The management of breakthrough cancer pain--educational needs a European nursing survey.

Poorly managed cancer pain is well known to profoundly impact the patient's daily life and interfere with quality of life. Nurses who cared for patients with cancer from 12 European countries participated in a survey of breakthrough cancer pain practice. The purpose was to investigate how nurses assess breakthrough cancer pain, use of standardised tools, confidence in supporting patients and awareness of medications. Responses from 1241 participants showed country variations. The majority of the sample was female, Germany had the highest proportion of male nurses (21.0%), followed by Greece (15.8%). A significantly larger proportion of nurses with longer experience and more education (78.8%) used a comprehensive definition of breakthrough cancer pain. Significant variations in training were found; 71% of Finnish nurses had received training compared with 6% of Greek nurses. Training and using a standardised assessment tool was associated with a significant increase in the nurses' perceived ability to distinguish between breakthrough and background pain. Nurses in countries with the highest proportion of training were most confident in supporting patients. In conclusion, there still exists problems with effective management of patients' breakthrough cancer pain, continuing inability to define the difference between background and breakthrough cancer pain leads to poor treatment.

Pain in patients living in Norwegian nursing homes.

The aims of this study were to describe the pain and use of pain medication in nursing home patients and examine which variables that were associated with pain. Inpatients (n = 307) older than 64 years from nursing homes were included. Pain was measured with a 4-point verbal rating scale in the self-reported group (SRG) and Doloplus-2 in the proxy-rated group (PRG). The mean age was 86 years (SD, 7), and more than two-thirds were female. A total of 128 (60%) patients were able to self-report their pain. Approximately 50% of the SRG reported 'pain now', and of these, nearly 50% reported moderate or severe pain intensity. Better cognitive function was associated with higher pain and receiving more potent pain medication in the SRG. The pain prevalence in the PRG was higher than in the SRG (67.5% vs 51%), but no variable was associated with proxy-rated pain. Nearly 30% in the SRG and 40% in the PRG did not receive pain medication in spite of pain. Pain is still a huge problem in the nursing homes, and more research is needed on pain management in nursing home residents.

Changes in pain, stiffness and physical function in patients with osteoarthritis waiting for hip or knee joint replacement surgery.

OBJECTIVE: Little has been reported on changes in health status in patients with osteoarthritis (OA) while waiting for hip or knee replacement surgery. In this study we assessed (1) changes in self-reported pain, stiffness and physical function in patients with OA of the hip or knee, from the decision to undergo surgery to 14 days prior to surgery, and (2) the determinants of these changes. METHODS: Among 353 baseline respondents, 170 waited >30 days for surgery, completed the Western Ontario and McMaster Universities Arthritis Index (WOMAC) before surgery and were included in the analysis of changes; 120 with OA of the hip and 50 of the knee. We analyzed changes in WOMAC scores using the paired t test and determinants of the changes using multiple linear regression. RESULTS: Patients with OA of the hip did not change on any WOMAC scale before surgery. Knee patients deteriorated with time on the WOMAC stiffness and total scales, but not on the pain or physical function subscales. In both patient categories, higher baseline WOMAC scores were associated with smaller changes on all subscales and the total score, and female sex was associated with deterioration on the pain subscale. CONCLUSIONS: Patients with OA of the hip reported no change in pain, stiffness or physical function while waiting for joint replacement surgery, whereas patients with OA of the knee deteriorated on the stiffness and total scales of the WOMAC. This suggests a difference in patient selection, referral pattern or disease development between the patient categories.

An evaluation of the leg and foot ulcer treatment provided in Oslo.

OBJECTIVE: This study set out to gather more information about the treatment of leg and foot ulcers in the community in Oslo, Norway. METHOD: A structured questionnaire on leg and foot ulcer treatment was sent to 173 community nurses in Oslo, of whom 102 responded with data on 145 patients. RESULTS: Of the sample, 55.9% had leg ulcers, 32.2% had foot ulcers and 11.9% both; 26.2% had diabetes. Thirty-four per cent of the patients had not had a diagnosis of leg ulceration. Saline was the preferred cleansing solution. Compression therapy was used on all types of ulcer. Pain was a problem for 52.9% of the patients, of whom 9% did not receive analgesia. CONCLUSION: Nurses and doctors working in this community need to update their knowledge of wound treatments.

Quality of life in women with breast cancer: a review of the literature and implications for nursing practice.

This article discusses the gap between an ever-increasing interest in research on the quality of life in patients with breast cancer and the lack of impact this research has had in the actual care of these women. A critical review of the literature is used to answer the question of how much can be accepted as established knowledge despite the often methodologically weak studies and contradictory results. Deficiency in research studies is no rationale for not improving nursing care in areas wherein there is an expressed need for support and assistance. Nurses are in contact with patients who have breast cancer at all stages of the disease and treatment, because they meet the women in the hospital, at the outpatient clinic, and in their homes. They play an important role in meeting the needs of these women. Ways of improving nursing practice at the different stages of the illness, from the pretreatment phase to posttreatment follow-up assessment, are discussed, and concrete suggestions made. This article addresses the women's need both for adequate information and for social and emotional support.

Cancer nursing research priorities: a Norwegian perspective.

The purpose of the study was to determine research priorities among Norwegian nurses in cancer care, and to investigate implications that these priorities might have for future planning of nursing research. Differences between specialists in cancer nursing and other nurses working in cancer care, and between the current results and earlier findings in this area also were evaluated. Half the members of The Norwegian Society of Nurses in Cancer Care (n = 197) were mailed a questionnaire used in a similar Canadian study. The nurses were asked to select the five topics they perceived as most important from a list of 80 items, and to rank them in order of research priority. The response rate was 43% (197/464), and 75 respondents were specialists in cancer nursing. Quality of life was given the highest research priority in the total sample. Psychosocial support/counseling, communication between patient and nurse, patient participation in decision making, nurse burnout, and ethics also were ranked highly. In contrast to the others, cancer nursing specialists ranked ethics as their number one priority. Except for symptom management, the priorities given in Norway and other Western countries were found to be similar. These results might suggest topics for future research tailored to the needs of cancer nursing.

Hope in newly diagnosed patients with cancer.

In this study, 131 Norwegian patients with recently diagnosed cancer completed the Nowotny Hope Scale (NHS). The NHS is composed of six subscales, and both global and subscale scores were assessed. Most of the patients were found to be hopeful or moderately hopeful. The variable with the single most positive contribution to hope was whether the patient lived alone. Younger people, in particular, experienced less hope when living alone. Gender, the time elapsed since diagnosis, and treatments had no observable effect on the global hope score. However, age, education level, and type of cancer was associated with particular domains of hope.

Changes in the importance of quality of life domains after cancer diagnosis.

The aim of this study was to describe what domains in quality of life were considered most or least important by patients with newly diagnosed cancer and in what way the domains of importance changed during a 9-month period. We also analysed the impact of selected demographic variables on the important domains. The Ferrans' and Powers' Quality of Life Index was used to measure quality of life. As this index consists of one section measuring the importance of various domains of life, information about changing standards was available. The study sample consisted of 131 adult patients recently diagnosed with different cancers. The whole sample filled in the questionnaire once, while part of the sample (n = 41) filled it in four times during a 9-month period. Items related to family matters were rated as most important, while faith in God was reported to be of least importance. The patients fluctuated somewhat in terms of what was most important to them during the study period. Overall, the most unstable items tended to be less important over time. In addition, results showed significant differences in the importance of quality of life domains according to gender, age, educational level and cohabitation.

Quality of life in newly diagnosed cancer patients.

The aim of this study was to examine which domains of quality of life are most strongly affected in patients with newly diagnosed cancer, and to examine if quality of life was related to gender, age, educational level, cohabitation, time since diagnosis, treatment or type of cancer in these patients. Ferrans and Powers Quality of Life Index and the Cancer Rehabilitation Evaluation System, short form, were completed by 131 newly diagnosed Norwegian adult cancer patients. The patients had different cancer diagnoses, with breast cancer being the most common type. None of them were terminally ill, and 80% had been diagnosed within the last 6 months. The patients turned out to be satisfied with their lives, especially with the family and marital domains. They were least satisfied with health, functioning and sex life. Analyses of variance and multiple regression analysis were conducted to examine the impact on quality of life of cohabiting, age, gender, educational level, cancer diagnosis, treatment and time since diagnosis. Those cohabiting had significantly higher quality of life compared with those living alone. In contrast the younger group (19-39 years) living alone had significantly lower quality of life than the older groups living alone. Although age was only significantly associated with quality of life in one sub-scale, the elderly people reported their quality of life to be better in almost all sub-scales. Time since diagnosis was not associated with quality of life, while treatment was associated with quality of life as measured by Ferrans and Powers Quality of Life Index. Gender and educational level were only associated with one or two domains in quality of life, respectively.

Validity and reliability of the Norwegian version of the Ferrans and Powers Quality of Life Index.

The purpose of this study was to examine the validity and reliability of the Norwegian version of the Ferrans and Powers Quality of Life Index in a sample of 131 men and women with newly diagnosed cancer. The Quality of Life Index was translated into Norwegian using a standardized international approach, including back-translation. The findings showed high internal consistency reliability for the global score (alpha = 0.93 (test)) as well as for the following domains: health and functioning (alpha = 0.88), socio-economic (alpha = 0.82), psychological/spiritual (alpha = 0.82) and family (alpha = 0.79). The test-retest reliability after 3-4 weeks was 0.78 for the global score. A factor analysis partially confirmed the different subscales. In conclusion, the Quality of Life Index was found to be reliable and had sufficient validity to be used for measuring quality of life in Norwegian cancer patients.

Nursing intervention to increase hope and quality of life in newly diagnosed cancer patients.

The aim of this study was to evaluate the effect of nursing intervention on hope and quality of life in cancer patients. The sample consisted of 96 newly diagnosed Norwegian cancer patients ages 26 to 78 years, the majority of them women (71%). Breast cancer was the predominant type of cancer in this sample. The study used an experimental design in which patients were randomly allocated to three different groups. The first group was the experimental group, for which the intervention was designed to increase hope. The second group (attention control group) participated in the "Learning to Live with Cancer" program. The last group was a control group. The Nowotny Hope Scale was used to measure hope, and the Ferrans and Powers Quality of Life Index and the Cancer Rehabilitation and Evaluation Systems, short form, were used to measure quality of life. The questionnaires were completed four times: twice before, then 2 weeks and finally 6 months after the intervention. The level of hope was significantly increased (p = 0.020) for the members of the hope group just after the intervention, but not after 6 months. Despite the patients' positive evaluation of the intervention, there was no impact on quality of life.

Nursing intervention to increase hope in cancer patients.

Hope is considered to be of great significance for people diagnosed as having cancer, and is thus an important aspect of nursing care. It is therefore of value to document ways in which hope can be strengthened in these patients. An intervention programme based on Nowotny's (1986) definition of hope and designed to increase hope in groups of cancer patients with the nurse as the group leader was developed. The intervention was divided into eight sessions, each of which focused on a different aspect of hope. These included: belief in oneself and one's own ability, emotional reactions, relationships with others, active involvement, spiritual beliefs and values, and acknowledging that there is a future. By focusing on these aspects through interactional processes in the group, it was thought that the participants' hope could be strengthened.

Reliability and validity of the Norwegian version of the Nowotny Hope Scale. A nursing tool for measuring hope in cancer patients.

The purpose of the present study was to assess the reliability and validity of the Norwegian version of the Nowotny Hope Scale as applied to cancer patients. The questionnaire was first translated into Norwegian following internationally accepted guidelines. The scale was tested on a sample consisting of 131 newly diagnosed cancer patients. The findings supported the internal consistency of the instrument as a whole (alpha = 0.89) and of the six subscales: confidence (alpha = 0.85), relates to others (alpha = 0.75), future is possible (alpha = 0.80), spiritual beliefs (alpha = 0.94), active involvement (alpha = 0.53) and comes from within (alpha = 0.80). Stability over time was provided by a satisfactory 3-4-week test-retest correlation (r = 0.81). The validity was confirmed by the judgement of an expert and by a principal components analysis with orthogonal rotation. The result of the factor analysis was somewhat different from the original findings in an American sample. The results obtained in this study are promising and indicate that the Nowotny Hope Scale can be used to measure hope in newly diagnosed Norwegian cancer patients.

Hope and quality of life, two central issues for cancer patients: a theoretical analysis.

During the past years, the number of people diagnosed with cancer has increased. Cancer can be a threat to life itself, as well as to the individual's perception of the quality of life. The question of what contributes a clinically significant change or difference in perceived quality of life remains unanswered. Hope is frequently referred to as important for coping with a disease such as cancer. Hope enables people to cope with difficult and stressful situations and suffering. Nevertheless, hope is seldom stressed in definitions of the quality of life for cancer patients and discusses the relationship between hope and quality of life, and hope can be regarded as a coping strategy. From existing theory, hope can be seen as a variable positively contributes to the experience of quality of life. Future research should empirically explore to what extent hope contributes to the adaptive process that maintains the quality of life at an acceptable level despite having cancer.