Disclosure of cardiac variants of uncertain significance results in an exome cohort.

This study examined the impact of disclosing subclassifications of genetic variants of uncertain significance (VUS) on behavioral intentions. We studied return of VUS results to 79 individuals with a cardiomyopathy-associated VUS, subclassified into VUS-high or VUS-low. Primary outcomes were perceived risk (absolute and comparative), perceived severity, perceived value of information, self-efficacy, decision regret, and behavioral intentions to share results and change behaviors. There was no significant difference between the 2 subclasses in overall behavioral intentions (t = 0.023, P = .982) and each of the individual items on the behavioral intentions scale; absolute (t = -1.138, P = .259) or comparative (t = -0.463, P = .645) risk perceptions; perceived value of information (t = 0.582, P = .563) and self-efficacy (t = -0.733, P = .466). Decision regret was significantly different (t = 2.148, P = .035), with VUS-low (mean = 17.24, SD = 16.08) reporting greater regret. Combining the subclasses, perceived value of information was the strongest predictor of behavioral intentions (ß = 0.524, P < .001). Participants generally understood the meaning of a genetic VUS result classification and reported satisfaction with result disclosure. No differences in behavioral intentions were found, but differences in decision regret suggest participants distinguish subclasses of VUS results. The perceived value of VUS may motivate recipients to pursue health-related behaviors.

Patient-reported stressful events and coping strategies in post-menopausal women with breast cancer.

The objective of this paper was to explore what stressful events post-menopausal women with primary or recurrent breast cancer experience, how bothersome these events were and which coping strategies these women used. Data were collected from 131 patients diagnosed with primary or recurrent breast cancer. The Daily Coping Assessment was used. Thematic analysis was applied to form themes of stressful events. Six types of stressful events were extracted. The most frequently experienced events for women with primary cancer and those with recurrent cancer were 'distressing bodily symptoms'. The most bothersome event among primary cancer was 'everyday concerns' and in the recurrent group, 'distressing psychological reactions'. The most commonly used strategies were 'acceptance', 'distraction' and 'relaxation'. This study shows that women in different parts of the cancer trajectory differ in what they perceive to be stressful events when reporting them in their own words in a diary. The differences have an impact on the subsequent coping strategies they used.

Significant improvement in quality of life of patients with incurable cancer after designation to a palliative homecare team.

The aims of this study were to describe and compare quality of life before and after designation to a palliative homecare team in patients with different cancer diagnoses and to identify pre-designation predictors of post-designation global quality of life. We measured patients' quality of life 1 week before designation and 11 days (median time) after with the Assessment of Quality of life at the End of Life (Axelsson & Sjödén 1999). Of 163 eligible patients 63 participated without attrition. Patients' quality of life improved in the physical, psychological, medical and global areas. Six items significantly improved: hours recumbent during the day (P = 0.009), nausea (P = 0.008), anxiety (P = 0.007), getting hold of staff (P = 0.000), received care (P = 0.003) and global quality of life (P = 0.023). Depression/low in mood (r = 0.55) and meaningfulness (r = 0.70) associated to global quality of life. Furthermore, pain (P = 0.028) and meaningfulness (P = 0.028) predicted global quality of life. In the existential area, it is important to further explore how meaningfulness is associated to and predicts global quality of life.

Psychosocial profile in men and women with unexplained chest pain.

OBJECTIVE: The aim of this study was to compare men and women with unexplained chest pain (UCP) to a randomly selected population sample free of clinical heart disease with regard to sleep problems, mental strain at work, stress at home, negative life events and health-related quality of life (HRQOL). DESIGN AND SUBJECTS: The study was conducted at a university hospital in Sweden including 231 patients aged 25-69 without any organic cause for chest pain. As a reference group, 1069 participants, were recruited from the INTERGENE population-based study. RESULTS: Patients with UCP had more sleep problems (OR = 1.8, P < 0.0001), were almost three times more worried about stress at work (OR = 2.9, P < 0.0001), or had more stress at home (OR = 2.8, P < 0.0001), and were twice as likely to have negative life events (OR = 2.1, P < 0.0001). Women, but not men, with UCP, had a higher prevalence of cardiovascular risk factors (obesity, smoking, diabetes and hypertension) compared with references. With regard to HRQOL, UCP patients scored significantly lower than references in all dimensions of the SF-36. CONCLUSIONS: In comparison with a healthy reference group, patients with UCP reported more sleep problems, mental strain at work, stress at home and negative life events and had lower health-related quality of life. Aside from immigration the strongest independent psychosocial factors were mental strain at work and negative life events last year in men and stress at home in women.

The effectiveness of the comprehensive coping strategy program on clinical outcomes in breast cancer autologous bone marrow transplantation.

Patients with breast cancer who undergo autologous bone marrow/peripheral blood stem cell transplantation (ABMT) cope not only with a life-threatening medical treatment, but also with multiple, interrelated symptoms including pain, fatigue, psychological distress, and nausea. The purpose of this study was to determine, in a randomized controlled clinical trial, whether a comprehensive coping strategy program (CCSP) was effective in significantly reducing pain, fatigue, psychological distress, and nausea in patients with breast cancer who underwent ABMT. The CCSP was composed of preparatory information, cognitive restructuring, and relaxation with guided imagery. Randomization placed 52 patients in the CCSP treatment group and 58 patients in the control group. The CCSP was found to be effective in significantly reducing nausea as well as nausea combined with fatigue 7 days after the ABMT when the side effects of treatment were most severe. These results are important given the high incidence of nausea and fatigue in the ABMT population. The CCSP-treated group experienced mild anxiety as compared with the control group who reported moderate anxiety. The greatest effectiveness of CCSP may correspond to the time of the greatest morbidity for patients with breast cancer who have undergone ABM.

Pain, psychological distress, health status, and coping in patients with breast cancer scheduled for autotransplantation.

PURPOSE/OBJECTIVES: To describe pain, psychological distress, health status, and coping that patients with breast cancer who were scheduled for autotransplantation experienced; the strength and direction of relationships among pain, psychological distress, health status, and coping; and the percentage of variance within the concept of health status that age, pain, psychological distress, and coping. DESIGN: Descriptive, correlational. SETTING: An urban, National Cancer Institute-designated comprehensive cancer center located in the eastern United States. SAMPLE: A convenience sample of 83 female patients with breast cancer scheduled for autotransplantation. The population age ranged from 22-59 years (X = 44.47 years) and was comprised of 72 (88%) Caucasians, 6 (7%) African Americans, and 4 (5%) from other minorities. METHODS: An oncology clinical nurse specialist in the outpatient medical oncology clinic collected the data during a regularly scheduled visit approximately 20 days prehospitalization for high-dose chemotherapy and autotransplantation. Data were collected using a demographic data from and self-report instruments (Gaston-Johansson Painometer, State-Trait Anxiety Inventory, Beck Depression Inventory, Medical Outcomes Study Short-Form General Health Survey, and Coping Strategies Questionnaire). MAIN RESEARCH VARIABLES: Pain, psychological distress, health status, and coping. FINDINGS: Although the subjects experienced low pain intensity, the range of reported pain intensity ratings was wide. Pain locations varied but were reported mainly in the vagina, chest, shoulder, and arm. Although subjects reported primarily mild depression and mild state anxiety, the range of depression and state anxiety scores was wide. Coping strategies used most frequently to deal with pain included positive coping statements, diverting attention, praying and hoping, increasing activity level, and ability to control and decrease pain. Subjects reported moderate total health status and low role functioning. Moderate, positive correlations were seen between state anxiety and depression and physical functioning and role functioning. Sixty-five percent of the variance in health status was explained by sensory pain depression, and catastrophizing. CONCLUSIONS: Patients with breast cancer who are scheduled for autotransplantation may experience pain, psychological distress, and alterations in coping and perceived health status. Total pain intensity, sensory pain, depression, and catastrophizing appear to be important variables related to the patient's perceived health status. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses need to include assessment of pain, psychological distress, health status, and coping in their routine patient assessment prior to autotransplantation to provide appropriate care and make necessary multidisciplinary referrals. Future nursing research should be directed toward the implementation and evaluation of interventions that promote the use of comprehensive coping strategies to decrease pain, anxiety, and depression.

Fatigue, pain, and depression in pre-autotransplant breast cancer patients.

OBJECTIVES: The purpose of this study was to determine the influence of fatigue, pain, and depression on health status in breast cancer patients who had completed adjuvant chemotherapy and were scheduled for autologous bone marrow/peripheral blood stem cell transplant (AT). MATERIALS AND METHODS: A predictive, correlational design was used. A convenience sample of 127 women with stages II, III, and IV breast cancer was recruited. The setting was an urban National Cancer Institute-designated comprehensive cancer center located in the Eastern United States. Standardized questionnaires and the Gaston-Johansson Painometer (POM) were used to measure the variables. The subjects completed questionnaires in the outpatient clinic. Relationships between the multiple dimensions of fatigue and pain, depression, and health status were examined. Hierarchical regression techniques were used to determine the variance in health status accounted for by fatigue, pain, and depression. RESULTS: The subjects were age 22 to 60 years (Mean = 45; SD = 7.6), and primarily were married, white, Protestant, college educated, employed in a professional position, and had an average yearly household income of equal to or greater than $50,000. All subjects had previously received surgery and chemotherapy. Ninety-one percent of the participants reported fatigue as measured by the Fatigue Visual Analogue Scale. Forty-seven percent of the participants reported pain as measured by the Gaston-Johansson POM visual analogue scale. Fifty-four percent of the participants reported depression, ranging from mild to severe/high. Subjects reported a mean total perceived health status rating of 50.73 (SD 10.79). Fatigue, pain, and depression were all significantly correlated to each other and to total health status. Depression (P < .001) and pain (P < .01) significantly accounted for 64% (adjusted R2 = .60) of the variance in total health status. Fatigue (P < .05) and depression (P < .001) accounted for 42% (adjusted R2 = .36) of the variance in the perception of health status. CONCLUSIONS: Women with breast cancer previously treated with chemotherapy and awaiting AT may experience fatigue, pain, depression, and alterations in health status. Pain and depression had a significant impact on a woman's total health status, whereas depression and fatigue had an influence on perceived health status. Of the different dimensions of health status, one's perceptions of health status had the strongest correlation to total health status (r = .84, P < .001). Healthcare professionals need to be aware of the effects of multiple symptoms on health status and to provide appropriate care to alleviate them.

Pain, coping and analgesic medication usage in rheumatoid arthritis patients.

The major purposes of this study were to describe pain characteristics and coping strategies used in rheumatoid arthritis (RA) patients. Further purposes were to examine relationships among pain, coping and analgesic medication intake. Sixty-eight consecutively sampled subjects with RA participated in the study. The Pain-O-Meter was used to evaluate pain intensity and quality, and the Coping Strategies Questionnaire (CSQ) to determine coping strategies. The results showed that the patients with RA scored more intense sensory than affective pain although they used more affective pain descriptors. The sensory and total pain components were related to coping self-statements and increased pain activities. There were significant relationships between analgesic medication intake and all coping strategies used in the RA patients. The findings' implication for education and treatment are discussed.

Adolescents' perceptions of pain during labor.

This descriptive study systematically described the quality and intensity of adolescents' pain during the progression of labor. The Gaston-Johansson Pain-o-Meter was administered to 33 adolescents during the three labor phases (2-4 cm, 5-7 cm, and 8-10 cm) following a contraction. The most frequently selected sensory words were cramping in Phase I and pressing in Phases II and III. Miserable and killing were the most commonly chosen affective words during the three labor phases. Using the Gaston-Johansson Pain-O-Meter and the Gaston-Johansson Pain-O-Meter Visual Analogue Scale, the total pain intensity scores were highest during phase III of labor and delivery. At-test of independent samples found that quality and intensity pain scores for primiparous and multiparous adolescent participants were not significantly different during the progression of labor. The findings of the study illustrate the value of using objective measures, such as the Gaston-Johansson Pain-O-Meter and the Gaston-Johansson Pain-O-Meter Visual Analogue Scale, to assess pain during labor. The study also demonstrated that nurses can use these tools with minimal training.

PIP: To enable nurses to provide optimal pain management to adolescents during labor, a descriptive study was conducted of the quality and intensity of such pain at different stages of labor. Enrolled was a convenience sample of 24 primiparous and 9 multiparous women 16-19 years old (mean, 17.78 years) who entered a Nebraska hospital in full labor. The interactive Gaston-Johansson Pain-O-Meter was used to measure the affective, sensory, and intensity components of pain. The sensory words selected most frequently during the three stages of labor were "cramping" (46%), "pressing" (39%), and "pressing" (42%), respectively, while the most common affective terms were "killing" (52%), "miserable" (36%), and "killing" (79%). The highest mean affective and sensory pain scores were reported during the second stage of labor. Primiparas experienced the lowest pain levels during phase I of labor and the highest during phase II, while multiparas' mean scores increased as labor progressed; however, there were no significant differences in mean pain scores by parity. The study was not able to take into account the impact of variables such as self-efficacy, anxiety, analgesics, childbirth education class attendance, and length of labor on pain perceptions. Knowledge of the intensity of pain, and whether it is primarily affective or sensory, can assist nurses to develop individualized interventions for adolescents experiencing labor pains.

Pain intensity and health locus of control: a comparison of patients with fibromyalgia syndrome and rheumatoid arthritis.

The major purpose of this study was to determine if 31 patients with fibromyalgia syndrome (FS) reported different pain intensity and Health Locus of Control (HLC) scores than 30 patients with rheumatoid arthritis (RA). Another purpose was to determine the relationship among experienced actual pain (present, usual, worse, least), recalled prior episodes of pain (worse toothache, headache, and stomach ache), HLC orientation, age and the duration of the actual pain. Visual Analogue Scales were used to measure pain intensity. The Health Locus of Control Scale was used to determine external/internal orientation. The results showed that the FS patients reported significantly more intense actual pain, recalled pain for worse toothache and headache, and were more externally oriented than the RA patients. Present pain intensity was significantly correlated to actual intensity ratings, but not to reported earlier experienced pain, except for worse stomach ache in the RA group. The findings' implications for treatment and education are discussed.

Burden and health outcomes of family caregivers of hospitalized bone marrow transplant patients.

Twenty-four family caregivers of bone marrow transplant (BMT) patients were interviewed to describe the burden of care and health outcomes (anxiety, depression, symptom distress and fatigue). A descriptive correlational research design with repeated measures was used. Data were collected in a conference room in the oncology unit of a midwestern university hospital using a battery of questionnaires. Questionnaires were administered pre-BMT (prior to the patient's hospitalization) and 5 and 20 days post-BMT. Objective burden remained at a similar level throughout the study (mean range 31.4 to 32.9), whereas subjective burden was highest pre-BMT (mean range 25.3-21.7). Significant correlations were found between objective burden and all health outcomes (P < 0.01 to P < 0.001) on day 5. Symptom distress was significantly correlated to subjective burden pre-BMT and to both types of burden on days 5 and 20. Results of this study suggest that family caregivers of BMT patients may experience more objective burden than subjective burden, and that burden of care may contribute to negative health outcomes, especially on day 5 post-BMT. Interventions designed to reduce sources of caregiver burden and negative health outcomes should be planned according to critical time periods of the BMT patient's hospitalization.

An assessment of pain and return to normal activity. Laparoscopic herniorrhaphy vs open tension-free Lichtenstein repair.

BACKGROUND: Laparoscopic herniorrhaphy is controversial and deserves critical evaluation. METHODS: In a randomized prospective study transabdominal preperitoneal laparoscopic herniorrhaphy (n = 24) was compared in patients to the tension-free Lichtenstein repair (n = 29) utilizing validated and reliable pain and activity assessment tools. The Sickness Impact Profile (SIP) was used to compare preoperative normal activity to postoperative activity. A Pain-O-Meter (visual analogue scale plus affective and sensory pain descriptors) assessed intensity of pain. The total pain assessment score and SIP were compared across time (postoperative day 1-42). Analgesic medication was used as a covariate. RESULTS: The total pain score was less for laparoscopic herniorrhaphy but this did not reach statistical significance. Similarly, the SIP showed modest improvement for laparoscopic herniorrhaphy. No differences between groups were noted for morphine equivalents of administered analgesics or length of hospitalization. CONCLUSION: Further investigation of laparoscopic herniorrhaphy is warranted.

Measurement of pain: the psychometric properties of the Pain-O-Meter, a simple, inexpensive pain assessment tool that could change health care practices.

A self-administered pain assessment tool called the Pain-O-Meter (POM) was developed for the purposes of improving assessment and management of pain in acute and chronic pain patients. The POM is a hard, white, plastic tool that measures 8-in. long by 2-in. wide and 1-in. thick. Two methods for assessing pain are located on the POM. The first is a 10-cm visual analogue scale (POM-VAS) with a moveable marker that patients use to rate their pain. The second is a list of 15 sensory and 11 affective word descriptors (WDS). Each WDS is assigned an intensity value that can be as low as 1 or as high as 5. A pain intensity score is provided for the sensory and the affective WDSs. This psychometric study, which employed correlational and comparative designs, investigated the test-retest reliability and the concurrent and construct validity of the POM-VAS and the POM-WDS in 279 patients with acute or chronic pain. High correlations were found between initial and repeat pain intensity ratings on the POM-VAS (r = 0.88, P < 0.001) and POM-WDS (r + 0.84, P < 0.001) (test-retest reliability). Correlations between the POM-WDS and the McGill Pain Questionnaire (MPQ) (r = 0.69, P < 0.001) and POM-VAS (r = 0.85, P < 0.001) supported the concurrent validity of the POM-WDS. Construct validity was also supported for the Pain-O-Meter by showing that pain scores decreased significantly for POM-WDS (t + 5.53, P < 0.001), and POM-VAS (t = 6.18, P < 0.001) after the patients were treated with pain medication. The use of a pain tool, such as the POM, could improve patient care by facilitating the documentation of pain and evaluation of pain relief measures.

Psychological correlates of quality of life across the autologous bone marrow transplant experience.

A convenient sample of 24 patients was used to examine psychological response and quality of life (QOL) of patients undergoing autologous bone marrow transplantation (ABMT). The relationships among anxiety, depression, and quality also were examined. The study had a descriptive, correlational design. Instruments used to collect data were the Quality of Life Index (QLI), the Becks Depression Inventory, and the Spielberger State-Trait Anxiety Inventory. Data were collected 2 weeks before the patient's hospitalization for ABMT (baseline), 2 days before ABMT, and 5 and 20 days after ABMT. QOL and anxiety improved slightly after ABMT. Patients were significantly more depressed before ABMT (p < 0.05) than afterward. Analysis of QOL showed that health and functioning had the most negative impact on QOL, whereas family had the most positive impact on QOL. A strong negative relationship was found between depression and QOL (r = 0.79).

Psychological variables and cancer pain.

Pain can cause both physical and psychological distress that has a negative impact on a patient's quality of life. The purpose of this descriptive study was to determine whether cancer patients (N = 60) with pain (n = 30) had higher scores of depression, anxiety, somatization, and hostility than did cancer patients without pain (n = 30). The study was conducted in a midwestern medical center hospital during a 9-month period. Psychological variables were measured using subscales of the Brief Symptom Inventory (BSI). Patients who reported pain completed the McGill Pain Questionnaire (MPQ) and Visual Analogue Scale. Significant positive correlations were found between total MPQ scores and all four subscales of the BSI (r = 0.60-0.78, p < 0.05). Patients with pain scored higher on all four subscales of the BSI, with significant differences occurring in somatization (t = 2.05, p < 0.05) and hostility (t = 1.93, p < 0.05). The findings suggest a relationship between pain intensity and psychological status. Nursing interventions aimed at reducing these factors may help to decrease the pain, in addition to then decreasing the psychological distress experienced by patients with cancer.

The importance of nursing research design and methods in cancer pain management. Enhancing care.

Cancer is diagnosed currently in more than 1 million Americans every year and cancer pain is experienced by patients in all stages of the disease. Even though research indicates that optimal pharmacologic management alone can provide adequate relief for 70% to 90% of these patients, and additional relief can be obtained from nonpharmacologic interventions, the problem of pain continues to exist. This article focuses on the contributions of nurse scientists to the study of cancer pain during the last 5 years. Selected contributions of nursing research designs and methods to the understanding of pain caused by cancer and cancer treatment modalities are reviewed. Limitations of present methodologic approaches to the study of cancer pain and gaps in nursing knowledge are examined. Recommendations for future nursing research designs and methods used to study nursing management of cancer pain and the implications of projected future treatment modalities also are discussed.

Word descriptors in suspected acute myocardial infarction: a comparison between patients with and without confirmed myocardial infarction.

BACKGROUND: Acute myocardial infarction (AMI) will not develop in a large proportion of patients admitted to the coronary care unit because of suspected AMI. OBJECTIVE: To evaluate whether patients with confirmed AMI use different words to describe their pain than patients in whom AMI was not confirmed. DESIGN: A retrospective descriptive design. METHODS: The Pain-O-Meter, a verbal pain scale composed of 12 sensory and 10 emotional word descriptors, was used to assess pain. SETTING: Coronary care unit in Sahlgrenska Hospital in Goteborg, Sweden. SUBJECTS: A convenience sample of 889 consecutive patients admitted to the coronary care unit because of suspected AMI. RESULTS: SENSORY COMPONENT--patients with confirmed AMI differed from those without AMI in the use of the words "pricking" (12% vs 17%; p < 0.05) and "tearing" (11% vs 6%; p < 0.05). No difference was found in the remaining 10 words. Affective components--Patients with confirmed AMI differed from those without AMI in the use of "terrifying" (29% vs 18%; p < 0.001), "intolerable" (16% vs 10%; p < 0.01), and "worrying" (48% vs 59%; p < 0.01). Women used stronger word descriptors more frequently than men. CONCLUSION: The use of specific or more word descriptors to separate patients with AMI from those without AMI was not supported by the study data. Although patients with AMI more frequently used the sensory word tearing as well as the affective words terrifying and intolerable and less frequently used the sensory word pricking and the affective word worrying than patients without AMI, the differences do not suggest a clinical profile that can be used to differentiate these clinical entities.

Research application: teaching staff nurses to use library search strategies.

Journal reading is a major mechanism for disseminating research but much goes unread by practicing nurses. A survey revealed the 10 most frequently read journals are primarily of a clinical/technical nature. To encourage reading of research, we organized a series of library sessions to familiarize nurses with the library and modern search strategies. Over half of the 77 nurse participants indicated they had not visited the library in six months and were less than confident in their library skills. Hands-on experiences, including computerized literature search, gave nurses an opportunity to learn techniques for locating research articles.