Nurse-led intervention helps carers’ manage medication and cancer pain

The potential benefits of a new nurse-led intervention in supporting carers to manage pain medication in people with terminal cancer are explored in this article | ScienceDaily

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A study funded by Marie Curie and Dimbleby Cancer Care published today shows the potential benefits of a new nurse-led intervention in supporting carers to manage pain medication in people with terminal cancer. Researchers from the University of Southampton, Cardiff University and University of Leeds have developed a nurse-led intervention to help carers with medication management, and evaluated its use in routine practice.

The Cancer Carers’ Medicines Management (CCMM) intervention addresses carers’ beliefs, knowledge and skills and promotes self-evaluation of competence. It centres on a structured conversational process between a nurse and carer. It is the first time that a study has attempted to integrate an intervention developed using input from carers and nurses into routine palliative care. The research showed that the CCMM intervention compared favourably with current practice as it offered a more systematic and comprehensive approach to supporting carer management of pain medicines.

Nurses’ experiences of pain management for people with advanced dementia approaching the end of life

Pain management in end-stage dementia is a fundamental aspect of end-of-life care; however, it is unclear what challenges and facilitators nurses experience in practice, whether these differ across care settings, and whether training needs to be tailored to the context of care | Journal of Clinical Nursing

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Aims and objectives: To explore hospice, acute care and nursing home nurses’ experiences of pain management for people with advanced dementia in the final month of life. To identify the challenges, facilitators and practice areas requiring further support.

Conclusions: Achieving pain management in practice was highly challenging. A number of barriers were identified; however, the manner and extent to which these impacted on nurses differed across hospice, nursing home and acute care settings. Needs-based training to support and promote practice development in pain management in end-stage dementia is required.

Relevance to clinical practice: Nurses considered pain management fundamental to end-of-life care provision; however, nurses working in acute care and nursing home settings may be undersupported and under-resourced to adequately manage pain in people dying with advanced dementia. Nurse-to-nurse mentoring and ongoing needs-assessed interactive case-based learning could help promote practice development in this area. Nurses require continuing professional development in pharmacology.

Full reference: De Witt Jansen, B. et al. Nurses’ experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study. Journal of Clinical Nursing. 26,(9-10) pp. 1234–1244

Nurses’ experiences of pain management for people with advanced dementia approaching the end of life

De Witt Jansen, B. et al. (2017) Journal of Clinical Nursing. 26(9-10) pp. 1234–1244

Aims and objectives: To explore hospice, acute care and nursing home nurses’ experiences of pain management for people with advanced dementia in the final month of life. To identify the challenges, facilitators and practice areas requiring further support.

Background: Pain management in end-stage dementia is a fundamental aspect of end-of-life care; however, it is unclear what challenges and facilitators nurses experience in practice, whether these differ across care settings, and whether training needs to be tailored to the context of care.

Conclusions: Achieving pain management in practice was highly challenging. A number of barriers were identified; however, the manner and extent to which these impacted on nurses differed across hospice, nursing home and acute care settings. Needs-based training to support and promote practice development in pain management in end-stage dementia is required.

Relevance to clinical practice: Nurses considered pain management fundamental to end-of-life care provision; however, nurses working in acute care and nursing home settings may be undersupported and under-resourced to adequately manage pain in people dying with advanced dementia. Nurse-to-nurse mentoring and ongoing needs-assessed interactive case-based learning could help promote practice development in this area. Nurses require continuing professional development in pharmacology.

Read the abstract here

Opioid doses and the survival of advanced cancer patients receiving palliative care

Sathornviriyapong, A. et al. BMC Palliative Care. Published online: 21 November 2016

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Image source: Adrian Wressell, Heart of England NHSFT – Wellcome Images // CC BY-NC-ND 4.0

Background: Concerns that opioids may hasten death can be a cause of the physicians’ reluctance to prescribe opioids, leading to inadequate symptom palliation. Our aim was to find if there was an association between different opioid doses and the survival of the cancer patients that participated in our palliative care program.

Conclusions: Our study has demonstrated that different opioid doses in advanced cancer patients are not associated with shortened survival period.

Read the full abstract and article here

Identifying professionals’ needs in integrating electronic pain monitoring

Taylor, S. et al. Palliative Medicine. Published online: November 11,2016

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Image source: Spooky Pooka. Wellcome Images // CC BY-NC-ND 4.0

Background: Poor pain assessment is a barrier to effective pain control. There is growing interest internationally in the development and implementation of remote monitoring technologies to enhance assessment in cancer and chronic disease contexts. Findings describe the development and testing of pain monitoring systems, but research identifying the needs of health professionals to implement routine monitoring systems within clinical practice is limited.

Aim: To inform the development and implementation strategy of an electronic pain monitoring system, PainCheck, by understanding palliative care professionals’ needs when integrating PainCheck into routine clinical practice.

Conclusion: Even the most sceptical of health professionals could see the potential benefits of implementing an electronic patient-reported pain monitoring system. Health professionals have reservations about how PainCheck would work in practice. For optimal use, PainCheck needs embedding within existing electronic health records. Electronic pain monitoring systems have the potential to enable professionals to support patients’ pain management more effectively but only when barriers to implementation are appropriately identified and addressed.

Read the abstract here

Management of pain in the terminally ill

King, S.E. et al. Anaesthesia & Intensive Care Medicine. Published online: 23 September 2016

drug-1674890_960_720Pain management in the terminally ill can be complex and challenging necessitating a holistic approach. Multimodal analgesic strategies are usually employed to successfully manage pain and other symptoms. There are now a variety of opioid formulations available to treat moderate to severe pain. Neuropathic and cancer-induced bone pain can be difficult to treat, but newer drugs are available in addition to a number of established interventional procedures. The psychosocial aspects associated with terminal illness must be considered and managed with the involvement of a multidisciplinary palliative care team.

Read the abstract here

Information and communication technology for managing pain in palliative care: a review of the literature

Allsop, M. et al. BMJ Support Palliat Care 2015;5:481-489 doi:10.1136/bmjspcare-2013-000625

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Background Information and communication technology (ICT) systems are being developed for electronic symptom reporting across different stages of the cancer trajectory with research in palliative care at an early stage.

Aim/design This paper presents the first systematic search o the literature to review existing ICT systems intended to support management of pain in palliative care patients with cancer. The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses.

Data sources Four databases (Embase, MEDLINE, PsycINFO and Healthcare Management Information Consortium) from 1990 to December 2012 were searched, with exclusion of papers based on their description of ICT systems and language used.

Results 24 articles met the inclusion criteria, many of which reported the use of non-experimental research designs. Studies were identified at different stages of development with no systems having reached implementation. Most systems captured pain as part of quality-of-life measurement with wide variation in approaches to pain assessment.

Conclusions ICT systems for symptom reporting are emerging in the palliative care context. Future development of ICT systems need to increase the quality and scale of development work, consider how recommendations for pain measurement can be integrated and explore how to effectively use system feedback with patients.

Read the full article via BMJ Supportive & Palliative Care