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Acute postoperative and cancer-related pain management, Patients´ experiences and perceptions in relation to health-related quality of life and the multidimensionality of pain

Boström, Barbro LU (2003)
Abstract (Swedish)
Popular Abstract in Swedish

Vård och behandling av akut postoperativ och cancer-relaterad smärta: Patienters erfarenheter och uppfattningar i förhållande till hälsorelaterad livskvalitet och smärtans dimensioner



Trots att det finns effektiva behandlingsmetoder för patienter med postoperativ smärta och cancer-relaterad smärta så lider många patienter av smärta. Denna avhandling beskriver patienter med postoperativ smärta samt patienter inom palliativ vård med cancer-relaterad smärta samt deras erfarenheter och uppfattningar av vård och behandling, med avseende på hälsorelaterad livskvalitet och smärtans dimensioner. Både kvalitativa och kvantitativa metoder användes. Datainsamlingen bestod av intervjuer... (More)
Popular Abstract in Swedish

Vård och behandling av akut postoperativ och cancer-relaterad smärta: Patienters erfarenheter och uppfattningar i förhållande till hälsorelaterad livskvalitet och smärtans dimensioner



Trots att det finns effektiva behandlingsmetoder för patienter med postoperativ smärta och cancer-relaterad smärta så lider många patienter av smärta. Denna avhandling beskriver patienter med postoperativ smärta samt patienter inom palliativ vård med cancer-relaterad smärta samt deras erfarenheter och uppfattningar av vård och behandling, med avseende på hälsorelaterad livskvalitet och smärtans dimensioner. Både kvalitativa och kvantitativa metoder användes. Datainsamlingen bestod av intervjuer och frågeformulär; APS Outcome Questionnaire för värdering av smärta, SF:36 för skattning av hälso-relaterad livskvalitet (HRQOL) och ett frågeformulär PC-PCQ för utvärdering av vård av smärta inom palliativ vård. Visuella Analog Skalan (VAS) och Pain-O-Metern (POM) användes för smärtskattning.



Undersökningsgruppen bestod av 100 patienter, andra postoperativa dygnet (studie I) samt 75 patienter med cancer inom palliativ vård (studier II-V). Av dessa 75 patienter inom palliativ vård ingick ett stratifierat urval av 46 patienter i studie III samt ett strategiskt urval av 30 patienter i studie V. Dataanalysen var i huvudsak beskrivande och både parametriska och icke parametriska analysmetoder användes. Fenomenografisk ansats användes i den kvalitativa analysen (studie V).



Resultatet visade att 29 patienter inom postoperativ vård vid intervjutillfället värderade sin smärta till > 3 på VAS medan 79 patienter angav > 3 som värsta smärta senaste 24 timmarna. Ju högre smärtintensitet ju mer missnöjda var patienterna med sjuksköterskans sätt att behandla deras smärta. Alla 100 postoperativa patienter hade uppmanats att säga till vid smärta. Trettiotre patienter ansåg att de fått information om varför det var viktigt att få smärtbehandling.



Av de 75 patienterna inom palliative vård så angav 22 patienter vid intervjutillfället en smärta > 3 med POM-VAS och 47 patienter angav > 3 som värsta smärta senaste 24 timmarna. Den genomsnittliga smärtan senaste 24 timmarna angav 28 patienter till > 3 med POM-VAS. Tjugo-fyra patienter använde orden besvärlig och tröttande medan 6 patienter använde orden torterande, mördande eller fruktansvärd när de beskrev sin emotionella smärta. Vid beskrivning av den sensoriska smärtan så angav 15 patienter den som stickande eller ömmande medan 4 patienter angav smärtan som skärande eller sönderslitande. Patienternas uppfattning om smärtan var ”värk överallt” samt att de önskade bli smärtfria. De uttryckte även en rädsla för ökad smärta. HRQOL var sänkt för patienter med genomsnittssmärta > 3, statistiskt signifikant minskad var fysisk funktion samt antalet månader som patienterna levde efter intervjutillfället. Det visades inga statistiskt signifikanta skillnader avseende HRQOL och smärta beroende på om patienterna vårdades av ett sjuksköterskelett eller läkarlett palliativt vårdteam. Patienterna angav att vården inklusive smärtbehandlingen statistiskt signifikant hade förbättrats när de fick hjälp av ett palliativt vårdteam. Patienterna uttryckte ett behov för kommunikation mellan patient och vårdgivare angående smärta och smärtbehandling samt en planering för hur vården och smärtbehandlingen skulle genomföras. Trots att patienterna uttryckte att de ville klara sig själva så hade de ett starkt behov av stöd, någon att ringa och någon som de kunde lita på.



Alla patienter inom både postoperativ vård och palliativ vård hade ordinerad analgetika vanligen en kombination av Paracetamol, NSAID och opioid. Det förelåg ett statistiskt signifikanta samband mellan smärta vid tid för intervjuerna, värsta smärta och genomsnittssmärta senaste 24 timmarna samt smärta som väcker patienten. Kontinuitet i vården och möjlighet för samtal ökade patienternas känsla av trygghet vilket var viktigt för att patienterna skulle känna att de hade kontroll över smärtbehandlingen. (Less)
Abstract
This thesis describes patients in acute postoperative pain as well as patients with acute cancer-related pain in palliative care, and their experiences and perceptions of pain management in relation to HRQOL and the multidimensionality of pain. A combination of qualitative and quantitative methods was chosen. Data were collected using interviews and questionnaires; APS, SF:36 and a new developed questionnaire PC-PPQ measuring care related to pain management in palliative care. For assessing pain VAS and Pain-o-Meter were used. The study group consisted of 100 patients on their second postoperative day, and of 75 patients with cancer-related pain from two palliative care teams. The result showed that at the time of the interview 29 of the... (More)
This thesis describes patients in acute postoperative pain as well as patients with acute cancer-related pain in palliative care, and their experiences and perceptions of pain management in relation to HRQOL and the multidimensionality of pain. A combination of qualitative and quantitative methods was chosen. Data were collected using interviews and questionnaires; APS, SF:36 and a new developed questionnaire PC-PPQ measuring care related to pain management in palliative care. For assessing pain VAS and Pain-o-Meter were used. The study group consisted of 100 patients on their second postoperative day, and of 75 patients with cancer-related pain from two palliative care teams. The result showed that at the time of the interview 29 of the patients with postoperative pain reported a pain > 3 on VAS and 79 reported VAS > 3 as worst pain past 24 hours. The higher the intensity of pain the less satisfied the postoperative patients were with the nurses´ way of treating their pain. Thirty-three patients stated that they had received information regarding the importance of pain relief. Patients with postoperative pain as well as patients with cancer-related pain had been prescribed analgesics mostly a combination of Paracetamol, NSAID and opioid. Of the 75 patients with cancer-related pain and in palliative care 22 patients reported pain >3 on POM-VAS and 47 patients reported >3 on POM-VAS as worst pain past 24 hours. Twenty-eight patients reported an average pain > 3 on POM-VAS past 24 hours. Twenty-four patients used the words troublesome or tiring when describing their affective pain. Sensory pain was described as prickling or sore by 15 patients. The patients perceived their pain as “aching all over” and expressed a wish for pain relief as well as a fear for increased pain. HRQOL especially physical functioning decreased for patients with average pain > 3. Being cared for by a nurse-led or a physician-led palliative care team indicated no statistically significant differences for patients´ HRQOL or pain intensities. The patients had experienced a statistically significant better care after being referred to a palliative care team, despite that pain control had not been optimized. Patients expressed a need for communication, planning and trust in order to improve pain management. Continuity of care and the opportunity to talk increase the patients feeling of security, as well as improved their perceived pain control. Structured ongoing discussion concerning pain management from an early stage of the disease or already preoperatively can provide an important intervention to meet the results of this thesis. Pain assessment covering the multidimensionality of pain, and pain treatment plans including both pharmacological and non-pharmacological treatment are further important interventions. (Less)
Please use this url to cite or link to this publication:
author
opponent
  • Doc Sjöström, Björn, Göteborg University, Sweden
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Anestesiologi, intensivvård, intensive care, Anaesthesiology, SF-36., postoperative pain, Pain-o-Meter, perceptions, pain management, nursing care, Health-Related Quality of Life, American Pain Society, cancer-related pain
pages
144 pages
publisher
Barbro Boström, School of Social and Health Sciences, Halmstad University, Box 823, S-301 18 Halmstad, Sweden,
defense location
Halmstad University, Sweden
defense date
2003-04-04 10:15
ISBN
91-628-5575-1
language
English
LU publication?
yes
id
85919193-3152-4c4b-bd1d-c53761b56758 (old id 465508)
date added to LUP
2007-09-10 12:20:30
date last changed
2016-09-19 08:45:06
@phdthesis{85919193-3152-4c4b-bd1d-c53761b56758,
  abstract     = {This thesis describes patients in acute postoperative pain as well as patients with acute cancer-related pain in palliative care, and their experiences and perceptions of pain management in relation to HRQOL and the multidimensionality of pain. A combination of qualitative and quantitative methods was chosen. Data were collected using interviews and questionnaires; APS, SF:36 and a new developed questionnaire PC-PPQ measuring care related to pain management in palliative care. For assessing pain VAS and Pain-o-Meter were used. The study group consisted of 100 patients on their second postoperative day, and of 75 patients with cancer-related pain from two palliative care teams. The result showed that at the time of the interview 29 of the patients with postoperative pain reported a pain > 3 on VAS and 79 reported VAS > 3 as worst pain past 24 hours. The higher the intensity of pain the less satisfied the postoperative patients were with the nurses´ way of treating their pain. Thirty-three patients stated that they had received information regarding the importance of pain relief. Patients with postoperative pain as well as patients with cancer-related pain had been prescribed analgesics mostly a combination of Paracetamol, NSAID and opioid. Of the 75 patients with cancer-related pain and in palliative care 22 patients reported pain >3 on POM-VAS and 47 patients reported >3 on POM-VAS as worst pain past 24 hours. Twenty-eight patients reported an average pain > 3 on POM-VAS past 24 hours. Twenty-four patients used the words troublesome or tiring when describing their affective pain. Sensory pain was described as prickling or sore by 15 patients. The patients perceived their pain as “aching all over” and expressed a wish for pain relief as well as a fear for increased pain. HRQOL especially physical functioning decreased for patients with average pain > 3. Being cared for by a nurse-led or a physician-led palliative care team indicated no statistically significant differences for patients´ HRQOL or pain intensities. The patients had experienced a statistically significant better care after being referred to a palliative care team, despite that pain control had not been optimized. Patients expressed a need for communication, planning and trust in order to improve pain management. Continuity of care and the opportunity to talk increase the patients feeling of security, as well as improved their perceived pain control. Structured ongoing discussion concerning pain management from an early stage of the disease or already preoperatively can provide an important intervention to meet the results of this thesis. Pain assessment covering the multidimensionality of pain, and pain treatment plans including both pharmacological and non-pharmacological treatment are further important interventions.},
  author       = {Boström, Barbro},
  isbn         = {91-628-5575-1},
  keyword      = {Anestesiologi,intensivvård,intensive care,Anaesthesiology,SF-36.,postoperative pain,Pain-o-Meter,perceptions,pain management,nursing care,Health-Related Quality of Life,American Pain Society,cancer-related pain},
  language     = {eng},
  pages        = {144},
  publisher    = {Barbro Boström, School of Social and Health Sciences, Halmstad University, Box 823, S-301 18 Halmstad, Sweden,},
  school       = {Lund University},
  title        = {Acute postoperative and cancer-related pain management, Patients´ experiences and perceptions in relation to health-related quality of life and the multidimensionality of pain},
  year         = {2003},
}