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McGarragle KM, Zheng S, Gagliese L, Howell D, Edwards E, Pritlove C, McCready D, Elser C, Jones JM, Gauthier LR. Pain Self-Management Behaviors in Breast Cancer Survivors Six Months Post-Primary Treatment: A Mixed-Methods, Descriptive Study. Cancers (Basel) 2025; 17:1087. [PMID: 40227575 PMCID: PMC11987997 DOI: 10.3390/cancers17071087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 02/28/2025] [Accepted: 03/04/2025] [Indexed: 04/15/2025] Open
Abstract
Background/Objectives: One-third of breast cancer (BC) survivors experience chronic treatment-related pain (CTP) that requires multimodal management strategies, which may include pain self-management behaviors (PSMBs). Most studies exploring PSMBs focus on patients with advanced cancer, who may differ from survivors in their pain management needs and access to resources. This mixed-methods study explored PSMBs of survivors of BC, referral sources, and goals for pain relief, and examined the relationship between PSMB engagement and pain intensity/interference. Methods: Survivors of BC who were six months post-treatment completed measures assessing their pain intensity/interference and PSMB engagement. Purposive sampling identified a subset of participants who completed interviews, which were analyzed using thematic analysis. Results: Participants (n = 60) were 60 ± 10 years old. Worst Pain Intensity and Pain Interference were 3.93 ± 2.36 and 2.09 ± 2.11, respectively. Participants engaged in 7 ± 3.5 PSMBs. The most common were walking (76%) and distraction (76%). PSMBs described in the interviews (n = 10) were arm stretching and strengthening exercises, seeking specialized pain management services, and avoidance. Most PSMBs were self-directed or suggested by friends. All pain relief goals were to minimize pain interference. PSMB engagement was not associated with Worst, Least, or Average Pain Intensity (all rs ≤ -0.2, p ≥ 0.05) but was associated with Pain Interference (rs = 0.3, p ≤ 0.01). Conclusions: The survivors of BC engaged in many PSMBs, with varying levels of effectiveness and a varying quality of supporting evidence. Most PSMBs were self-directed and some required intervention from healthcare providers or other people, while others required access to limited specialized pain management services.
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Affiliation(s)
- Kaitlin M. McGarragle
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2M9, Canada; (K.M.M.); (S.Z.); (D.H.); (E.E.); (C.P.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 3H2, Canada
| | - Sunny Zheng
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2M9, Canada; (K.M.M.); (S.Z.); (D.H.); (E.E.); (C.P.)
| | - Lucia Gagliese
- School of Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada;
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON M5G 2C4, Canada
- Department of Anesthesia, University of Toronto, Toronto, ON M5T 2S8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5, Canada
| | - Doris Howell
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2M9, Canada; (K.M.M.); (S.Z.); (D.H.); (E.E.); (C.P.)
| | - Elizabeth Edwards
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2M9, Canada; (K.M.M.); (S.Z.); (D.H.); (E.E.); (C.P.)
| | - Cheryl Pritlove
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2M9, Canada; (K.M.M.); (S.Z.); (D.H.); (E.E.); (C.P.)
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Division of Social and Behavioral Science, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - David McCready
- Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2M9, Canada;
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Christine Elser
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2M9, Canada;
- Division of Medical Oncology, Faculty of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
- Marvelle Koffler Breast Center, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5, Canada
| | - Jennifer M. Jones
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2M9, Canada; (K.M.M.); (S.Z.); (D.H.); (E.E.); (C.P.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Lynn R. Gauthier
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada;
- Michel-Sarrazin Research Team in Psychosocial Oncology and Palliative Care, CHU de Québec-Laval University Research Center, Oncology Division, Quebec, QC G1J 1Z4, Canada
- Cancer Research Center, Laval University, Quebec, QC G1R 3S3, Canada
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Pagnucci N, Tolotti A, Valcarenghi D, Carnevale F, Sasso L, Bagnasco A. Conceptualising nursing theory and practice within a local cultural and professional context: a methodological example to inform theory development. J Res Nurs 2024:17449871241268493. [PMID: 39553400 PMCID: PMC11562256 DOI: 10.1177/17449871241268493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2024] Open
Abstract
Background Nursing theories are crucial toward orienting the development of knowledge and practice. However, there is a persistent debate in the literature regarding the gap between theory and practice. Theories and conceptual models developed in Anglo-Saxon countries are often proposed within diverse educational and clinical contexts in other countries, generating challenges in their application in practice. Aim This study aimed to develop and propose a methodology to promote the advancement of nursing theorising, considering local cultural and professional contexts. Methods This analysis was conducted within Italy, which served as a local cultural and professional context exemplar for this investigation. A Scoping Review was used to map local nursing knowledge related to nursing practice. Fawcett's metaparadigm was used as a general orienting frame for the literature analysis. Results In light of the analysis conducted, the four disciplinary concepts related to the local (Italian) cultural and professional context were described (person, environment, health, nursing). Conclusion This investigation aimed to present an example of how an inductive reflective approach can be used as a way to map nursing practice and define disciplinary concepts that can guide conceptual/theory development. The knowledge that was generated can orient initiatives to promote local nursing theory development.
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Affiliation(s)
- Nicola Pagnucci
- Senior Researcher in Nursing, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
- European Centre of Excellence for Research in Continuing Professional Development, RSCI Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Angela Tolotti
- Head of Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Dario Valcarenghi
- Researcher in Nursing, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Franco Carnevale
- Professor in Nursing, Ingram School of Nursing, McGill University, Montreal, Canada
| | - Loredana Sasso
- Professor in Nursing, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Annamaria Bagnasco
- Professor in Nursing, Department of Health Sciences, University of Genoa, Genoa, Italy
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Ali Alaswami H, Al Musalami AA, Al Saadi MH, AlZaabi AA. Identifying Barriers to Effective Cancer Pain Management in Oman: Implications for Palliative Care. Curr Oncol 2024; 31:2963-2973. [PMID: 38920709 PMCID: PMC11202896 DOI: 10.3390/curroncol31060225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Effective cancer pain management is essential for improving the quality of life of patients. However, the use of analgesics is often suboptimal due to various patient-related barriers. This study aims to explore the perceptions, knowledge, and attitudes toward analgesic use among cancer patients in Oman, which may influence their pain management strategies. METHODS In a cross-sectional study, we assessed 68 cancer patients undergoing pain management at an inpatient cancer clinic of a tertiary hospital in Oman from a pool of 154 eligible participants. The Barriers Questionnaire (BQ) and the Patient Pain Questionnaire (PPQ), both Arabic versions, were administered to evaluate the patients' barriers to cancer pain management. The study period and the criteria for patient selection are specified. RESULTS With a participation rate of 44.2% and a female-to-male ratio of 2.28:1, the mean score on the BQ was 2.52 (SD 0.84), indicating a moderate level of perceived barriers. Patients' scores suggested notable barriers, with older patients exhibiting reluctance toward analgesics for fear of masking symptoms and female patients expressing greater concerns about developing drug tolerance. CONCLUSION The findings highlight significant attitudinal barriers to effective cancer pain management in Oman, notably a prevalent fear of medication tolerance. The study stresses on the need for targeted patient education and the correction of misconceptions. It also points to the influence of cultural and religious beliefs on patient responses, advocating for the implementation of culturally sensitive, evidence-based pain management guidelines, and the support of multidisciplinary palliative care teams.
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Affiliation(s)
- Husain Ali Alaswami
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman (M.H.A.S.)
| | | | - Muaeen Hamed Al Saadi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman (M.H.A.S.)
| | - Adhari Abdullah AlZaabi
- Human and Clinical Anatomy Department, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
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Smith A, Olson RE, da Costa NC, Cuerton M, Hardy J, Good P. Quality of life beyond measure: Advanced cancer patients, wellbeing and medicinal cannabis. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:1709-1729. [PMID: 37283094 PMCID: PMC10946949 DOI: 10.1111/1467-9566.13684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/09/2023] [Indexed: 06/08/2023]
Abstract
Experiences of advanced cancer are assembled and (re)positioned with reference to illness, symptoms and maintaining 'wellbeing'. Medical cannabis is situated at a borderline in this and the broader social domain: between stigmatised and normalised; recreational and pharmaceutical; between perception, experience, discourse and scientific proof of benefit. Yet, in the hyper-medicalised context of randomised clinical trials (RCTs), cancer, wellbeing and medical cannabis are narrowly assessed using individualistic numerical scores. This article attends to patients' perceptions and experiences at this borderline, presenting novel findings from a sociological sub-study embedded within RCTs focused on the use of medical cannabis for symptom relief in advanced cancer. Through a Deleuzo-Guattarian-informed framework, we highlight the fragmentation and reassembling of bodies and propose body-situated experiences of wellbeing in the realm of advanced cancer. Problematising 'biopsychosocial' approaches that centre an individualised disconnected patient body in understandings of wellbeing, experiences of cancer and potential treatments, our findings foreground relational affect and embodied experience, and the role of desire in understanding what wellbeing is and can be. This also underpins and enables exploration of the affective reassembling ascribed to medical cannabis, with particular focus on how it is positioned within RCTs.
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Affiliation(s)
- Alexandra Smith
- School of Social ScienceThe University of QueenslandBrisbaneQueenslandAustralia
| | - Rebecca E. Olson
- School of Social ScienceThe University of QueenslandBrisbaneQueenslandAustralia
| | - Nathalia Cordeiro da Costa
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQueenslandAustralia
- School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | - Maddison Cuerton
- School of Social ScienceThe University of QueenslandBrisbaneQueenslandAustralia
| | - Janet Hardy
- Department of Palliative and Supportive Care Mater Health ServicesMater Research‐University of QueenslandSouth BrisbaneQueenslandAustralia
| | - Philip Good
- Department of Palliative and Supportive Care Mater Health ServicesMater Research‐University of QueenslandSouth BrisbaneQueenslandAustralia
- Department of Palliative CareSt. Vincent's Private Hospital BrisbaneBrisbaneQueenslandAustralia
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Obaid A, Hroub AA, Rifai AA, Alruzzieh M, Radaideh M, Tantawi Y. Barriers to Effective Cancer Pain Management, Comparing the Perspectives of Physicians, Nurses, and Patients. Pain Manag Nurs 2023; 24:498-505. [PMID: 37573153 DOI: 10.1016/j.pmn.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 07/08/2023] [Accepted: 07/09/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Pain associated with cancer is one of the most significant concerns for patients, families, and health care providers. Various barriers may hinder optimal pain management. AIM The study was conducted in specialized cancer center in Jordan and aimed to explore the barriers to effective cancer pain management from the perspectives of physicians, nurses, and patients. METHODS A quantitative descriptive cross-sectional design was used, with a total sample of 185 participants (55 Physicians, 70 Nurses, and 60 Patients) who completed a demographic datasheet and the Arabic-Barrier Questionnaire II (BQII). RESULTS The overall BQII of patient score was 2.4 (standard deviation [SD] = 0.7). The harmful effects of pain medications were the highest barrier 2.7 (SD = 1.0), followed by the physiologic effect 2.4 (SD = 0.9), and the communication 2.4 (SD = 1.1) subscales. Nurses and physicians reported an overall BQII of 1.9 (SD = 1.1) and 1.8 (SD = 0.9), respectively. One-way analysis of variance showed that the perspectives of patients, physicians, and nurses differed significantly in the overall BQII F(2, 182) = 6.81, p < .01, communication F(2, 182) = 10.55, p < .01, and harmful effects F(2, 182) = 7.26, p < .01. Multiple pairwise comparisons also showed that the patients significantly perceived higher communication barriers, more concerns of analgesic harmful effects, and higher overall barriers than nurses and physicians. CONCLUSIONS Significant differences were found in the perspectives of patients, physicians, and nurses toward pain management barriers in the overall barriers, communication, and harmful effect. It is recommended to develop awareness programs for patients about pain management, barriers, use of analgesia, and communication. Nurses and physicians are advised to discuss mutual concerns and pay more attention to overcoming patient concerns.
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Affiliation(s)
- Abdullah Obaid
- Nursing Department, King Hussein Cancer Center, Amman, Jordan; Nursing Department, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Ahmad Al Hroub
- Nursing Department, King Hussein Cancer Center, Amman, Jordan
| | - Anwar Al Rifai
- Nursing Department, King Hussein Cancer Center, Amman, Jordan.
| | | | | | - Yazan Tantawi
- Nursing Department, King Hussein Cancer Center, Amman, Jordan
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Zhang J, Chan DNS, Liu X, Cai Y, Chen J, Xie M. Effects of self-management interventions for cancer patients with pain: A systematic review of randomised controlled trials. J Clin Nurs 2023; 32:5652-5667. [PMID: 36929168 DOI: 10.1111/jocn.16669] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/09/2023] [Accepted: 02/08/2023] [Indexed: 03/18/2023]
Abstract
AIMS To evaluate the effects of self-management interventions targeting individuals with cancer-related pain on pain intensity, self-efficacy, quality of life (QoL), pain medication adherence, and pain-related knowledge and provide recommendations for the content and format of self-management interventions based on the existing evidence. DESIGN A systematic review of randomised controlled trials (RCTs) and narrative synthesis. DATA SOURCES A search of six electronic databases, including Medline, PsycINFO, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus. REVIEW METHODS This systematic review followed the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published from January 2011 to March 2022 in English were retrieved. The Cochrane Risk of Bias Tool was used to assess quality. Data were summarised using narrative synthesis. RESULTS This systematic review included six RCTs involving 748 patients with cancer-related pain. The results support the effectiveness of the intervention on QoL and pain-related knowledge. Mixed results were observed in the effectiveness on pain intensity, self-efficacy and medication adherence. Overall, the quality of the evidence was low. The content of self-management interventions varied across studies but with similar formats (face-to-face coaching and telephone follow-up). CONCLUSION The existing evidence supports the effectiveness of self-management interventions on pain-related knowledge and QoL. Further high-quality RCTs are needed to determine the most effective interventions. RELEVANCE TO CLINICAL PRACTICE Self-management is recommended to improve cancer patients' pain awareness, self-management behaviour and adaptability. Components for self-management of cancer pain, including patient attitude and knowledge assessment, nurse coaching and counselling, reinforcement during follow-up period, and provision of supplementary materials on pain management and medication adherence, could be covered in the intervention. In the future, it is worthwhile exploring an effective intervention using Internet-based information technology, for example WeChat, to aid the delivery of self-management intervention. NO PATIENT OR PUBLIC CONTRIBUTION This systematic review does not necessarily involve patients or public members in this work.
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Affiliation(s)
- Junfeng Zhang
- Department of Nursing, SSL Central Hospital of Dongguan City, Dongguan, People's Republic of China
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Dorothy N S Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Xingling Liu
- Department of Nursing, SSL Central Hospital of Dongguan City, Dongguan, People's Republic of China
| | - Yingying Cai
- Department of Nursing, Jieyang People's Hospital, Jieyang, People's Republic of China
| | - Jiawen Chen
- Department of Nursing, SSL Central Hospital of Dongguan City, Dongguan, People's Republic of China
| | - Minjuan Xie
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, People's Republic of China
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Tsele-Tebakang T, Morris-Eyton H, Pretorius E. Concurrent use of herbal and prescribed medicine by patients in primary health care clinics, South Africa. Afr J Prim Health Care Fam Med 2023; 15:e1-e7. [PMID: 37403682 PMCID: PMC10319942 DOI: 10.4102/phcfm.v15i1.3829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND The use of herbal medicine (HM) as a self-management practice for treating various diseases has gained popularity worldwide. Consumers co-administer herbal products with conventional medicine without the knowledge of possible herb-drug interaction (HDI). AIM This study aimed to assess patients' perception and use of HM and their knowledge of HDI. SETTING Participants attending primary health care (PHC) clinics in three provinces (Gauteng, Mpumalanga and Free State), South Africa, were recruited. METHODS Focus group discussions comprising a total of thirty (N = 30) participants were conducted using a semi-structured interview guide. Discussions were audio-recorded and then transcribed verbatim. Data were analysed using thematic content analysis. RESULTS Reasons for using HM, sources of information on HM, co-administration of HM and prescribed medicine, disclosure of the use of HM, PHC nurses' attitudes and not having time to engage were frequently discussed. Respondents' lack of knowledge and perceptions about HDI and their dissatisfaction with prescribed medicine because of experienced side effects were also discussed. CONCLUSION Because of the lack of discussions and non-disclosure about HM in PHC clinics, patients are at risk of experiencing HDIs. Primary health care providers should regularly enquire about HM use on every patient, to identify and prevent HDIs. The lack of knowledge about HDIs by patients further compromises the safety of HM.Contribution: The results highlighted the lack of knowledge of HDI by patients thus assisting the healthcare stakeholders in South Africa to implement measures to educate patients attending PHC clinics.
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Affiliation(s)
- Tebogo Tsele-Tebakang
- Department of Complementary Medicine, Faculty of Health Sciences, University of Johannesburg, Johannesburg.
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Halverson CM, Penwell HL, Francomano CA. Clinician-associated traumatization from difficult medical encounters: Results from a qualitative interview study on the Ehlers-Danlos Syndromes. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100237. [PMID: 37426705 PMCID: PMC10328215 DOI: 10.1016/j.ssmqr.2023.100237] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Patients with hypermobile Ehlers Danlos Syndrome often experience psychological distress resulting from the perceived hostility and disinterest of their clinicians. We conducted 26 in-depth interviews with patients to understand the origins of this trauma and how it could be addressed in practice. We found that the cumulative effects of numerous negative encounters lead patients to lose trust in their healthcare providers and the healthcare system, and to develop acute anxiety about returning to clinic to seek further care. We describe this as clinician-associated traumatization. Ultimately, our interviewees described the result of this traumatization as worse - but preventable - health outcomes.
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Affiliation(s)
- Colin M.E. Halverson
- Center for Bioethics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anthropology, Indiana University, Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
| | - Heather L. Penwell
- Center for Bioethics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Clair A. Francomano
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
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Restivo L, Dudoit É, Duffaud F, Salas S, Dany L. "Fortunately I felt pain, or I would have thought I was on my way out": experiencing pain and negotiating analgesic treatment in the context of cancer. J Psychosoc Oncol 2023; 41:150-165. [PMID: 35653187 DOI: 10.1080/07347332.2022.2074337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To explore cancer patients' experience of pain and coping strategies as well as beliefs and representations associated with pain, pain management and treatments. METHOD AND PARTICIPANTS A qualitative study based on semi-structured interviews was conducted among 16 patients with cancer. The inductive research strategy adopted derived from the Grounded Theory approach and the data transcribed verbatim were gradually analyzed involving researcher triangulation. FINDINGS The experience of pain and the coping strategies developed by patients to deal with it are shaped by the experience and representations of cancer associated with death and suffering. Pain acts both as an indication to the patients that they are still alive and as an indicator of the progression of the disease. Cancer also models patients' relationships to analgesic treatments and health care providers, since pain is an area in which patients can take back control of what is happening to them. Patients' expression of reluctance to accept analgesic treatments is also influenced by the significance of opioid treatments in this context, which are perceived as an indication that the end of life is close. CONCLUSIONS The contextualization of pain through the particularities of cancer is critical in order to understand cancer patients' experience of pain. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Not only patients' knowledge but also the meaning-making of pain should be incorporated in interventions targeting pain management.
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Affiliation(s)
- Léa Restivo
- Aix Marseille Univ, Aix-en-Provence, France.,Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Equipe CANBIOS Labellisée Ligue 2019, Marseille, France
| | - Éric Dudoit
- APHM, Timone, Medical Oncology Department, Marseille, France
| | | | - Sébastien Salas
- APHM, Timone, Medical Oncology Department, Marseille, France
| | - Lionel Dany
- Aix Marseille Univ, Aix-en-Provence, France.,APHM, Timone, Medical Oncology Department, Marseille, France
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Téllez-López AM, Bermudez-Camps IB, Reyes-Hernández I, Fegadolli C, Gómez-Oliván LM. Methodological - Theoretical approach to phenomenological studies on the experience of medication use: A systematic review. Res Social Adm Pharm 2023; 19:845-858. [PMID: 36878811 DOI: 10.1016/j.sapharm.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/04/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND The study of medication use should include pharmacological, family, and social dimensions to explain how the lived experiences, beliefs, and perceptions of everyone, and their social and cultural environment affects consumption, using for this purpose the qualitative approach. OBJECTIVE To conduct a systematic review of the theoretical-methodological approaches to phenomenology to identify studies that allow an understanding of patients' experiences with the use of medications.a. METHODS A systematic literature search was conducted following the PRISMA guidelines to identify studies that address phenomenological research on patients' experiences of medications used and to apply them in subsequent studies. A thematic analysis was performed using ATLAS.ti software to facilitate data management. RESULTS Twenty-six articles were identified, most of them including adult patients diagnosed with chronic degenerative diseases. The semantic network obtained places Phenomenology at the center as the interpretative referential framework, with three theoretical approaches: descriptive, interpretative, and perceptual under the philosophies of Husserl, Heidegger, and Merleau-Ponty respectively; two techniques to collect data which are in-depth interview and focus groups; and to explore the life experiences of patients and understand the meaning in the context of their lives, thematic analysis, content analysis, and interpretative phenomenological analysis were identified. CONCLUSIONS It was evidenced that Qualitative Research approaches, methodologies, and techniques are applicable to describe people's experiences towards the use of medications. Phenomenology constitutes a useful referential framework in qualitative research to explain the experiences and perceptions about the disease and the use of medicines.
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Li L, Mangali S, Kour N, Dasari D, Ghatage T, Sharma V, Dhar A, Bhat A. Syzygium cumini (jamun) fruit-extracted phytochemicals exert anti-proliferative effect on ovarian cancer cells. J Cancer Res Ther 2021; 17:1547-1551. [PMID: 34916393 DOI: 10.4103/jcrt.jcrt_210_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The medicinal properties of Syzygium sp., especially the antidiabetic property, date back to the ancient times. However, in the recent past, extracts from different parts of the Syzygium sp. have demonstrated promising anticancer activities in diverse cancer types, and now, attempts are being made to identify the active phytochemicals. Aims and Objectives In this study, we intended to test the anticancer properties of phytochemicals extracted from the fruit of Syzygium cumini plant in ovarian cancer cells. Materials and Methods A total of nine phytochemicals extracted from the S. cumini fruits using chloroform were tested for their anticancer activity in the ovarian cancer cell line PA-1. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide tetrazolium assay was performed to calculate the 50% inhibition (IC50) concentration and cell cytotoxicity values. Cell scratch assay was performed to assess the proliferation inhibition activity of the phytochemicals. Cisplatin was used as positive control. Results Out of the nine phytochemicals tested, quercetin (QC), gallic acid (GA), and oleanolic acid (OA) were found active. QC and GA were most effective with more than 90% cell cytotoxicity at 2.5 µ g/ml and above concentrations and OA moderately effective up to 5 µg/ml serial concentrations. Cell proliferation was significantly inhibited by QC and GA and moderately but significantly by OA. Conclusion Our data demonstrate the anticancer activity of QC, GA, and OA phytochemicals, which is consistent with the previous reports. However, this is the first report showing the anticancer activity of these phytochemicals derived from S. cumini in the ovarian cancer cells. These data suggest that there is a potential to develop these phytochemicals as anticancer therapeutic agents either as monotherapeutic agents or in combination with commonly used chemotherapeutic agents, which needs to be explored.
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Affiliation(s)
- Li Li
- Department of Gynecology, Jinan Municipal Hospital of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Sureshbabu Mangali
- Department of Pharmacy, Birla Institute of Technology and Sciences, Hyderabad Campus, Hyderabad, Telangana, India
| | - Navneet Kour
- Division of Biochemistry, Faculty of Basic Sciences, Sher-e-Kashmir University of Agricultural Sciences and Technology of Jammu, Jammu, India
| | - Deepika Dasari
- Department of Pharmacy, Birla Institute of Technology and Sciences, Hyderabad Campus, Hyderabad, Telangana, India
| | - Trupti Ghatage
- Department of Pharmacy, Birla Institute of Technology and Sciences, Hyderabad Campus, Hyderabad, Telangana, India
| | - Vikas Sharma
- Division of Biochemistry, Faculty of Basic Sciences, Sher-e-Kashmir University of Agricultural Sciences and Technology of Jammu, Jammu, India
| | - Arti Dhar
- Department of Pharmacy, Birla Institute of Technology and Sciences, Hyderabad Campus, Hyderabad, Telangana, India
| | - Audesh Bhat
- Centre for Molecular Biology, Central University of Jammu, Samba, Jammu and Kashmir, India
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12
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Azizoddin DR, Knoerl R, Adam R, Kessler D, Tulsky JA, Edwards RR, Enzinger AC. Cancer pain self-management in the context of a national opioid epidemic: Experiences of patients with advanced cancer using opioids. Cancer 2021; 127:3239-3245. [PMID: 33905550 PMCID: PMC8355015 DOI: 10.1002/cncr.33532] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/10/2021] [Accepted: 03/01/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The US opioid epidemic has prompted dramatic changes in public attitudes and regulations governing opioid prescribing. Little is known about the experiences of patients with advanced cancer using opioids in the context of the epidemic. METHODS Semistructured interviews of 26 patients with advanced cancer were conducted between May 2019 and April 2020; their experiences self-managing chronic pain with opioids were evaluated. RESULTS Patients consistently described the negative impact of the opioid epidemic on their ability to self-manage pain. Negative media coverage and personal experiences with the epidemic promoted stigma, fear, and guilt surrounding opioid use. As a result, many patients delayed initiating opioids and often viewed their decision to take opioids as a moral failure-as "caving in." Patients frequently managed this internal conflict through opioid-restricting behaviors (eg, skipping or taking lower doses). Stigma also impeded patient-clinician communication; patients often avoided discussing opioids or purposely conveyed underusing them to avoid being labeled a "pill seeker." Patients experienced structural barriers to obtaining opioids such as prior authorizations, delays in refills, or being questioned by pharmacists about their opioid use. Barriers were stressful, amplified stigma, interfered with pain control, and reinforced ambivalence about opioids. CONCLUSIONS The US opioid epidemic has stigmatized opioid use and undermined pain management in individuals with advanced cancer. Interventions seeking to alleviate cancer pain should attend to the multiple, negative influences of the opioid crisis on patients' ability to self-manage. LAY SUMMARY Patients with advanced cancer suffer from significant pain and frequently receive opioids to manage their pain. Of the 26 patients with advanced cancer interviewed, the majority of patients experienced stigma about their opioid use for cancer pain management. All patients felt that the opioid epidemic fostered this stigma. Several struggled to use opioids for pain because of this stigma and the logistical complications they experienced with pharmacies and insurance coverage. Many were afraid to share their concerns about opioids with their providers. .
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Affiliation(s)
- Desiree R Azizoddin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Faber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Robert Knoerl
- Harvard Medical School, Boston, Massachusetts.,Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rosalind Adam
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Daniela Kessler
- Department of Medical Oncology, Division of Population Sciences, Dana-Faber Cancer Institute, Boston, Massachusetts
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Faber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Andrea C Enzinger
- Harvard Medical School, Boston, Massachusetts.,Department of Medical Oncology, Division of Population Sciences, Dana-Faber Cancer Institute, Boston, Massachusetts
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13
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Nakata C, Sharp LK, Spanjol J, Cui AS, Izberk-Bilgin E, Crawford SY, Xiao Y. Narrative arcs and shaping influences in long-term medication adherence. Soc Sci Med 2021; 285:114264. [PMID: 34329922 DOI: 10.1016/j.socscimed.2021.114264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/11/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
Long-term adherence to medications is not well understood and poses a significant challenge for many chronically ill persons. Past research provides insights on adherence in short durations such as a day or several weeks, even though chronically ill patients are required to take medications for periods as long as a lifetime. To fill this important knowledge gap, we study the temporal unfolding of prolonged medication-taking experiences among thirty adults, mostly African American, with chronic hypertension in the U.S. Specifically, we take an extended, experience-centered, narrative approach to examine retrospective patient accounts of adherence efforts over spans of one year to more than four decades. Applying Gergen and Gergen's concept of narrative forms (1983), we find four distinct narrative arcs, or patterned sequences of medication consumption, that we term Out of the Gate, Existential Turn, Fits and Starts, and Slow Climb, along with individual and social elements that shape and shift practices in the context of time.
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Affiliation(s)
- Cheryl Nakata
- Department of Marketing, Entrepreneurship, Hospitality, & Tourism, Bryan School of Business and Economics, University of North Carolina at Greensboro, 516 Stirling Street, 348 Bryan Building, Greensboro, NC, 27402, USA.
| | - Lisa K Sharp
- Institute for Health Research and Policy, 463 Westside Research Office Building, 1747 West Roosevelt Road, Chicago, IL, 60608, USA; Department of Pharmacy Systems, Outcomes, and Policy in the College of Pharmacy, University of Illinois at Chicago, 833 S. Wood Street (MC 871), Chicago, IL, 60612, USA.
| | - Jelena Spanjol
- Ludwig-Maximilians-Universität (LMU) München, LMU Munich School of Management, Geschwister-Scholl-Platz 1, 80539 München, Germany.
| | - Anna Shaojie Cui
- Department of Marketing, College of Business Administration, University of Illinois at Chicago, 601 S. Morgan (MC 243), Chicago, IL, 60607, USA.
| | - Elif Izberk-Bilgin
- Department of Management Studies, College of Business, University of Michigan-Dearborn, 151 FCS, Dearborn, MI, 48126, USA.
| | - Stephanie Y Crawford
- Department of Pharmacy Systems, Outcomes, and Policy in the College of Pharmacy, University of Illinois at Chicago, 833 S. Wood Street (MC 871), Chicago, IL, 60612, USA.
| | - Yazhen Xiao
- Department of Marketing, University of Tennessee, 321 Stokely Management Center, 916 Volunteer Boulevard, Knoxville, TN, 37996-0530, USA.
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14
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Brant JM, Silbermann M. Global Perspectives on Palliative Care for Cancer Patients: Not All Countries Are the Same. Curr Oncol Rep 2021; 23:60. [PMID: 33829323 PMCID: PMC8026388 DOI: 10.1007/s11912-021-01044-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE OF THE REVIEW The integration of cancer-related palliative care is essential to holistic, quality cancer care. While some similarities exist between countries, this manuscript will focus on five differences that impact palliative care for cancer patients including the epidemiology of cancer and related symptoms, cancer-specific integration into care, palliative care education, economic development of the country, and cultural and religious differences. RECENT FINDINGS The epidemiology of cancer varies around the world resulting in variable symptoms and the need for individualized approaches to palliative care. While palliative care is integrated in some countries, it is lacking in over half of the world, and specific integration into cancer care is virtually absent. Education and training are the key to expansion, and yet oncology-focused palliative care education is lacking or is not well-reported in the literature. To complicate this global lens even further are the economic disparities that exist. Low-to-middle-income countries (LMICs) are resource poor and have the fewest resources and least amount of integration, and yet patients with advanced cancer are over-represented in these countries. Essential to cancer-related palliative care is a tailored approach that addresses cultural and religious differences around the globe. Palliative care is developing around the globe and yet palliative care specific for cancer patients is in its infancy. Cancer care professionals should (1) understand the epidemiologic differences that exist globally and the impact this has on palliative care, (2) integrate palliative care into the cancer care arena, (3) provide cancer-specific palliative education focused on the cancer trajectory from diagnosis through survivorship and end of life, (4) advocate for LMICs, which suffer from a lack of resources and services, and (5) understand cultural and religious differences that exist to provide holistic and sensitive cancer-related palliative care.
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Affiliation(s)
- Jeannine M Brant
- Billings Clinic, 2651 North Bridger Drive, Billings, MT, 59102, USA.
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15
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Corrigan KL, Knettel BA, Ho N, Carr S, Shah B, Cahill J, Chino J, Watt MH, Suneja G. Improving Access to Cancer Care in the HIV Population: Qualitative Research to Identify Barriers to Care. Health Equity 2020; 4:468-475. [PMID: 33269330 PMCID: PMC7703398 DOI: 10.1089/heq.2020.0001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose: People living with HIV are less likely to receive cancer treatment and have worse cancer-specific survival, yet underlying drivers of this disparity have minimally been explored. We investigated cancer care barriers from the perspective of patients living with HIV and cancer (PLWHC) to inform future interventions, reduce disparities, and improve outcomes. Methods: We conducted in-depth semistructured interviews with 27 PLWHC. The interview guide explored perceptions of the cancer care experience, treatment decision making, and barriers to cancer treatment. Interview data were analyzed using the constant comparative method of qualitative analysis. Results: Study participants were predominantly men (n=22, 81%) with a median age of 56 years and median annual income of $24,000. Among those who experienced challenges with cancer treatment adherence, barriers included debilitating side effects of cancer treatment, stigma surrounding HIV, issues with coping and mental health, the financial burden of cancer care, and challenges with care accessibility. Despite these challenges, participants indicated that their past experiences of coping with HIV had prepared them to accept and address their cancer diagnosis. Resiliency and social support were key facilitators for cancer treatment adherence. Conclusion: This qualitative study of PLWHC in the United States found that a cancer diagnosis created a substantial added stress to an already challenging situation. Health- and stigma-related stressors impacted patients' ability to fully complete cancer treatment as prescribed. There is a need for improved provider communication and mental health support for PLWHC to ensure equitable access to and completion of cancer treatment.
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Affiliation(s)
| | - Brandon A Knettel
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Noelani Ho
- Department of Population Health Sciences, Duke University Health System, Durham, North Carolina, USA
| | - Stuart Carr
- Department of Pediatrics Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Bijal Shah
- Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina, USA
| | - Joan Cahill
- Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina, USA
| | - Junzo Chino
- Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina, USA
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Gita Suneja
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina, USA
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16
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Mousavizadeh SN, Banazadeh Z. Loss of Time in the Treatment Adherence Process: A Qualitative Study in a Sample of Iranian People with Diabetes. J Med Life 2020; 13:293-299. [PMID: 33072199 PMCID: PMC7550146 DOI: 10.25122/jml-2019-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Diabetes is a significant public health problem and one of the causes of death and disability globally. One of the main problems with diabetes control is the lack of adherence to therapeutic regimens in people with diabetes. This study investigates the experiences and views of the Iranian people with diabetes to identify the challenges of the process of adherence to treatment. A grounded theory research design was used, incorporating in-depth interviews to collect the data. Using purposeful sampling, 28 people with type 2 diabetes (9 men, 19 women) from different places were included in the study. Constant comparative analysis was undertaken to identify key categories. The main challenge in this process is losing the golden time of preventing the complications of the disease that occurs for the following reasons: cultural habits and values, religious beliefs (believing diabetes was God’s will), resistance to change due to age, job conditions, lack of harmony in the family, and non-shared decision-making in the health system. People with diabetes go through trial and error in order to achieve awareness and insight, and consequently, adherence to treatment. Therefore, they need help and support to achieve insight and adherence to treatment faster and without complications. In fact, if the care plan is designed to encourage active patient participation by the treatment team in the shortest possible time, the time to achieve compliance will be shorter and will have the least side effects for these people.
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Affiliation(s)
- Seyedeh Narjes Mousavizadeh
- Department of Psychiatric Nursing, Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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17
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Rosa WE, Chittams J, Riegel B, Ulrich CM, Meghani SH. Patient Trade-Offs Related to Analgesic Use for Cancer Pain: A MaxDiff Analysis Study. Pain Manag Nurs 2020; 21:245-254. [PMID: 31648906 PMCID: PMC7170763 DOI: 10.1016/j.pmn.2019.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/05/2019] [Accepted: 07/26/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE Many patients with cancer pain deviate from prescribed analgesic regimens. Our aim was to elicit the trade-offs patients make based on their beliefs about analgesic use and rank utilities (importance scores) using maximum difference (MaxDiff) scaling. We also investigated if there were unique clusters of patients based on their analgesic beliefs. METHODS This was a secondary analysis of a three-month, prospective observational study. Patients (N = 207) were self-identified African Americans and Whites, >18 years, diagnosed with multiple myeloma or solid tumor, and were prescribed at least one around-the-clock analgesic for cancer pain. MaxDiff analysis allowed us to identify patients utilities. Second, a cluster analysis assisted in ranking how analgesic beliefs differed by groups. Third, clusters were described by comparing key sociodemographic and clinical variables. RESULTS Participants' beliefs were a significant factor in choices related to analgesic use (chi-square = 498.145, p < .0001). The belief, 'Pain meds keep you from knowing what is going on in your body', had the highest patient endorsement. Two distinct clusters of patients based on analgesic beliefs were identified; 'knowing body' was ranked as top priority for both clusters. The belief that cancer patients become addicted to analgesics was moderately important for both clusters. Severity of side effects was the only key variable significantly different between clusters (p = .043). CONCLUSIONS Our findings support tailored pain management interventions that attend to individual beliefs about cancer pain and analgesic use. Future research should explore the relationship between analgesic utilities, actual analgesic taking behaviors, and how they impact patients' cancer pain outcomes.
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Affiliation(s)
- William E Rosa
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
| | - Jesse Chittams
- BECCA Lab, Office of Nursing Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Barbara Riegel
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Connie M Ulrich
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Salimah H Meghani
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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18
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Xu LP, Yang SL, Su SQ, Huang BX, Lan XM, Yao RJ. Effect of wrist-ankle acupuncture therapy combined with auricular acupuncture on cancer pain: A four-parallel arm randomized controlled trial. Complement Ther Clin Pract 2020; 39:101170. [PMID: 32379695 DOI: 10.1016/j.ctcp.2020.101170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/27/2020] [Accepted: 04/02/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cancer pain affects the quality of life of cancer patients; therefore, various methods exist for alleviating the adverse effects caused by cancer pain. Nonpharmacological intervention is regarded as an important means of auxiliary therapy for drug treatment, with acupuncture receiving the most attention; However, there are numerous types of acupuncture therapies, including acupuncture, wrist-ankle acupuncture (WAA) and auricular acupuncture (AA). Previous studies have demonstrated that all types of acupuncture therapy can alleviate cancer pain. However, the effects and pathways of different acupuncture treatments are not similar, and it is unknown whether single therapy or combination therapy has better analgesic effects. This study aimed to examine the effect of WAA therapy combined with AA on cancer pain. DESIGN A randomized controlled trial. METHOD A total of 160 patients were selected and randomly divided into groups A, B, C and D, with 40 patients in each group. Group A received conventional analgesia alone, with opioids administered based on the World Health Organization (WHO) 3-tiered "cancer pain ladder". Group B received WAA, in addition to the treatment received by group A. Group C received AA, in addition to the treatment received by group A. Group D received WAA combined with AA, in addition to the treatment received by group A. Analgesic effects and analgesic drug use before and 3, 5 and 7 days after treatment were observed in each group. RESULT A total of 159 patients were included in the analysis. The verbal rating scale (VRS) and numeric rating scale (NRS) scores for patients who received mono-acupuncture therapy and combination therapy for 1 week were significantly different from those of the control group. Combination therapy had a stronger effect on the VRS score and a faster onset time, based on the NRS score, and the patients who received combination therapy had reduced analgesic drug use. CONCLUSION WAA combined with AA can more quickly reduce pain symptoms with more lasting analgesic effects and can effectively reduce analgesic drug use.
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Affiliation(s)
- Li-Ping Xu
- Nursing Department, The Third Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China.
| | - Shi-Lai Yang
- School of Nursing, Quanzhou Medical College, Quanzhou, China.
| | - Shao-Qing Su
- People's Hospital Affiliated of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Bi-Xia Huang
- The Third Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xin-Mei Lan
- The Third Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ru-Jie Yao
- The Third Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
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19
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Rosa WE, Riegel B, Ulrich CM, Meghani SH. A concept analysis of analgesic nonadherence for cancer pain in a time of opioid crisis. Nurs Outlook 2020; 68:83-93. [DOI: 10.1016/j.outlook.2019.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/20/2019] [Accepted: 06/23/2019] [Indexed: 11/25/2022]
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20
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Combinational Use of Phytochemicals and Chemotherapeutic Drugs Enhance Their Therapeutic Potential on Human Cervical Cancer Cells. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.91783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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21
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Wright EM, El-Jawahri A, Temel JS, Carr A, Safren SA, Park ER, Pirl WF, Bruera E, Traeger L. Patient Patterns and Perspectives on Using Opioid Regimens for Chronic Cancer Pain. J Pain Symptom Manage 2019; 57:1062-1070. [PMID: 30831237 PMCID: PMC6557123 DOI: 10.1016/j.jpainsymman.2019.02.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 01/24/2023]
Abstract
CONTEXT With increasing attention to the undertreatment of cancer pain in parallel with concerns about opioid misuse, little is known about how patients with advanced cancer adhere to opioid regimens for chronic cancer pain. OBJECTIVES We explored patient approaches to managing chronic cancer pain with long-acting opioids. METHODS In a multimethods study at an academic medical center, adult patients with chronic cancer pain (n = 17) used electronic pill caps to record adherence to prescribed long-acting opioid regimens. After eight weeks, patients viewed their adherence records and completed a semistructured interview about their opioid use. With a framework approach, we coded interview data (Kappa >0.95) and identified themes in how patients perceived and used opioids to manage cancer pain. RESULTS Patients (59% female; 94% non-Hispanic white; median age = 65 years) felt grateful about pain benefit from opioids yet concerned about opioid side effects and addiction/tolerance. Main reasons for nonadherence included both intentional decisions (e.g., skipping doses) and unintentional barriers (e.g., missing doses due to inconsistent sleep schedules). Overall, patients set their own opioid adherence goals and developed routines to achieve them. Residual pain varied and was not consistently linked with opioid adherence. CONCLUSION Patients commonly felt conflicted about using prescribed long-acting opioids to manage cancer pain due to concurrent perceptions of their risks and benefits, and they set their own parameters for opioid-taking practices. Intentional and unintentional deviations from prescribed opioid schedules highlight the need to enhance adherence communication, education, and counseling, to optimize the use of long-acting opioids as a component of cancer pain management.
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Affiliation(s)
- Emily M Wright
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Alaina Carr
- Department of Psychology, University of Colorado Denver, Denver, Colorado, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Elyse R Park
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - William F Pirl
- Harvard Medical School, Boston, Massachusetts, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Lara Traeger
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
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22
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Abstract
OBJECTIVES To provide an overview of the global disparities in cancer pain management. To discuss cultural, religious, and spiritual considerations in cancer pain assessment and management. DATA SOURCES Peer-reviewed articles, book chapters, Internet. CONCLUSION Significant disparities in pain management exist globally, especially in developing countries. Cultural and religious differences influence pain care and opioid availability is lacking in many countries. Significant barriers impede good pain management; however, some countries have made positive strides in improving pain management for their population. IMPLICATIONS FOR NURSING PRACTICE Globally, nurses have a vital role in recognizing and addressing barriers to good pain management and can be ambassadors to advocate for improved pain assessment and management globally.
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Affiliation(s)
- Gülbeyaz Can
- Istanbul University - Cerrahpasa, Florence Nightingale Nursing Faculty, Abide-i Hurriyet Cad, Caglayan, Istanbul, Turkey
| | - Tayreez Mushani
- University Health Network, Toronto, ON, Canada; Aga Khan University School of Nursing and Midwifery, Nairobi
| | | | - Jeannine M Brant
- Collaborative Science and Innovation, Billings Clinic, Billings, MT, USA.
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23
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Erol O, Unsar S, Yacan L, Pelin M, Kurt S, Erdogan B. Pain experiences of patients with advanced cancer: A qualitative descriptive study. Eur J Oncol Nurs 2018; 33:28-34. [DOI: 10.1016/j.ejon.2018.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/22/2017] [Accepted: 01/08/2018] [Indexed: 01/09/2023]
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24
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Al-Atiyyat NMH, Vallerand AH. Patient-related attitudinal barriers to cancer pain management among adult Jordanian patients. Eur J Oncol Nurs 2018; 33:56-61. [DOI: 10.1016/j.ejon.2018.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 01/20/2018] [Accepted: 01/22/2018] [Indexed: 11/29/2022]
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25
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Garrino L, Borraccino A, Peraudo E, Bobbio M, Dimonte V. “Hosting” an implantable cardioverter defibrillator: A phenomenological inquiry. Res Nurs Health 2017; 41:57-68. [DOI: 10.1002/nur.21842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 10/27/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Lorenza Garrino
- Department of Public Health and Paediatrics; University of Torino; Torino Italy
| | - Alberto Borraccino
- Department of Public Health and Paediatrics; University of Torino; Torino Italy
| | | | - Marco Bobbio
- Department of Public Health and Paediatrics; University of Torino; Torino Italy
| | - Valerio Dimonte
- Department of Public Health and Paediatrics; University of Torino; Torino Italy
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26
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Neufeld NJ, Elnahal SM, Alvarez RH. Cancer pain: a review of epidemiology, clinical quality and value impact. Future Oncol 2017; 13:833-841. [DOI: 10.2217/fon-2016-0423] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cancer-related pain, reported by more than 70% of patients, is one of the most common and troublesome symptoms affecting patients with cancer. Despite the availability of effective treatments, cancer-related pain may be inadequately controlled in up to 50% of patients. With the growing focus on ‘value’ (healthcare outcomes achieved per dollar spent) in healthcare, the management of cancer-related pain has assumed novel significance in recent years. Data from initiatives that assess the quality of pain management in clinical practice have shown that effective management of cancer-related pain improves patient-perceived value of cancer treatment. As a result, assessment and effective management of cancer-related pain are now recognized as important measures of value in cancer care.
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Affiliation(s)
| | - Shereef M Elnahal
- Department of Radiation Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
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27
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Meghani SH, Knafl GJ. Salient concerns in using analgesia for cancer pain among outpatients: A cluster analysis study. World J Clin Oncol 2017; 8:75-85. [PMID: 28246587 PMCID: PMC5309716 DOI: 10.5306/wjco.v8.i1.75] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 12/01/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To identify unique clusters of patients based on their concerns in using analgesia for cancer pain and predictors of the cluster membership.
METHODS This was a 3-mo prospective observational study (n = 207). Patients were included if they were adults (≥ 18 years), diagnosed with solid tumors or multiple myelomas, and had at least one prescription of around-the-clock pain medication for cancer or cancer-treatment-related pain. Patients were recruited from two outpatient medical oncology clinics within a large health system in Philadelphia. A choice-based conjoint (CBC) analysis experiment was used to elicit analgesic treatment preferences (utilities). Patients employed trade-offs based on five analgesic attributes (percent relief from analgesics, type of analgesic, type of side-effects, severity of side-effects, out of pocket cost). Patients were clustered based on CBC utilities using novel adaptive statistical methods. Multiple logistic regression was used to identify predictors of cluster membership.
RESULTS The analyses found 4 unique clusters: Most patients made trade-offs based on the expectation of pain relief (cluster 1, 41%). For a subset, the main underlying concern was type of analgesic prescribed, i.e., opioid vs non-opioid (cluster 2, 11%) and type of analgesic side effects (cluster 4, 21%), respectively. About one in four made trade-offs based on multiple concerns simultaneously including pain relief, type of side effects, and severity of side effects (cluster 3, 28%). In multivariable analysis, to identify predictors of cluster membership, clinical and socioeconomic factors (education, health literacy, income, social support) rather than analgesic attitudes and beliefs were found important; only the belief, i.e., pain medications can mask changes in health or keep you from knowing what is going on in your body was found significant in predicting two of the four clusters [cluster 1 (-); cluster 4 (+)].
CONCLUSION Most patients appear to be driven by a single salient concern in using analgesia for cancer pain. Addressing these concerns, perhaps through real time clinical assessments, may improve patients’ analgesic adherence patterns and cancer pain outcomes.
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Riedl G, Radbruch L. [Complex pain therapy: if the right hand does not know what the left hand does - A case report]. Wien Med Wochenschr 2015; 165:472-6. [PMID: 26572624 DOI: 10.1007/s10354-015-0401-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 10/29/2015] [Indexed: 11/29/2022]
Abstract
In this case report difficulties in cancer pain therapy are highlighted which can make adequate pain relief difficult. In addition to compliance, the main factor in this case report related to the patient, organizational setting and technological developments in recent years have become increasingly important. The transfer in storing medical records from paper version to a digital file has already started, and due to increasing amounts of data is also without alternative, though there is a lack of compatibility of the available information technology (IT) systems in Austria as well as across the borders in Europe. This often impedes continuous care to cancer patients, because this patient population is often treated by physicians in different settings and various disciplines. In particular, changes in the analgesic regimen to optimize pain relief in an inpatient setting sometimes cause problems when the medicines have to be prescribed subsequently in a private practice.Based on the available literature, the need for electric data collection in the health system and close networking with general practitioners and other physicians working in private practice will be discussed especially with regards to the medication. This is not only sensible and necessary in order to increase transparency and traceability of medical prescriptions, but also to minimize medical errors and avert harm to the patient.
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Affiliation(s)
- Gunther Riedl
- Praktischer Arzt beim mobiles Palliativteam Baden, Mühlgasse 74, 2500, Baden, Österreich.
| | - Lukas Radbruch
- Palliativmedizin am Universitätsklinikum Bonn und Zentrums für Palliativmedizin am Malteser Krankenhaus Bonn/Rhein-Sieg, Bonn, Deutschland
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