Effect of a theory-driven educational intervention on the level of knowledge, attitudes, and assessment practices regarding breakthrough cancer pain (BTCP) management among medical nurses in Hong Kong.

PURPOSE: To examine the effect of an educational intervention intended to improve medical nurses' adherence to breakthrough cancer pain (BTCP) assessment practices and their level of knowledge, attitudes and perceived assessment practices regarding BTCP management. METHODS: Nurses working in a regional hospital were recruited to this quasi-experimental study. The intervention group received a 3-h educational workshop and one session of individual clinical instruction, whilst the control group did not receive any intervention. Chart audits were performed to examine adherence to BTCP assessment practices as the primary outcome. A self-developed questionnaire was used to measure nurses' knowledge, attitudes and perceived assessment practices regarding BTCP management as the secondary outcomes. The chi-square or Fisher's exact test was used to compare the rate of adherence to BTCP assessment practices between groups. A generalised estimating equation was used to compare changes in knowledge, attitudes, and perceived assessment practices between groups over time. RESULTS: One hundred and five nurses completed the study. The chart audits revealed a significantly higher rate of adherence to BTCP assessment practices in the intervention group after the intervention (p < .05). The intervention group exhibited significant positive changes in scores for knowledge (ß = 25.49, p < .001), attitude (ß = 0.98 to 2.81, p < .01), and their perceived assessment practices (ß = 1.33 to 3.14, p < .002) when compared with the control group. CONCLUSIONS: This theory-driven educational intervention significantly improved the medical nurses' adherence to BTCP assessment practices and their level of knowledge attitudes and perceived assessment practices regarding BTCP management.

Effectiveness of advanced nursing care (ANC) on bone cancer pain, psychological disorders and quality of life in patients with primary bone cancers: A protocol for a PRISMA-compliant meta-analysis.

BACKGROUND: Advanced nursing care (ANC) has been reported to effectively relieve bone cancer pain, prevent psychological disorders and improve the quality of life (QoL) in patients with primary bone cancers (PBC) during the treatment. However, the exact effect of ANC remains controversial. This systematic review will aimed to assess the effectiveness of ANC on bone cancer pain, psychological disorders and QoL in patients with PBC. METHODS: Eligible randomized controlled trials (RCTs) and high-quality prospective cohort studies were searched from Excerpt Medica Database (Embase), PubMed, Google Scholar, Medline, Cochrane Library, Web of Science (WOS), China National Knowledge Infrastructure (CNKI), Chinese Bio Medical Database (CBM), China Scientific Journal Database (CSJD), and Wanfang Database. Papers in English or Chinese published from January 2000 to July 2020 will be included without any restrictions. The clinical outcomes including bone cancer pain, psychological disorders, QoL, and adverse events of ANC in patients with PBC were systematically evaluated.Two reviewers will separately carry out study selection and data extraction. Stata 14.0 and Review Manager 5.3 were used for data analysis. Methodological quality for each eligible clinical trial will be assessed by using Cochrane risk of bias tool. Subgroup and meta-regression analysis will be carried out depending on the availability of sufficient data. RESULTS: This study will comprehensively summarize all potential evidence to systematically investigate the effects and safety of ANC on bone cancer pain, psychological disorders and QoL in patients with PBC. CONCLUSION: The findings of this study will help to determine whether ANC is effective or not on bone cancer pain, psychological disorders and QoL in patients with PBC. INPLASY REGISTRATION NUMBER: INPLASY202090037.

Comparative evaluations of single-item pain-intensity measures in cancer patients: Numeric rating scale vs. verbal rating scale.

AIMS AND OBJECTIVES: To evaluate the psychometric quality of two single-item pain-intensity measures: the Numeric Rating Scale (NRS) and the Verbal Rating Scale (VRS). BACKGROUND: Measuring pain intensity is a vital step in initiating symptom management and evaluating the effectiveness of interventions with cancer patients. Single-item pain-intensity measures of the NRS and VRS format have been evaluated to be acceptable for use in clinical practice and research; however, evidence to choose one over the other, as a standardised pain-assessment format, is insufficient. DESIGN: Descriptive correlational study. The study was guided and reported following the STROBE guideline. METHODS: Data accrued at two time points during cancer treatment with a total of 249 patients treated in a Korean University Hospital. Two single-item measures were constructed to assess pain intensity over 1 week. The Brief Pain Inventory (BPI; pain intensity subscale and interference subscale) and the functional assessment of chronic illness therapy-fatigue were the criterion. Convergent and concurrent validity were tested with Pearson's correlations. RESULTS: In the convergent-validity evaluation of the cross-sectional association with the BPI, the NRS showed a much higher level of association than the VRS (0.81 versus 0.61). In convergent validity with a longitudinal association with the BPI, the NRS score change had a much higher level of association (0.61 versus 0.37). In concurrent-validity evaluation, the NRS and VRS showed similar levels of associations with fatigue (-0.48 versus -0.49). Yet, the NRS showed statistically higher levels of correlation with functional limitations than the VRS (0.55 versus 0.42), comparable to the concurrent validity of the BPI. CONCLUSION: The NRS showed higher validity than VRS when assessing overall pain intensity over the past week. RELEVANCE TO CLINICAL NURSING: Pain assessment is a vital role of nurses in caring for patients with cancer. Current study findings support the use of the single-item NRS pain measure to assess global pain intensity over the past week.

Barriers to Cancer Pain Management Among Nurses in Kenya: A Focused Ethnography.

BACKGROUND: Up to 80% of cancer patients in Kenya suffer from untreated moderate to severe pain. AIM: This study explored barriers to cancer pain management among nurses caring for oncology patients in Kenya. This was part of a larger study whose primary objective was to understand the role of nursing subculture on cancer pain management. DESIGN: A focused ethnographic was used in this study. SETTINGS: An oncology private unit in large referral hospital in Kenya. PARTICIPANTS: Twenty-five (n = 25) nurses participated in this study. METHODS: Semi- structured interviews and observations were used to collect data. Nurses were recruited through purposive, snowball sampling strategy. Content analysis led to identification of key barriers to optimal cancer pain management. RESULTS: Organizational, cognitive, professional and patient/family related barriers to cancer pain management were noted. Specifically, barriers such as lack of accessibility to pain management guidelines and training, professional collaboration, restrictive dispensing guidelines, and opioid related fears were identified. CONCLUSIONS: Interventions should streamline palliative care training and implementation of pain management guidelines in both units. Interventions should consider the influence of different subcultures while implementing pain management policies and training.

Analysis of Unscheduled Telephone Calls Received by a Specialized Cancer Pain Nurse.

BACKGROUND: A key to successful symptom management in patients with cancer is to adapt the treatment to patient needs and complexities in an individual and dynamic manner. Rapid access to a clinician via telephone consultation supports treatment compliance, safety, and effectiveness and reduces the number of patients unnecessarily consulting emergency departments. AIMS: To define the role of a cancer pain nurse in the management of unscheduled phone calls to the clinic. DESIGN: The study is a retrospective analysis of unscheduled phone calls received at an outpatient cancer pain clinic. Details collected included caller identification, reasons for the call, and interventions provided. Actions taken after analysis of the nature of calls are discussed. SETTINGS: Retrospective chart analysis. PARTICIPANTS/SUBJECTS: Medical charts of patients seen at the cancer pain clinic. METHODS: During three consecutive months, 102 unscheduled telephone calls fulfilling research criteria were analyzed. Seventy-four percent were initiated by patients or carers. In 46% and 45% of the calls, respectively, the reason for the call was to report a symptom or concern about the treatment. RESULTS: Pain was the most common reported symptom (59.6%) followed by side effects (23.4%). The most frequent inquiry about medications concerned renewal of prescriptions (47.8%). The most common intervention was related to patients' treatments (74.5%), and it included an element of teaching in 51.3% of calls. In one third of cases, a prescription was changed after the call. The nurse was able to provide the intervention without involving a doctor in 87.3% of calls. Several changes were initiated after the analysis to decrease unnecessary calls to the nurse. CONCLUSIONS: A telephone call service available for patients and other clinicians is an efficient way to enhance continuity of care for ambulatory patients. Continued efforts to make such a service cost effective must be implemented.

An Overview of Cancer Pain: Epidemiology and Pathophysiology.

OBJECTIVE: To present an overview of the epidemiology and pathophysiology of cancer pain related to disease and treatment. DATA SOURCES: Published manuscripts, Web sites, and textbook chapters. CONCLUSION: Current knowledge of cancer pain epidemiology and pathophysiology widens and focuses the opportunities to prevent, limit, and treat cancer pain. IMPLICATIONS FOR NURSING PRACTICE: Nurses' knowledge of transduction, transmission, perception, and modulation in cancer pain pathophysiology outlines pathways for multimodal approaches to treat complex and diverse pain experiences. Use of standard vocabulary of pain terms and definitions facilitates pain assessment and management across different disciplines.

Nurses' knowledge, perceived barriers, and practices regarding cancer pain management: a cross-sectional study from Palestine.

BACKGROUND: Accurate knowledge and good pain evaluation and documentation practices should be present for efficient pain management. In this study, we aimed to assess the knowledge and practices of nurses relating to the management of cancer pain in Palestine, and to determine the barriers to efficient pain control in cancer patients. METHODS: A cross-sectional survey took place at 8 hospitals across Northern West Bank. A convenience sample of 220 Nurses working in governmental and private hospitals in West Bank/Palestine was studied. For that purpose, a questionnaire was developed to assess knowledge, practices, perceived barriers, and delaying processes relating to cancer pain management (CPM). RESULTS: In total, 220 questionnaires were completed with a response rate of 88%. Participants' mean age was 30.34 years. Overall, 69.5% worked in governmental hospitals, 26.8% worked in the private sector and the remainder worked in both governmental and private sectors. The correct response rate to questions that assess knowledge relating to cancer pain control was calculated and a mean knowledge score was found to be 5.1 with a standard deviation of 2.1. A relationship between the knowledge score and the sample characteristics was made and showed that males scored significantly higher (p = 0.001) than females with median scores of 6 [4-7] and 5 [3-6] for males and females, respectively. Inadequate pain assessment (76.8%), insufficient knowledge of pain control (70.5%) and strict regulation on opioid use (69.5%) were the most frequently perceived barriers. Nurses reported that they would assess pain on every round and check all items related to pain assessment. Contacting the physician for the prescription of opioids was cited as the main delaying process by 56.4% of participants. CONCLUSIONS: This study allowed us to recognise the knowledge deficit and the barriers to effective management. On the other hand, the analysis has shown good pain documentation practices among nurses. Those knowledge deficits demonstrate the need for more education about CPM. The improvement of coordination and communication between physicians and nurses seems to play a crucial role in CPM, as contacting physicians was cited as the most delaying process in CPM by nurses.

Cancer Pain Assessment and Measurement.

OBJECTIVES: To review the incidence of cancer pain; assessment of acute, chronic, and breakthrough pain; and provide insight on assessment approaches and reliable and valid instruments for clinical and research settings. DATA SOURCES: Peer-reviewed journal articles, book chapters, Internet. CONCLUSION: Quality pain management for patients with cancer is dependent on an accurate pain assessment and ongoing reassessment, considering the whole person. Being knowledgeable about evidence-based pain assessment practices is key. IMPLICATIONS FOR NURSING PRACTICE: Concentrated efforts to address pain assessment barriers and effectively report pain assessments in diverse populations are warranted, especially in this current health care environment when pain assessment is challenging.

Pain and Suffering.

OBJECTIVE: To review literature on the relationship of pain, spirituality, and suffering as it relates to the patient with cancer who is experiencing pain. DATA SOURCES: Peer-reviewed articles, textbooks, internet. CONCLUSION: Pain and suffering are distinct and yet closely related in patients with cancer. Oncology nurses are important in assessing a patient's pain, including dimensions of spirituality and suffering. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses are the front line of pain management for patients. This includes recognizing existential distress and suffering and responding to suffering.

Using Cannabis to Treat Cancer-Related Pain.

OBJECTIVE: To describe which cannabinoids and terpenes are effective for treating pain. DATA SOURCES: Peer-reviewed articles, book chapters. CONCLUSION: Cannabis and cannabinoid medicines, as modulators of the endocannabinoid system, offer novel therapeutic options for the treatment of cancer-related pain, not only for patients who do not respond to conventional therapies, but also for patients who prefer to try cannabis as a first treatment option. IMPLICATIONS FOR NURSING PRACTICE: Understanding the endocannabinoid system, cannabinoids, terpenes, routes of administration, potential drug interactions, clinical implications, and potential side effects ensures nurses can better assist patients who use cannabis for the treatment of cancer pain.

Pain Management in the Cancer Survivor.

OBJECTIVES: To describe assessment and interdisciplinary management of pain in the cancer survivor over the continuum of cancer care. DATA SOURCES: Review of the literature and treatment standards. CONCLUSION: Pain remains a primary concern throughout the cancer trajectory across all age groups and diagnoses, emphasizing the need to integrate pain assessment and management across the continuum of cancer survivorship and across care settings. Types of pain, pain patterns, assessment of cancer pain in cancer survivors, current strategies and challenges for management, and effective communication and documentation of the process are described. Communication between and among health care clinicians in a way that effectively articulates the individual patient experience, including documentation in the electronic medical record, requires consistent workflows and terminology. The opioid crisis increases the urgency in effective strategies for interdisciplinary pain assessment and management. IMPLICATIONS FOR NURSING PRACTICE: Oncology clinicians must be able to adequately assess pain, track pain over time, understand and implement a cadre of strategies to manage pain, and effectively pursue any suspicious pain patterns that may indicate recurrence or progression of cancer or other underlying etiologies. The oncology nurse is at the core of patient-clinician communication, critical to effectively describing pain as experienced by the individual patient and continues to play a key role in maintaining consistency of message that is necessary to manage pain over the continuum of cancer survivorship.

Managing Cancer Pain in Patients with Opioid and Substance Use Disorders.

OBJECTIVE: To discuss the assessment and management of pain in patients with substance use disorders. DATA SOURCES: Peer-reviewed articles, book chapters, internet sources. CONCLUSION: Patients should be routinely assessed for SUDs. Pain management should be stratified according to patient risk. An interdisciplinary approach is essential. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses should be aware of assessment approaches to screen and monitor patients with SUDs. Oncology nurses are an essential part of the interdisciplinary team when monitoring patients with SUDs.

Perspectives on Cancer Pain Assessment and Management in Children.

OBJECTIVE: To report evidence regarding pain assessment and management for children and adolescents receiving treatment for cancer. DATA SOURCES: Published research and clinical guidelines. CONCLUSION: Children and adolescents experience multiple sources of pain across the cancer continuum. They require developmentally relevant approaches when assessing and managing pain. This review suggests that consideration of the developmental stage and age of the child are essential in both pain assessment and pain management. IMPLICATIONS FOR NURSING PRACTICE: Pediatric oncology nurses play a key role in developmentally appropriate pain assessment, identification of potential strategies to manage pain, and delivery of pharmacologic and nonpharmacologic therapies.

Cancer Pain Management Considerations in Older Adults.

OBJECTIVE: To address the pharmacokinetics and pharmacodynamics of aging and its impact on the complexities of pain management in older adults with cancer. To describe assessment and nursing strategies for individualized care and side effect management DATA SOURCES: Peer-reviewed articles. CONCLUSION: Cancer pain is a complex problem in older adults because of the variations in aging and alterations in pharmacokinetics and pharmacodynamics. Pain management must be based on thorough assessment, incorporating the unique factors of each patient. Ongoing follow-up is critical to ensure adequate pain control with optimization of functional status. IMPLICATIONS FOR NURSING PRACTICE: Awareness of physiological changes of aging is important in caring for older adults. Oncology nurses can play a key role in the assessment of older adults with cancer and education of patients and caregivers regarding pain medications, side-effects, and oral adherence.

The Use of Ketamine as an Adjunct to Treating Opioid Refractory Cancer-Related Pain in the Emergency Department.

The Research to Practice column is designed to provide advanced practice registered nurses (APRNs) with an analysis of a current research topic with implications for practice change within the emergency care settings. This review examines a recent study conducted by entitled "Ketamine as an adjunct to opioids for acute pain in the emergency department: A randomized controlled trial." The authors conducted a randomized, double-blinded, placebo-controlled trial at a single academic emergency department (ED) to compare standard opioid pain control in the ED population to the use of ketamine in conjunction with opioids in the same population. Participants were randomized into either the ketamine group, receiving 0.1 mg/kg of ketamine in conjunction with an intravenous opioid, or to the control group, receiving an equivalent volume of normal saline in addition to an intravenous opioid. Participants were evaluated for adequacy of pain control, side effects, and level of sedation every 30 min up to the 120-min time point. Data revealed that patients receiving ketamine had a statistically significant lower mean pain score, 0.6512 (p = 0.0083), compared with patients in the control group. The data also showed that patient satisfaction with pain control was similar for the ketamine group and the control group. These and other associated findings have implications for APRN practice, including managing acute pain in the ED setting and preventing hospital admission of acute-on-chronic pain exacerbations in the ED.

Addressing Educational Needs in Managing Complex Pain in Cancer Populations: Evaluation of APAM: An Online Educational Intervention for Nurses.

CONTEXT: Cancer-related pain is associated with significant suffering and is one of the most challenging symptoms to manage. Studies indicate that front-line clinicians often lack the knowledge on best practices in cancer pain management. OBJECTIVES: The current project, a quality improvement (QI) initiative, evaluated the outcome of an online educational intervention for nurses on complex cancer pain management. METHODS: An online 7-module educational intervention, Advanced Pain Assessment and Management, was offered from 2012 to 2017. Pre-post course evaluations included self-reported knowledge and confidence across cancer pain management domains. In-course competency assessments included knowledge examination, online discussion forum participation, opioid dosage calculation assignment, and small-group-based case study. A mixed-model statistical analysis was used to assess pre-post course change in pain management confidence level. RESULTS: In all, 306 nurses from 89 hospitals in Ontario, Canada, were enrolled in the course; 81.4% returned the precourse survey and 71.9% successfully completed the course. The average confidence level on pain management was low at baseline (57.5%) but improved significantly post-course. In-course competency assessments ranged from 81% to 89%. Mixed-model results showed post-course improvements in confidence levels, independent of sociodemographic background, clinical role, and professional educational level. Nurses with longer years of practice and more cancer cases reported greater confidence. CONCLUSION: A facilitator-led online educational intervention focusing on complex cancer pain management can significantly improve nurses' knowledge, confidence, and skills. Low baseline knowledge among nurses highlights the pressing need for health-care organizations to implement cancer pain management training as an integral part of health-care QI initiative.

Cancer Pain Management Among Oncology Nurses: Knowledge, Attitude, Related Factors, and Clinical Recommendations: a Systematic Review.

The current study evaluated the oncology nurse's knowledge, attitude, related factors of cancer-related pain management (CPM), and clinical recommendations for improving knowledge and attitude. In this systematic review, international databases (PubMed, EMBASE, Web of science (WOS), Science Direct, and Scopus) were searched for relevant studies published in English language from March 30, 2000 to March 30, 2018. The quality of the studies was evaluated using the Hoy instrument. Out of 888 initial studies, 12 studies performed on 3574 participants were included in the final stage of the review. Based on the results, most studies indicated that nurses had a poor (n = 4) or moderate (n = 4) knowledge of CPM. The lowest and the highest knowledge levels were 28.5% and 75%, respectively. According to most studies, nurses had a fair (average) (n = 4) or negative (n = 3) attitude toward CPM. The important factors related to the nurses' knowledge of CPM included previous pain-related education programs (n = 7) and having work experience with cancer patients (n = 4). The most important barrier was the deficit in staff's knowledge of pain (n = 2). The important clinical recommendations for improving nurses' levels of knowledge included the implementation of educational programs (n = 9), training programs (n = 3) on CPM and including CPM topics in nursing curricula (n = 5). This systematic review showed that most nurses had poor knowledge of CPM and a fair attitude toward CPM, indicating the importance of considering the barriers to knowledge, strengthening the positive relevant factors, and using clinical recommendations based on clinical guidelines such as including CPM topics in nursing curricula and implementing educational programs on CPM to improve the knowledge, attitude, and skills of oncology nurses. The results of the present study could be used by policymakers to provide care for cancer patients and manage their pain.

A Survey of the Knowledge and Attitudes of Oncology Nurses toward Pain in United Arab Emirates Oncology Settings.

BACKGROUND: Effective cancer pain management mandates precise attitude, assessment, skills, and knowledge. Health professionals' knowledge and attitudes concerning cancer pain management have often been referred to as insufficient. AIMS: This study explored pain knowledge and attitudes of nurses working in oncology settings. SETTING AND PARTICIPANTS: Population 115 oncology nurses working at 2 hospitals in the United Arab Emirates. METHODS: A descriptive, correlational, cross-sectional design was used to examine nurse knowledge and attitudes about pain using the Nurses' Attitude and Knowledge Survey Regarding Pain (NKASRP) survey. NKASRP score differences were examined among nurses with varying demographics, levels of pain education and experience. RESULTS: The mean KASRP was 45%, significantly below the passing score of 80%. Pain management education was not found to have a significant impact on KASRP thus suggesting the need for more effective educational approaches to developing appropriate knowledge and attitudes towards pain among the nurses. No significant differences between sex, educational level, nursing and oncology experience, and nationality or religion were found. INTERPRETATION AND CONCLUSIONS: The study highlights the need for new initiatives targeting nurses working with cancer patients who are likely to experience significant pain. An ongoing need exists for more effective evidence-based educational programs in cancer pain management. Interactive teaching strategies such as on the job training, improvisational learning, and case studies should be tested for their influence on pain knowledge and attitudes and patient outcomes.

Enhancing Cancer Pain Assessment and Management in Hospice.

Pain is one of the most common symptoms in individuals with cancer and is directly associated with significantly reduced quality of life. The purpose of this project was to enhance assessment and management of cancer-related pain for patients in the hospice setting. Nurse attitudes and knowledge about pain were evaluated using the Nurses' Knowledge and Attitudes Survey Regarding Pain before and 6 weeks after an educational program. Nurses completed a pain assessment at each home visit and followed an algorithm based on the National Comprehensive Cancer Network Clinical Practice Guidelines to manage pain. Baseline data were collected on the last 30 patients admitted into hospice with cancer as the primary diagnosis before project implementation. Following the practice change, chart audits of the patients' reported pain and adherence to recommended management were manually extracted from 26 patient records. Results revealed statistically significant differences in acquired knowledge (t = 3.95, P < .05) and attainment of patient-identified pain goals (t = 23.904, P < .05). Patient-reported pain levels decreased by 21%, and comprehensive pain assessment completion rates increased by 10% during the project. Current knowledge of evidence-based pain interventions and a management algorithm improved pain control in patients with cancer.