Journal of pain and symptom management
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J Pain Symptom Manage · Aug 2008
Randomized Controlled Trial Multicenter StudyEfficacy and safety of transdermal buprenorphine: a randomized, placebo-controlled trial in 289 patients with severe cancer pain.
Strong opioids are recommended for treating severe cancer pain in the advanced stages of the disease. Few data are available concerning the efficacy of buprenorphine in cancer pain. We compared transdermal buprenorphine 70 microg/h (BUP TDS) to placebo in an enriched design study. ⋯ This result was supported by a lower daily pain intensity, lower intake of buprenorphine sublingual tablets and fewer dropouts in the BUP TDS group. The incidence of adverse events was slightly higher for BUP TDS. In conclusion, BUP TDS 70 microg/h is an efficacious and safe treatment for patients with severe cancer pain.
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J Pain Symptom Manage · Aug 2008
Multicenter Study Clinical TrialAssessing analgesic regimen adherence with the Morisky Medication Adherence Measure for Taiwanese patients with cancer pain.
The purposes of this study were (1) to examine the psychometric properties of the Taiwanese version of the Morisky Medication Adherence Measure (MMAM), including its validity and reliability, (2) to investigate levels of analgesic regimen adherence, and (3) to explore the predictors of adherence to the analgesic regimen in a sample of Taiwanese cancer patients with pain. One hundred thirty-five patients receiving analgesics for cancer pain participated in this study. Instruments consisted of the Taiwanese version of the MMAM, the Barriers Questionnaire-Taiwan form, the Chinese version of the Brief Pain Inventory, the American Pain Society Outcome Questionnaire, Karnofsky Performance Status, and a demographic questionnaire. ⋯ The model accounted for 63% of the variance in the medication adherence score. The Taiwanese version of the MMAM shows excellent reliability and validity. The use of this reliable, valid, simple, and easily administered tool can improve communication between patients and clinicians about use of analgesics and further improve the analgesic regimen adherence.
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J Pain Symptom Manage · Aug 2008
Controlled Clinical TrialPain, distress, and adult-child interaction during venipuncture in pediatric oncology: an examination of three types of venous access.
This study examined pain and distress from needles in children undergoing blood sampling as a function of adult-child interaction and type of venous access (i.e., central external venous lines, internalized ports, or peripheral access via venipuncture). Participants were 55 pediatric oncology patients, aged 3-18 years, who were undergoing routine blood work. Pain ratings were obtained using the Faces Pain Scale-Revised (FPS-R) and conversation during the procedure was audio taped for coding using the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R). ⋯ Results of the transcribed CAMPIS-R data indicate that the influences in adult-child interaction are bidirectional. Support was found for the well-established positive relationship between child distress and adult reassurance and empathy. Implications for intervention and selection of central venous access devices are discussed.
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J Pain Symptom Manage · Aug 2008
Clinical TrialMeeting the communication and information needs of chronic heart failure patients.
There is a lack of evidence on how best to meet policy guidance in fulfilling the information needs of patients with chronic heart failure (CHF) and their families. We aimed to generate guidance for appropriate information provision to CHF patients and their families through a cross-sectional qualitative methodology with constant comparison of emergent themes. Participants were 20 CHF patients (New York Heart Association Functional Classification III, III-IV, and IV); 11 family carers; six palliative care staff; and six cardiology staff. ⋯ We identified four types of barriers to the discussion of disease progression: disease-specific; patient-specific; specialism-specific; and staff time and resources. This is the first study to integrate cardiology, palliative care, and patient and family views to develop feasible recommendations on meeting information needs. Three recommendations for hospital-based clinical practice were generated from the data: (1) improved methods of providing information; (2) introduction of mutual education and joint working; and (3) development of care pathways and referral criteria.
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Palliative care services provided to patients and families vary substantially across hospices. Literature suggests regulation can act as a standardizing force in health care delivery. However, little is known about the effect of regulation on the delivery of palliative care in hospice and whether its effect differs for different types of hospice providers. ⋯ The effect of ownership on certification differences was most apparent for the provision of skilled nursing (prevalence difference in difference=52.4%), spiritual care (prevalence difference in difference=49.6%), and social services (prevalence difference in difference=48.1%). This study is the first to demonstrate the substantial association between the regulation of hospices and the provision of a multidisciplinary range of services to patients and families. It provides valuable insights regarding the potential role of regulation in standardizing the quality of palliative care across the increasingly diverse palliative care programs developing outside of hospice.