Women's experience of acute and chronic pain following breast cancer surgery.

AIMS AND OBJECTIVES: To gain knowledge of how women experience pain and pain treatment after breast cancer surgery and to identify areas of pain management that they believe could be improved. BACKGROUND: According to the literature, 20-60% of patients develop chronic pain after breast cancer surgery and treatment. Because of the short length of hospitalisation in Norway, breast cancer patients are left responsible for most of their own pain management. DESIGN: An explorative and qualitative design was chosen. METHODS: In-depth interviews were conducted with eight women who experienced chronic pain rated at 3-5 on a 11-point numerical rating scale one year or more after breast cancer surgery. This study is part of a larger, quantitative study assessing pain after surgery. The interviews were taped, transcribed and analysed according to qualitative content analysis. RESULTS: The interviewees had expected pain in the acute postoperative period, but had not expected that pain would persist. None of the women recalled having received information about pain. They took few analgesics and were generally sceptical about medication, mostly because of earlier reactions to drugs. They received no explanations for and little help with chronic pain. Most of them were active and worked outside the home. CONCLUSIONS: After short hospital stays, adequate information and follow-up after discharge may optimise pain management regimens. Those who develop chronic pain need more information and help to manage their pain. RELEVANCE TO CLINICAL PRACTICE: Finding the appropriate time for information about postoperative pain management is necessary to optimise a good analgesic regimen. Multimodal and aggressive treatment of acute pain should be emphasised.

Last three days of life in the hospital: a comparison of symptoms, signs and treatments in the young old and the oldest old patients using the Resident assessment instrument for palliative care.

BACKGROUND: Knowledge concerning the provision of end of life care to the oldest old hospitalised patients is deficient. AIMS AND OBJECTIVES: To analyse whether there were differences in registered nurses' documentation of the young old vs. the oldest old patients according to symptoms, clinical signs and treatment in the last 3 days of life. DESIGN: Data were collected retrospectively in a cross-sectional comparative study at a hospital between autumn 2007 and spring 2009. Methods. The study included 190 patients: 101 (65-84 years) and 89 (85+). Data were extracted from the patients' electronic records using the Resident Assessment Instrument for Palliative Care (RAI-PC). RESULTS: Falls (OR = 4.01, 95% CI 1.47-10.90) and peripheral oedema (OR = 2.74, 95% CI 1.06-7.11) were significantly more frequent documented in the oldest old patients compared with the young old patients. Delirium was recorded in 15.3% of all patients. CONCLUSION: With the exception of more falls and peripheral oedema in the oldest old patients, this study showed no differences in symptoms and treatment between the young old and the oldest old patients. Delirium was poorly documented compared to other studies. Implications for practice. The oldest old patients have a higher risk of falls in the final phase of life, and fall prevention should be considered.

Health related quality of life in trauma patients. Data from a one-year follow up study compared with the general population.

BACKGROUND: Trauma patients have impaired health-related quality of life (HRQOL) after trauma. The aim of the study was to assess HRQOL during the first year after trauma and hospital stay in trauma patients admitted to an intensive-care unit (ICU) for >24 hours compared with non-ICU trauma patients and the general population, and to identify predictors of HRQOL. METHODS: A prospective one-year follow-up study of 242 trauma patients received by the trauma team of a trauma referral centre in Norway was performed. HRQOL was measured using the Medical Outcomes Study Short Form 36 (SF-36) at 3 and 12 months. RESULTS: The mean age of the cohort was 42.3 years (95% CI, 40.4-44.3 years). The median Injury Severity Score (ISS) was 10, interquartile range 16. The HRQOL improved significantly from the 3 to the 12 months follow up in the trauma patients. However their scores were significantly lower for most subscales of SF-36 compared to the general population. Significant differences between ICU and non-ICU patients at 12 months were observed only for physical functioning and role physical subscales. Optimism was an independent predictor of good HRQOL at 12 months, in all dimensions (beta, 0.95-2.45). A higher depression score at baseline predicted lower HRQOL in four of eight dimensions (beta -1.1 to -1.70). In addition, better physical functioning was predicted by lower age (beta, -0.20), and having head injury (reference) as the most severe injury vs. spine or extremity injuries (beta, -9.49 and -10.85), and better mental health by higher age (beta, 0.21) and being employed or studying before the trauma (beta, 12.27). In addition to optimism good general health was predicted by lower score for post-traumatic stress (PTS) symptoms at baseline (beta, -0.27) and lower ISS score (beta -10.59). CONCLUSIONS: The HRQOL improved significantly from the 3 to the 12 months follow up in our sample. However their scores were significantly lower for most subscales of SF-36 compared to the general population. Significant differences between ICU and non-ICU patients were observed for only two subscales. Better HRQOL at 12 months was predicted mainly by optimism, low score for depression and PTS symptoms at baseline. High ISS predicted low general health exclusively.