Models of healthcare delivery in cancer pain management.

The delivery of pain management services to patients with cancer varies across healthcare settings. Identification of areas common to successful programs would be helpful to healthcare professionals developing or restructuring their own programs. The delivery of pain management services in six different systems is described with respect to organizational structure, service process, and essential components. Three elements common to successful programs are identified: (1) team effort and coordination, (2) provision of education, and (3) accountability and administrative support. The authors conclude that these three elements are critical to the delivery of pain management services across healthcare settings.

Effects of controlled-released morphine on quality of life for cancer pain.

Oncology nursing is concerned with pain relief and overall Quality of Life (QOL). The purpose of this study was to determine the effects of controlled-release morphine on QOL for patients with cancer. Eighty-three subjects were randomly assigned in a clinical trial of short-acting versus controlled-release analgesia (MS Contin, Purdue Frederick Co., Norwalk, CT). Data was collected in a repeated measures design every 2 weeks for 6 weeks yielding a total of 240 visits. Five instruments were used to assess QOL, pain, and functional status. Study findings indicate improved pain management with controlled-release MS Contin and important nursing implications for the management of analgesia-induced gastrointestinal symptoms. Through appropriate pain management with pain therapies such as controlled-release analgesia, nurses can greatly enhance QOL for the patient with cancer.

Quality of life as an outcome variable in the management of cancer pain.

Valid measurement tools are needed by oncology researchers to help in the evaluation of the effectiveness of pain relief methods used in the treatment of cancer patients. A study was conducted to assess the validity and reliability of a tool designed to evaluate quality of life as a measure of pain management outcome in the individual patient. Items in the tested quality of life survey represented the areas of psychologic well-being, physical well-being, general and specific symptom control, and degree of social support. Using the test instrument, two oncology nurses interviewed subjects in three groups, each consisting of 50 subjects: cancer patients with pain, cancer patients without pain, and subjects with no cancer. Statistical analysis of the interview results revealed that the instrument has test-retest reliability, internal consistency, and interrater reliability, as well as content and construct validity for the major factors, psychologic well-being, worry, and nutrition. Further revision of the instrument is needed to restructure its subscales. The quality of life tool will enable researchers to evaluate a treatment regarding not only its effect on pain intensity but also its impact on the total individual.