was no significant difference between levels of pain intensity and barriers to pain management perceived by patients.The results of this study suggest that patients with cancer and caregivers hold wrong conceptions regarding pharmacological management of cancer pain. Nurses should recognize this issue by systematically assessing barriers to pain management, particularly ones related to pain medications so that pain education programs can be offered in order to reduce barriers which aim at improving the effective pain management among patients with cancer in Thailand.

Validity and Reliability of the Modified Thai Adolescent’s Physical Activity Questionnaire

This study sought to determine the validity and reliability of a self-report instrument, the Modified Thai Adolescent’s Physical Activity Questionnaire (MTAPAQ). Concurrent validity was assessed using 40 secondary school Thai adolescents (17 males and 23 females), who wore an ActiGraph accelerometer, during their waking hours for seven consecutive days. The students completed the MTAPAQ upon completion of the recording period. Reliability was evaluated using 30 secondary school Thai adolescents (12 males and 18 females) who completed the MTAPAQ by recalling their physical activities during the previous seven days, on two separate occasions that were three days apart.A significant correlation was found between the Metabolic Equivalent of Tasks (MET-mins), as determined by the MTAPAQ, and log (10) transformed activity counts, as determined by the ActiGraph accelerometer. The test-retest reliability, of the two administrations of the MTAPAQ, was found to be significant. The findings provide evidence of an acceptable level of concurrent validity and test-retest reliability of the MTAPAQ for use with Thai adolescents.

Music Therapy with Female Surgical Patients: Effect on Anxiety and Pain

Pain and anxiety are common phenomena for surgical patients. Although music has been shown to be useful and have advantages, as an intervention for managing anxiety and pain, no study was located, using repeated measures. This study examined the effect of music therapy, at multiple times, on reducing pre- and post-operative anxiety, and post-operative pain sensation and pain distress, in 102 Malaysian female surgical patients. A pre/post-test design, with subjects randomly placed into either the music therapy group (n=51) or the control group (n=51), was used. Those in the music therapy group listened to self-selected music twice daily the day before surgery and for 3 days post-operative. Visual Analogue Scales were used to measure anxiety before and after the music intervention, as well as pain sensation and pain distress during the post-operative period. State-trait anxiety, during the pre- and post-operative periods, also was measured. Data were analyzed using the T-test and F-test for comparison between groups and across time.  The results showed that the music group reported lower pre-operative anxiety than the control group. The music group demonstrated reduced post-operative anxiety, pain sensation and pain distress. Music was found to have a cumulative effect, post-operatively, across the variables. In summary, listening to self-selected music the day before surgery and continuing for 3 days post-operatively was effective in reducing anxiety, pain sensation and pain distress. The findings suggest the use of music, as a complementary empirically-based nursing intervention, for reducing pre-operative anxiety, post-operative pain sensation and post-operative pain distress among female adult surgical patients.