Cancer Pain in End of Life Cancer Patients - Research Paper Example

? Cancer pain in end of life cancer patients Ferrel, B., Levy, M.H. And Paice, J. (2008) Managing pain from advanced cancer in the palliative caresetting, Clinical Journal of Onchology Nursing, 12 (4), 575-81. This article stresses upon the need of “managing complex pain at the end of life” and assuming that best care to such patients can be given only by understanding the “physiological sources of pain”, utilizes an interdisciplinary team to assess the “physiological, social and spiritual factors” involved (Ferrel, Levy and Paice, 2008, p.575). A single case study of a 58-year old woman suffering from advanced ovarian cancer, is considered in this study for in depth analysis. The article has pointed to the lacuna that exists in pain management in terms of interdisciplinary intervention and also the need for integration of “physical, physiological, social, and spiritual well-being” so that the patient experiences “comfort (…) (and) dignity (…) at the end of life” (Ferrel, Levy and Paice, 2008, p.575). The article has prepared a step by step, scientific methodology for pain assessment and intervention strategies and based on this methodology, has thoroughly examined the case and provided care as the multidisciplinary team went on recording and analyzing the interventions as well. The study has utilized a standardized scale to assess pain, used four basic approaches to pain relief that includes, “modify the source(s) of pain(s)(,) alter the central perception of pain(,) modulate transmission of pain to the central nervous system(,) (and) block transmission of pain to the central nervous system (Ferrel, Levy and Paice, 2008, p.575-577). It has also made use of approved methods of pharmacological management of pain including co-analgesic therapy (Ferrel, Levy and Paice, 2008, p.577). As “5,70,000 people, who die from cancer, each year in the United States”, are in need of similar end of life care to manage pain, this article is crucial in suggesting an interdisciplinary approach, incorporation of physical, physiological, spiritual and social aspects into the intervention plan and also stressing upon the co-analgesic therapy approach (Ferrel, Levy and Paice, 2008, p.581). These three aspects of pain management in end of life cancer patients, is what this researcher also intends to propose. 2. Fayers, P.M., Hjermstad, M.J., Klepstad, P., Loge, J.H., Caraceni, A., Hanks, G.W. ...Kaasa, S. (2011), The dimensionality of pain: Palliative care and chronic pain patients differ in their reports of pain intensity and pain interference, Pain, 152 (7), 1608-20. This article has drawn attention to the importance of accurate assessment of pain in palliative care (Fayers et al., 2011, p.1608). This is observed in the context that different chronic pain patients report the intensity of pain in different degrees (Fayers et al., 2011, p.1608). This study has made use of quantitative methodology to assess pain in chronic pain patients and carried out a questionnaire survey of a sample of such patients. By carrying out a psychometric analysis of the data collected, this article has provided statistical information based on which, two main dimensions of pain have been identified, namely, “intensity and interference” (Fayers et al., 2011, p.1608). It is inferred that in order to have a “higher-level summary measure of patient's pain experience”, the two dimensions, intensity and interference both have to be assessed in a distinct manner (Fayers et al., 2011, p.1608). Though this article does not directly deals with the proposed change put forth by this researcher, it provides crucial information on the nature and factor influencing reported pain in palliative patients. Yet, this article does not provide information on morbidity, mortality, and rate of incidence or rate of occurrence in the general population, of this problem. 3. Kumar, S.P. (2011), Reporting characteristics of cancer pain: A systematic review and quantitative analysis of research publications in palliative care journals, Indian Journal of Palliative Care, 17 (1), 57-66. This article has identified cancer as a “global health burden” and has reviewed all existing important scientific literature on palliative care to find out whether there exists “adequate scientific research base on cancer pain” (Kumar, 2011, p.57). The review research has been adopted by this study as its methodology and this qualitative research article is based on “search conducted in MEDLINE and CINAHL (...) to locate all studies published in 19 palliative/ hospice/ supportive/ end-of-life care journals from 2009 to 2010” (Kumar, 2011, p.57). It is through finding out the percentage of studies on cancer pain among the total studies published in this sample that the researcher has arrived at the conclusion, there is a deficiency in cancer pain research (Kumar, 2011, p.57). It is found out that only 5.86% of the research published in this time period and these journals, is on cancer pain, pointing to the lack of adequate scientific research. This research article has suggested, it is only through further research on cancer pain that “appropriate guidelines for cancer pain management can be developed” (Kumar, 2011, p.57). Though this article has not provided statistical information on the morbidity, mortality, and rate of incidence of cancer pain in the general population, it supports the proposed change put forth by this researcher by pointing to the inadequacy of cancer pain research. This is also important because the very context of the research study that this researcher proposes is this very inadequacy. 4. Fine, P., Herr, K., Titler, M., Sanders, S., Cavanaugh, J., Swegle, J. ...Reyes, J. (2010), The cancer pain practice index: A measure of evidence-based practice adherence for cancer pain management in older adults in hospice care, Journal of Pain and Symptom Management, 39 (5), 791-802. The context of this study, as described by this article is that “systematic evaluations or methodologically sound studies of adherence to pain management practice guidelines within Medicare-certified hospice programs are lacking” (Fine et al., 2010, p.791). The lack of pain management guidelines for cancer pain management is an area that this researcher also proposes to investigate and hence this article is significant to that research (Fine et al., 2010, p.791). Especially this article has pointed to the importance of evidence-based practice, a proposition that this researcher also intends to make (Fine et al., 2010, p.791). This article has developed a tool that can be used to “create a consolidated score for comparative and quality improvement purposes” in cancer pain management, thereby deriving a quantitative methodology to assess and manage cancer pain. In turn, this tool can be considered as an effective instrument to describe the nature of the problem, and address the deficit that exists in that realm (Fine et al., 2010, p.791). The article has also provided information about the degree and gravity of the problem in the general population. It has pointed out that among those who use hospice services, the percentage of whom have risen to 40% in the past ten years, “pain and related symptom distress are highly prevalent” (Fine et al., 2010, p.791). 5. Syrjala, K.L., Abrams, J.R., Polissar, N.L., Hansberry, J., Robinson, J., DuPen, S. ...DuPen, A. (2008), Patient training in cancer pain management using integrated print and video materials: a multisite randomized controlled trial, Pain, 135 (1-2), 175-186. Syrjala et al. (2008), in this article, have focused on the role of patient training in cancer pain management. They (Syrjala et al., 2008) have started their article by pointing to the need of reducing professional time in cancer pain management all the same not compromising quality of care and even “achieving sustained intervention effectiveness” (p.175). The research methodology adopted was quantitative using the multiside, randomized, controlled trial method (Syrjala et al., 2008, p.175). Trained patients' experience of pain was measured as against a control group and statistical data was generated and video and print material was used for training meant for data collection (Syrjala et al., 2008, p.175). This article has anchored itself on the premise that though the role of patient training as an effective tool to control cancer pain is an acknowledged fact, there is a lack of effective strategies to maintain a “sustained impact” (Syrjala et al., 2008, p.175). It is also noted that “a barrier to the adoption of routine patient pain training is the professional time required” (Syrjala et al., 2008, p.175). Especially, this article has discussed the usefulness of video materials in patients training, a point that this researcher also envisages incorporating into the intervention strategies proposed. 6. Yennurajalingam, S., Kang, J.H., Hui, D., Kang, D.H., Kim, S.H. And Bruera, E. (2012) Clinical response to an outpatient palliative care consultation in patients with advanced cancer and cancer pain, Journal of Pain and Symptom Management, 44 (3), 340-50. This article presents focused data on “outcomes of palliative care consult on cancer pain treatment at the first follow-up visit” and has pointed to the inadequacies in pain management of patients with cancer pain in their first follow up visit (Yennurajalingam, Kang, Hui, Kang, Kim, and Bruera, 2012, p.340). The methodology followed in this paper is quantitative secondary data analysis. The huge size of the sample selected has imparted great credibility and validity to this research effort as: Data from consecutive patients (n=1612) who were referred to the outpatient Supportive Care Center at The University of Texas M. D. Anderson Cancer Center and completed the Edmonton Symptom Assessment System at their initial and subsequent visits from January 2003 to December 2010 were reviewed ( Yennurajalingam, Kang, Hui, Kang, Kim, and Bruera, 2012, p.340). The data thus generated is also important in the sense that all patients involved were given interdisciplinary care ( Yennurajalingam, Kang, Hui, Kang, Kim, and Bruera, 2012, p.340). The findings of this study indicate that there is a deficiency in pain relief support for cancer patients. The article does not provide detailed statistical information on the rate of occurrence of the problem in the general population but has alluded to the context of cancer patient not getting enough care and pain relief. This article has adopted a methodology that is coherent with evidence-based practice and by pointing to the lacunae in the area involved, and also to the need for further research, it validates the proposed research by this researcher. 7. King, S., Forbes, K., Hanks, G.W., Ferro, C.J. and Chambers, E.J. (2011), A systematic review of the use of opioid medication for those with moderate to severe cancer pain and renal impairment: A European Palliative Care Research Collaborative opioid guidelines project, Palliative Medicine, 25 (5), 525-552. The use of opioids in cancer pain management has been a controversial issue and any research effort regarding cancer pain has to deal with this controversy. It is in this context that the article written by King, Forbes, Hanks, Ferro and Chambers (2011) gains relevance for the study proposed by this researcher. It is the “adverse effects” of the use of opioids that have led to opposing views on their use (King, Forbes, Hanks, Ferro and Chambers, 2011, p.525). This study has utilized the qualitative, narrative systematic review and metaanlysis methodology to generate relevant data and arrive at conclusions. This article has weighed the pros and cons of the use of opioids in cancer pain management through data analysis and revealed that there is no quality-evidence to support the use of opioids (King, Forbes, Hanks, Ferro and Chambers, 2011, p.525). This study has also put forth recommendations based on the comparative negative effects of specific opioids, thereby providing this researcher, some basic assumptions to start with. 8. Capewell, C.M.R., Gregory, W., Clos, S.J., and Bennett, M.I. (2010), Brief DVD-based educational intervention for patients with cancer pain: feasibility study, Palliative Medicine, Retrieved from http://pmj.sagepub.com/content/early/2010/06/17/0269216310371704.abstract This article is also about patient training and the use and effectiveness of video material for it (Capewell, Gregory, Clos and Bennett, 2010). It has identified “patient attitudes and knowledge regarding cancer pain and strong opioid analgesia” as hurdles before good management of cancer pain (Capewell, Gregory, Clos and Bennett, 2010). This is a premise that this researcher also want to anchor her study in. It is also pointed out that though the significance of patient training has been well-approved in oncology outpatients, the case of patients in critical condition has not been duly researched and intervention strategies formulated (Capewell, Gregory, Clos and Bennett, 2010). The use of DVDs is the specific focus of this study with respect to cancer patient training and to prove the effectiveness of this particular category of material, a randomized controlled clinical trial is carried out (Capewell, Gregory, Clos and Bennett, 2010). This follows the tradition of experimental quantitative research. The findings suggest that the use of DVDs is an effective intervention strategy (Capewell, Gregory, Clos and Bennett, 2010). This article has not provided statistical information on the degree of prevalance of the problem but has accepted the problem as having a high level of occurance (Capewell, Gregory, Clos and Bennett, 2010). This study is relevant to the proposed study in that it deals with the training aspect, which will be part of the intervention strategies included in the proposed study. 9. Bhatnagar, S. (2011), Individualized interventional pain management technique in early stage of cancer pain: A desirable protocol for improving quality of life, Indian Journal of Palliative Care, 17 (2), 91. This article has elaborately dealt with the topics of pain and pain management, and hence present ample background information to start with the proposed research (Bhatnagar, 2011). The different aspects of “interventional pain treatment” are delineated and different intervention strategies for different kinds of cancer are also discussed specifically (Bhatnagar, 2011, p.91). Though this article is not based on scientific research methods but only a compilation of scientific information available, it has presented this information in the form of a “protocol for improving quality of life” (Bhatnagar, 2011, p.91). By focusing on the early intervention options, this article has also provided relevant information that can be used in formulating the intervention strategies in the proposed research research. 10. Dulko, D. Hertz, E., Julien, J., Beck, S. and Mooney, K., (2010), Implementation of cancer pain guidelines by acute care nurse practitioners using an audit and feedback strategy, Journal of the American Academy of Nurse Practitioners, 22 (1), 45-55. This article has pointed to the inadequacy in cancer pain management noting down that “despite the availability of clinical practice guidelines (CPGs) for cancer pain, consistent integration of these principles into practice has not been achieved” (Dulko, Hertz, Julien, Beck and Mooney, 2010, p.45). It is an “optimal method” for the application of clinical practice guidelines that this research paper has attempted to find out (Dulko, Hertz, Julien, Beck and Mooney, 2010, p.45). The methodology followed by this article is quantitative using two patient groups, one assigned as intervention group and one kept as control group (Dulko, Hertz, Julien, Beck and Mooney, 2010, p.45). The study is particularly about the effectiveness of “an audit and feedback (A/F) intervention” with respect to the implementation of clinical practice guidelines by nursing practitioner, and also in relation to “hospitalized patients' self-report of pain and satisfaction with pain relief” (Dulko, Hertz, Julien, Beck and Mooney, 2010, p.45). The results of this study suggest that audit and feedback intervention can positively influence nurses' adherence to clinical practice guidelines (Dulko, Hertz, Julien, Beck and Mooney, 2010, p.45). The findings also showed a reduction in pain interference and more patient satisfaction with respect to pain relief (Dulko, Hertz, Julien, Beck and Mooney, 2010, p.45). This article can provide crucial information to the proposed research regarding intervention strategies from the angle of nursing profession. Though this article does not provide much information on the prevalence of the problem in the general population, indirectly it has admitted to the same, by stressing upon the urgent need for intervention (Dulko, Hertz, Julien, Beck and Mooney, 2010, p.45). 11. Rustoen, T., Gaardsrud, T., Leegaard, M. and Wahl, A.K. (2009) Nursing pain management--a qualitative interview study of patients with pain, hospitalized for cancer treatment, Pain Management Nursing, 10 (1), 48-55. This article has explored pain management in the backdrop of evidence-based nursing (Rustoen, Gaardsrud, Leegaard and Wahl, 2009, p.48). The study carried out has been done in hospitalized patients and the sampling method for this study that combines qualitative and quantitative methods, has been a combination of stratified and cluster sampling (Rustoen, Gaardsrud, Leegaard and Wahl, 2009, p.48). Once the sample was selected, data were collected through in depth interviews and qualitative description methods (Rustoen, Gaardsrud, Leegaard and Wahl, 2009, p.48). This study offers certain crucial facts that are relevant to the proposed study. One such information is that patients often find it difficult to assess their nursing requirements and expectations with respect to cancer pain management (Rustoen, Gaardsrud, Leegaard and Wahl, 2009, p.48). This information points to the need for developing new strategies while conducting research on the topic with a patient-oriented approach. Yet this article has summarized the most important benchmarks of patient satisfaction as, “1) being present and supportive; 2) giving information and sharing knowledge; 3) taking care of medication; and 4) recognizing the pain” (Rustoen, Gaardsrud, Leegaard and Wahl, 2009, p.48). This finding can be used as a primary guideline while assessing patient perception of cancer pain management in the proposed research. This study also supports the position taken by the proposed research in suggesting that there needs to be improvement in nurses' awareness of their role in cancer pain management. One drawback of this study is that it does not provide any statistical information on the degree of occurrence of the given problem in the general population. 12. Miaskowski, C. (2010) Outcome measures to evaluate the effectiveness of pain management in older adults with cancer, Oncology Nursing Forum, 37 Suppl., 27-32. This is a very important study relevant to the proposed research. This article uses a combination of qualitative research methodologies to make an assessment of the “most appropriate outcome measures to determine the effectiveness of pain management plans in older adults with cancer” (Miaskowski, 2010, p.27). Without going into the data on the degree of prevalence of cancer pain among the total population, this article has started its investigation on the premise that this is an issue worth addressing (Miaskowski, 2010, p.27). It is stated that “unrelieved chronic pain can have a significant impact on older adults' activity levels and their ability to function” (Miaskowski, 2010, p.27). It is also reminded that “effective pain management in older adults requires a comprehensive approach, including assessment of functional outcomes” (Miaskowski, 2010, p.27). This is a basic assumption that the proposed research shares with this article. By adopting the qualitative methodologies in a combination mode, this article has been able to do in depth investigation on the topic concerned. By adding data and knowledge gathered from clinical experience to the data generated through review research, this article has presented results that are triangulated and validated through that. The outcomes observed by this paper include, “pain relief, physical functioning, emotional functioning, patients' ratings of global improvement and satisfaction with treatment, and symptoms and adverse effects associated with analgesic medications” (Miaskowski, 2010, p.27). In the proposed research, these outcomes can be incorporated as the yardsticks for measurement of the effectiveness of intervention strategies. 13. Coleman, E.A., Coon, S.K., Lockhart, K., Kennedy, R.L., Montgomery, R., Copeland, N., ...Stewart, C. (2009) Effect of certification in oncology nursing on nursing-sensitive outcomes, Clinical Journal of Oncology Nursing, 13 (2), 165-72. This article presents results of a quantitative survey research carried out to assess the differences in quality of care for cancer pain patients, between oncology certified nurses and non-certified nurses (Coleman et al., 2009, p.165). This essay has asserted the importance of oncology certification of nurses who attend to cancer pain patients (Coleman et al., 2009, p.165). The comparatively big size of the sample used for this study is significant in asserting the validity of this study. The Nurses' Knowledge and Attitudes Survey Regarding Pain and the Nausea Management: Nurses' Knowledge and Attitudes Survey, were the tools used in this investigation (Coleman et al., 2009, p.165). The findings “showed that certified nurses followed National Comprehensive Cancer Network guidelines for chemotherapy-induced nausea and vomiting (CINV) management more often than noncertified nurses” (Coleman et al., 2009, p.165). This article has also asserted that “nurses and physicians continuously should be educated on evidence-based guidelines for symptom management of cancer pain and CINV, and a CINV knowledge and attitude assessment tool should be developed” (Coleman et al., 2009, p.165). This study has not provided any information on the gravity of the problem in the society but has moved ahead on the assumption that the prevalence of the problem is a pre-acknowledged fact. This essay imparts the vision of a possible new intervention strategy for cancer pain management by throwing light upon the relevance of certification, a point that the proposed research can explore further. 14. Mair, J. (2009) Caring for people with chronic cancer pain, Journal of Community Nursing, 23 (5), Retrieved from http://www.cabdirect.org/abstracts/20103191291.html;jsessionid=068AB866513E2085DAA99062B77F7607?gitCommit=4.13.11-15-g9672536 This article presents an overall picture of the cancer pain and care scenario (Mair, 2009). It is not a scientific study but only a summary of all available and crucial information on the topic. The different aspects of the topic are comprehensively discussed. The subjects of discussion include, “chronic pain and the cancer patient, assessment of chronic pain, therapeutic interventions, pharmacologic strategies (opioids, non-opioid analgesics and adjuvant drugs), non-pharmacological strategies (physical therapy, psychological therapy), social aspects and spirituality” (Mair, 2009). The role that nurses can play in pain management is also a major focus of this discussion (Mair, 2009). This study has provided detailed description on the prevailing status of the problem in the society (Mair, 2009). It is a comprehensive summary and can provide basic information for the proposed research in understanding the scenario and also formulating key words to search for further literature. 15. Ajello-Laws, L., Reynolds, J., Deyzer, N., Peterson, M., Ameringer, S. and Bakitas, M. (2009) Putting evidence into practice: what are the pharmacologic interventions for nociceptive and neuropathic cancer pain in adults?, Clinical Journal of Oncology Nursing, 13 (6), 649-55. This article also support the assumption of the proposed research that cancer pain remains a not adequately treated and cared for problem in adult patients (Ajello-Laws, Reynolds, Deyzer, Peterson, Ameringer, and Bakitas, 2009, p.649). This article is also an outcome of a project-based experimental and observational research carried out for compiling the pharmacological interventions possible in patients with “nociceptive and neuropathic cancer pain” (Ajello-Laws et al., 2009, p.649). These two aspects of cancer pain being the major ones, this paper offers a comprehensive view on the optimization of pharmacological care (Ajello-Laws et al., 2009, p.649). The study has made a crucial observation that “pain is a nursing-sensitive patient outcome” implying that there are several interpersonal and spiritual aspects to pain management (Ajello-Laws et al., 2009, p.649). As the article goe on evaluating the positive and negative effects of each medicine involved, there is a clear picture presented on the possible options (Ajello-Laws et al., 2009, p.649). This study also has not discussed the degree of prevalence of the problem. It is not also statistical in nature. Yet, the sheer magnitude of the project involved, based on which this study is made, presents a set of valuable data can further be longitudinally analysed for future research purposes. Read More