Health-Care Professionals Perceived Barriers to Effective Cancer Pain Management in the Home Hospice Setting: Is Dying at Home Really Best?

2019 ◽  
pp. 003022281985787
Author(s):  
Lee A. Johnson ◽  
Cynthia J. Bell ◽  
Sheila Ridner ◽  
Barbara Murphy
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Cancer Pain ◽  
Health Care Professionals ◽  
Cultural Beliefs ◽  
Comparative Approach ◽  
Unexpected Finding ◽  
Convenience Sample ◽  
Alternative Placement ◽  
Patients At Risk

Hospice health-care professionals (HCP) evaluate and manage cancer pain in patient homes. This study explores HCP’s perceptions of barriers that affect pain management for home hospice cancer patients. A convenience sample of 20 experienced hospice HCP were recruited from a regional hospice agency. Data were collected through two focus groups using semistructured interviews and analyzed using a constant comparative approach to generate themes. An unexpected finding revealed patient’s religious and cultural beliefs about suffering and family caregiver’s beliefs that patients deserve to suffer due to past actions are barriers to pain management in home hospice. Hospice HCP can identify patients at risk for suffering at the end of life. Interventions targeting spiritual suffering and needs are needed. Home hospice HCP have an ethical obligation to address undue suffering through family’s withholding of necessary pain medications and should consider alternative placement when home is not suitable for a peaceful death.

Overcoming Barriers in Cancer Pain Management

2014 ◽  
Vol 32 (16) ◽  
pp. 1727-1733 ◽  
Author(s):  
Jung Hye Kwon
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Cancer Pain ◽  
Health Care Professionals ◽  
Pain Treatment ◽  
Educational Interventions ◽  
Cognitive Factors ◽  
Cancer Pain Management ◽  
Affective Factors

Pain is a devastating symptom of cancer that affects the quality of life of patients, families, and caregivers. It is a multidimensional symptom that includes physical, psychosocial, emotional, and spiritual components. Despite the development of novel analgesics and updated pain guidelines, cancer pain remains undermanaged, and some patients with moderate to severe pain do not receive adequate pain treatment. Inadequate pain management can be attributed to barriers related to health care professionals, patients, and the health care system. Common professional-related barriers include poor pain assessment, lack of knowledge and skill, and the reluctance of physicians to prescribe opioids. Patient-related barriers include cognitive factors, affective factors, and adherence to analgesic regimens. System-related barriers such as limits on access to opioids and the availability of pain and palliative care specialists present additional challenges, particularly in resource-poor regions. Given the multidimensional nature of cancer pain and the multifaceted barriers involved, effective pain control mandates multidisciplinary interventions from interprofessional teams. Educational interventions for patients and health care professionals may improve the success of pain management.

scholarly journals Preferences and Perceptions of Patients Attending Emergency Departments with Low Acuity Problems in Hong Kong

2009 ◽  
Vol 16 (3) ◽  
pp. 148-154 ◽  
Author(s):  
CA Graham ◽  
WO Kwok ◽  
YL Tsang ◽  
TH Rainer
Keyword(s):  
Health Care ◽  
Hong Kong ◽  
Health Care Providers ◽  
Waiting Time ◽  
Health Care Professionals ◽  
Waiting Times ◽  
Medical Advice ◽  
Care Providers ◽  
Convenience Sample ◽  
Waiting Area

Objective To explore why patients in Hong Kong seek medical advice from the emergency department (ED) and to identify the methods by which patients would prefer to be updated on the likely waiting time for medical consultation in the ED. Methods The study recruited 249 semi-urgent and non-urgent patients in the ED of Prince of Wales Hospital from 26th September 2005 to 30th September 2005 inclusive. A convenience sample of subjects aged ≥15 years old in triage categories 4 or 5 were verbally consented and interviewed by research nurses using a standardized questionnaire. Results From 1715 potential patients, 249 were recruited ad hoc (mean age 44 years [SD18]; 123 females). About 63% indicated that an acceptable ED waiting time was less than or equal to two hours, and 88% felt that having individual number cards and using a number allocation screen in the ED waiting area would be useful. Perceived reasons for attending the ED rather than other health care providers such as primary health care or the general outpatient clinic (GOPC) included: a desire for more detailed investigations (56%); a perception that more professional medical advice was given in the ED (35%); patients were under the continuing care of the hospital (19%); and patients were referred to the ED by other health care professionals (11%). Notably, 26% of participants had considered attending the GOPC prior to attending the ED. Patients educated to tertiary level expected a shorter waiting time than those educated to lesser degrees (p=0.026, Kruskal-Wallis test). Suggestions were made on how to provide a more pleasant ED environment for the wait for consultations, which included the provision of a television screen with sound in the waiting area (43%), more comfortable chairs (37%) and health care promotion programs (32%). Conclusion Patients chose ED services because they believed they would receive more detailed investigations and more professional medical advice than available alternatives. Clear notification of the likely waiting times and enhancement of comfort before consultation are considered desirable by patients. Enhanced public education about the role of the ED and making alternatives to ED care more accessible may be useful in reducing inappropriate ED attendances in Hong Kong.

scholarly journals Acute and chronic musculoskeletal pain situations among the working population and their pain education needs: an exploratory study

2020 ◽  
Vol 37 (4) ◽  
pp. 445-452
Author(s):  
Shuk Kwan Tang ◽  
Mimi Mun Yee Tse ◽  
Sau Fong Leung ◽  
Theofanis Fotis
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Health Care Professionals ◽  
Work Performance ◽  
Online Survey ◽  
Management Education ◽  
Well Being ◽  
Working Population ◽  
Pain Education

Abstract Background Pain affects a person’s physical and psychological well-being, work performance and productivity. Working population bear their pain and continue to work which may contribute to the worsening of their pain condition. However, their pain situation was not well-examined. Objective The aim of the study was to explore the prevalence of acute and chronic pain in the working population in Hong Kong, understand their pain management strategies and determine their preferences with regard to the use of electronic pain management materials. Methods This was an exploratory online survey. The participants’ pain history, their preferences in methods of pain management, the source of the pain management education that they had received, sources and preferences in relation to the use of the Internet for pain education, and the participants’ demographic characteristics were collected. Results A total of 210 participants joined the study, 67% of whom were experiencing pain. Of the group in pain, 71.6% were in chronic pain that has persisted for 3 months or more. Pain intensities ranged from 2.82 to 3.82 on a 10-point numeric scale. Of the participants, 85.7% reported not receiving adequate pain management education, and 91.4% of those agreed pain services were inadequate. Websites and health care professionals were the sources from which they obtained their pain management education. Conclusions The high prevalence of pain in the working population requires special attention. Health care professionals should be proactive and an online pain management programme can be a solution to address the critical problem of pain in the working population.

Barriers in the Decision Making About and Performance of Continuous Sedation Until Death in Nursing Homes

2019 ◽  
Vol 60 (5) ◽  
pp. 916-925
Author(s):  
Lenzo Robijn ◽  
Luc Deliens ◽  
Judith Rietjens ◽  
Peter Pype ◽  
Kenneth Chambaere
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Nursing Homes ◽  
Health Care Professionals ◽  
Comparative Approach ◽  
Organizational Barriers ◽  
Organization Of Care ◽  
Continuous Sedation ◽  
And Performance ◽  
Design And Methods

Abstract Background and Objectives While decision making about and performance of continuous sedation involve many challenges, they appear to be particularly pervasive in nursing homes. This study aims to identify barriers to the decision making and performance of continuous sedation until death in Flemish nursing homes as experienced by the health care professionals involved. Research Design and Methods Ten focus groups were held with 71 health care professionals including 16 palliative care physicians, 42 general practitioners, and 13 nursing home staff. Discussions were transcribed verbatim and analyzed using a constant comparative approach. Results Perceived barriers concerned factors prior to and during sedation and were classified according to three types: (a) personal barriers related to knowledge and skills including the lack of clarity on what continuous sedation should be used for (linguistic ambiguity) and when and how it should be used (practical ambiguity); (b) relational barriers concerning communication and collaboration both between health care professionals and with family; (c) organizational barriers related to the organization of care in nursing homes where, for example, there is no on-site physician, or where the recommended medication is not always available. Discussion and Implications The findings suggest there are considerable challenges for sound decision making about and performance of continuous sedation until death in nursing homes. There is a need for multicomponent initiatives that provide guidance in the context of the complexity of a resident’s medical situation, the family, and the specific organization of care, which would have the potential to facilitate and improve the decision-making process and performance of continuous sedation in nursing homes.

scholarly journals The South African traditional belief scale as an instrument to aid culture-congruent health care

2005 ◽  
Vol 10 (4) ◽  
pp. 29-40 ◽  
Author(s):  
Johann Beuster ◽  
Gerhard Schwär
Keyword(s):  
Health Care ◽  
Effective Treatment ◽  
South African ◽  
Psychological Health ◽  
Health Care Professionals ◽  
Full Text ◽  
Culturally Diverse ◽  
Cultural Beliefs ◽  
Traditional Belief ◽  
Belief Scale

Medical and psychological health care professionals are becoming increasingly aware that effective treatment in culturally diverse societies requires sensitivity to the patient’s cultural beliefs and customs (Davidhizar & Giger, 2001:2; Foley & Wurmser, 2004:2; Hickson & Christie, 1989:162; Mkize, 2003:4; Narayanasamy, 2003:1). Opsomming Mediese en sielkundige gesondheidsorgberoepslui word toenemend daarvan bewus dat doeltreffende behandeling in kultureel diverse gemeenskappe sensitiwiteit teenoor die pasiënt se kulturele oortuigings en gebruike vereis (Davidhizar & Giger, 2001:2; Foley & Wurmser, 2004:2; Hickson & Christie, 1989:162; Mkize, 2003:4; Narayanasamy, 2003:1). *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

scholarly journals Interpreting the Meaning of Pain Severity Scores

2002 ◽  
Vol 7 (4) ◽  
pp. 192-198 ◽  
Author(s):  
Marilyn J Hodgins
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Health Care Professionals ◽  
Pain Measurement ◽  
Management Practices ◽  
Care Organization ◽  
Treatment Goals ◽  
Severity Scores ◽  
Measurement Tools ◽  
The Impact

Poor pain management practices are generally discussed in terms of barriers associated with the patient, clinician and/or health care organization. The impact of deficiencies in the tools that are used to measure pain are seldom addressed. Three factors are discussed that complicate the measurement of pain: the nature of pain, the lack of meaning associated with scores generated by pain scales, and treatment goals that lack specificity and are not linked to patients' pain scores. The major premise presented in the present article is that the utility of pain measurement is limited because health care professionals do not have a common understanding of the meaning of scores generated by pain measurement tools, especially within the acute care setting. To address this issue, approaches to establishing instrument validity need to be broadened to include the examination of the meaning and consequences of these measurements within a specific context. Substantive improvements in pain management are unlikely to occur until criteria are identified to link explicitly the scores generated by pain measurement tools to treatment goals.

Pain management by health care professionals: Impact on the hospitalized patient

2013 ◽  
Vol 24 ◽  
pp. e259
Author(s):  
J. Espírito Santo ◽  
A. Santos ◽  
C. Canha ◽  
J. Fonseca ◽  
R. Tenreiro ◽  
...  
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Health Care Professionals ◽  
Hospitalized Patient

Death Distress among Two Samples of Lower and Higher Stress in Health Care Professionals

2013 ◽  
Vol 113 (1) ◽  
pp. 318-327 ◽  
Author(s):  
Fatma Ayyad
Keyword(s):  
Internal Medicine ◽  
Health Care ◽  
Intensive Care Unit ◽  
Health Care Professionals ◽  
Depression Scale ◽  
Lower Stress ◽  
Convenience Sample ◽  
Two Samples ◽  
Pearson Correlations ◽  
Death Depression

A convenience sample of 195 volunteer nurses working in different medical departments was recruited (77 Kuwaiti, 118 non-Kuwaiti from 10 countries; 55 men, 140 women; ages 25 to 51 years). Participants responded in English to the Arabic Scale of Death Anxiety, the Death Depression Scale, the Death Obsession Scale, and the Reasons for Death Fear Scale. Pearson correlations between the four scales were statistically significant and positive. The only significant sex difference was on the Death Depression Scale with men reporting more stress. It was also found that nurses dealing with critical cases and working in higher stress departments (Intensive Care Unit and Heart Department) obtained higher mean scores on the Death Depression Scale, Death Obsession Scale, and Reasons for Death Fear Scale than their counterparts working in lower stress departments such as internal medicine. It was concluded that working in higher stress nursing departments affected death distress. Nurses with high scores on death distress may benefit from a thanatopsis program. There is reason to believe that this may ameliorate relations with patients.

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