Improvement of pain-related self-management for cancer patients through a modular transitional nursing intervention: a cluster-randomized multicenter trial.

Patients' self-management skills are affected by their knowledge, activities, and attitudes toward pain management. This trial aimed to test the Self Care Improvement through Oncology Nursing (SCION)-PAIN program, a multimodular structured intervention to reduce patients' barriers to self-management of cancer pain. Two hundred sixty-three patients with diagnosed malignancy, pain>3 days, and average pain > or = 3/10 participated in a cluster-randomized trial on 18 wards in 2 German university hospitals. Patients on the intervention wards received, in addition to standard pain treatment, the SCION-PAIN program consisting of 3 modules: pharmacologic, nonpharmacologic pain management, and discharge management. The intervention was conducted by specially trained cancer nurses and included components of patient education, skills training, and counseling. Starting with admission, patients received booster sessions every third day and one follow-up telephone counseling session within 2 to 3 days after discharge. Patients in the control group received standard care. Primary end point was the group difference in patient-related barriers to self-management of cancer pain (Barriers Questionnaire-BQ II) 7 days after discharge. The SCION-PAIN program resulted in a significant reduction of patient-related barriers to pain management 1 week after discharge from the hospital: mean difference on BQ II was -0.49 points (95% confidence interval -0.87 points to -0.12 points; P=0.02). Furthermore, patients showed improved adherence to pain medication; odds ratio 8.58 (95% confidence interval 1.66-44.40; P=0.02). A post hoc analysis indicated reduced average and worst pain intensity as well as improved quality of life. This trial reveals the positive impact of a nursing intervention to improve patients' self-management of cancer pain.

Improvement of pain related self management for oncologic patients through a trans institutional modular nursing intervention: protocol of a cluster randomized multicenter trial.

BACKGROUND: Pain is one of the most frequent and distressing symptoms in cancer patients. For the majority of the patients, sufficient pain relief can be obtained if adequate treatment is provided. However, pain remains often undertreated due to institutional, health care professional and patient related barriers. Patients self management skills are affected by the patients' knowledge, activities and attitude to pain management. This trial protocol is aimed to test the SCION-PAIN program, a multi modular structured intervention to improve self management in cancer patients with pain. METHODS: 240 patients with diagnosed malignancy and pain > 3 days and average pain >or= 3/10 will participate in a cluster randomized trial on 18 wards in 2 German university hospitals. Patients from the intervention wards will receive, additionally to standard pain treatment, the SCION-PAIN program consisting of 3 modules: pharmacologic pain management, nonpharmacologic pain management and discharge management. The intervention will be conducted by specially trained oncology nurses and includes components of patient education, skills training and counseling to improve self care regarding pain management beginning with admission followed by booster session every 3rd day and one follow up telephone counseling within 2 to 3 days after discharge. Patients in the control group will receive standard care. Primary endpoint is the group difference in patient related barriers to management of cancer pain (BQII), 7 days after discharge. Secondary endpoints are: pain intensity & interference, adherence, coping and HRQoL. DISCUSSION: The study will determine if the acquired self management skills of the patients continue to be used after discharge from hospital. It is hypothesized that patients who receive the multi modular structured intervention will have less patient related barriers and a better self management of cancer pain. TRIAL REGISTRATION: ClinicalTrials NCT00779597.

Irrelevant words trigger an attentional blink.

It has been argued that salient distractor items displayed during rapid serial visual presentation (RSVP) trigger an attentional blink (AB) when they share features with the target item. Here we demonstrate that salient distractor words induce an AB independently of feature overlap with the target. In two experiments a color-highlighted irrelevant word preceded a target by a variable lag in an RSVP series of false font strings. Target identification was reduced at short relative to long temporal lags between the distractor word and the target, irrespective of feature sharing with the distractor word. When the target shared features with the distractor word, target accuracy was reduced across all lags. Accordingly, feature sharing between the distractor word and the target did not amplify the AB, but had an additive effect on attentional capture by the distractor word.

The effect of fearful faces on the attentional blink is task dependent.

In a set of three rapid serial visual presentation experiments, we investigated the effect of fearful and neutral face stimuli on the report of trailing scene targets. When the emotional expression of the face stimuli had to be indicated, fearful faces induced a stronger attentional blink (AB) than did neutral faces. However, with identical physical stimulation, the enhancement of the AB by fearful faces disappeared when participants had to judge the faces' gender. If faces did not have to be reported, no AB was observed. Thus, fearful faces exhibited an effect on the AB that crucially depended on the observer's attentional set. Hence, the AB can be influenced by an emotional T1 when T1 has to be reported, but this influence is modulated by task context. This result indicates a close connection between temporal attention and emotional processing that is modulated by task context.