Core aspects of satisfaction with pain management: cancer patients' perspectives.

CONTEXT: The coexistence of high levels of satisfaction and high levels of pain has been perplexing. OBJECTIVES: The aims of this study were to 1) describe patient expectations related to the experience of cancer-related pain, 2) explore the cognitive processes and meaning that underlie patient judgments about satisfaction and dissatisfaction with pain management, and 3) explore the discrepancies between ratings of high satisfaction with pain management with high pain intensity. METHODS: The sample included 33 patients: 18 with advanced cancer and 15 experiencing pain after a surgery for a cancer diagnosis. All patients had experienced "worst pain" of at least moderate intensity and were interviewed using standard pain measures from the American Pain Society Patient Outcome Questionnaire and open-ended questions about the underlying meaning of their answers. We systematically analyzed the transcribed qualitative data using NVivo software. RESULTS: Fifty-five percent of patients were females and were aged 25-78 years. Most (75%) were satisfied or very satisfied with their overall pain management. Key findings indicate that for some, the worst pain rating was often brief, even momentary. Most patients expected pain relief. Four key themes were important to the quality of pain management: being treated right, having a safety net, being in a partnership with their health care team, and having pain treatment that was efficacious. Key aspects of the patient-provider relationship that mattered were how the nurses and doctors behaved toward them and how quickly they responded to reports of pain. For some, an important factor was whether they had control of the amount of pain they experienced. CONCLUSION: The findings inform measurement of patient satisfaction with the quality of pain management.

Symptom experiences and quality of life of rural and urban older adult cancer survivors.

This study examined the symptom experience, health-related quality of life, and functional performance of elderly cancer survivors at 1 and 3 months after the completion of initial treatment. The study used a descriptive, comparative, repeated-measures design. A mixed-methods approach combined completion of survey instruments with qualitative interviews. Of the 52 participants, 22 resided in rural (n = 12) or semirural (n = 10) areas and 30 lived in urban settings. There were 23 women and 29 men ranging in age from 65 to 81 years (mean age, 71.53 years). Survivors experienced a significant number of symptoms (mean, 4.58), which were, on average, moderate in intensity and did not differ based on urban or rural residence. The Medical Outcomes Study SF-12 Physical Component Summary was less than the national norm for elderly individuals or those with a chronic disease. There was minimal improvement 3 months after treatment. Elderly survivors, regardless of whether they were rural or urban, experienced a significant number of unrelieved symptoms, including fatigue, pain, and difficulty sleeping. Eighty-eight percent had other chronic diseases. Comorbidities were associated with greater symptom intensity and less physical health status. Survivorship care for elderly adults should include a comprehensive geriatric assessment and tailored strategies for symptom management.