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Most cancer patients suffer from pain in varying degrees during their illness. The management of this pain and its relationship in improving the wellbeing of the patient is the primary focus of this study. This paper approached the study by researching articles that dealt with pain management from different angles. After critical analysis of these articles this paper will arrive at a conclusion that addresses the research question. The topics reviewed included:
1. The use of a clinical instruction module (CLIM) for hospice nurses to upgrade their skills (Plymale, M. et al, 2001)
2. The role of cognition in promoting the psychological well being of the patient (Chen, Mei-Ling. 2002)
3. The use of pain management autobiographies to discover how best to deal with pain management (Schumacher, K. et al. 2001)
4. Overcoming patient related barriers to pain management by educating them (Chang, Ming-Chuan. 2002)
5. Providing a description of advanced cancer pain in home hospice subjects to enable the caregivers to alleviate their suffering (Dobratz, M. 2001)
The material for this study was searched from the University of Wollongong database of Medline. The key words in the search for journal articles were nursing, research and cancer pain. Articles were chosen for their relevance to the research question and the findings they came up with. Information that was obtained from these studies enabled the writer to draw important conclusions as concerns pain management in cancer patients with pain.
The research is of extreme importance to the writer. I lost my husband to cancer. The trauma we all went through watching him in pain gave me a new impetus to do all in my power to ensure that no other patient will need to go through the same suffering as he did. As I continue to practice, I would like to contribute to breaking new ground in pain management in cancer patients; especially as concerns alleviating their pain and improving their quality of life.
In an article entitled ‘Cancer Pain Education: A Structured Clinical Instruction Module For Hospice Nurses’, appearing in the journal ‘Cancer Nursing ‘,Plymale M. et al (2001) studied the effect of pain education on the quality of service by caregivers. The research aimed to determine whether educating nurses on pain management will improve their ability to assess and manage pain in cancer patients. A clinical instruction module (CLIM) based on cancer pain management and assessment skills was administered to 25 hospice nurses whose average field practice was 4.1 years (Plymale M. et al. 2001, p. 424).The course involved the nurses going round 8 stations focussing on different aspects of cancer pain, assessing 5 cancer survivors and one actor. They carried out tests on various aspects of pain management. Prior to and after the exercise the nurses self assessed their skills in pain management using a 5-point Likert scale ranging from 1(not competent) to 5(very competent). They also evaluated the CLIM on a similar scale. (1= strongly disagree; 5= strongly agree)
All participants agreed that the course helped improve their competence in the teaching items that were being addressed. The use of patients with cancer was considered more beneficial as opposed to having actors. Nurses that felt competent enough before the course did not perceive any noticeable improvement in their abilities in the post exercise self assessment. This finding is consistent with the view that hospice nurses are more competent in dealing with cancer pain management than those nurses working in hospitals. Those who assessed themselves as not competent indicated a higher assessment of themselves after the course.
In a further study conducted among post instruction medical students, those trained using a CLIM on pain management did better than those schooled it traditional methods. (Sloan P.A. et al., 2001, 112) There is an urgent need to introduce CLIM’s addressing pain assessment and management in the teaching courses for all nurses and caregivers in a bid to improve their skills and service delivery. The more competent the nurses the better will be the treatment of patients in prolonging their lives and alleviating the pain they go through. A significant observation of this study is the competence level of hospice nurses was higher than that of their counterparts. It is advisable to seek their input in developing manuals and modules of this nature as they have first hand knowledge that is invaluable to this area of study.
‘Pain And Hope in Patients with Cancer’, an article written by Chen, Mei-Ling and appearing in the journal ‘Cancer Nursing’ (2003) examines the relationship between pain and hope in cancer patients. Hope is a therapeutic factor in the treatment of any disease including cancer. Patients with high levels of hope coped better with the disease than did those who dwelt on the hopelessness of their situation. The hopeful patients on average tended to live longer and had extended periods of remission. This study had three main purposes;
i. Examine the effect of disease status on hope levels among patients with cancer who have pain
ii. Compare the level of hope between patients with cancer that have pain and those who do not
iii. Determine which dimensions of pain are associated with hope (Chen, Mei-Ling. 2002, p.62)
The conceptual framework for the study was based on the ‘self- regulation model of coping with health threats’. (Chen, Mei-Ling. 2002, p.62) The main emphasis is on how people cope with their health problems in their own unique ways. Personal beliefs, religious orientation, cultural practises and previous experiences all work to determine a patient’s attitude towards his illness.(Donavan, H.S., Ward, S., 2001, pp. 211 – 216)
Any one of the factors mentioned will have a bearing on the hope levels of the individual. The study employed the use of the Herth Hope Index (HHI) to assess the level of hope. It sampled 274 inpatients with cancer at two medical centres in Taiwan. 226 of them finalised the survey and the analysis was based on their responses. The study used Perceived Meaning of Cancer Pain Inventory (PMCPI) to measure the meanings that patients ascribed to their pain. Four subscales were used and these were challenge, threat, spiritual awareness and loss.
The findings showed that in cancer patients with pain and those without pain, the hope levels did not differ. However, sensory dimensions of pain showed a link between the bearable pain intensity and level of hope (Chen, Mei-Ling. 2002, p. 65) The findings supported the view that the hope levels in patients were higher in those who were able to tolerate more pain. Perception of one’s pain played an important role in the way one held on to hope. Those who viewed the pain as a challenge were more hopeful than those who took it from a negative perspective. In assessing one’s reaction to treatment, it is notable that the findings showed no difference in hope levels for those patients who were unsure of the effect of treatment and those who affirmed that the treatment was working positively.