Re: A note on "The significance of significance".
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Data Interpretation, Statistical↗
Biomedical subjects
Sandra E Ward
Publications and source records attributed to Sandra E Ward.
The Discomfort Behavior Scale: a measure of discomfort in the cognitively impaired based on the Minimum Data Set 2.0.
Because persons with cognitive impairment often cannot self-report pain, it is imperative to develop instruments that use observable indicators. The purpose of this study was to develop and test the psychometric properties of the Discomfort Behavior Scale (DBS), which is comprised of 17 items from the Minimum Data Set (MDS). MDS data from 29,120 cognitively impaired nursing home residents were used for psychometric testing. Factor analyses of the DBS indicated that it reflects a single discomfort dimension. The items are tau equivalent, allowing unity weighting and simple summation to create scale scores, and the internal consistency was good. The DBS has potential to be useful in studies of efforts to improve pain management in cognitively impaired residents of nursing homes.
Aged↗
Racial and ethnic disparities in pain management in the United States.
PURPOSE: To critically examine research on racial and ethnic disparities in pain management with a focus on who has been studied, the magnitude of disparities, and potential explanations for those disparities. DESIGN: A systematic literature review. Articles included were reports of original research in which at least two racial or ethnic groups were compared on adequacy of pain management. METHODS: Review of research articles published between 1990 and 2004 with the primary aim of identifying the influence of race or ethnicity on pain management in the US. Databases were CINAHL, Medline, and Pubmed. Relevant articles were categorized by pain type. Effect sizes were calculated where sufficient data were provided. FINDINGS: Studies were focused on Blacks or African Americans, Whites or non-Hispanic Whites, Hispanics, and Asians. Terms for describing these groups were neither well defined nor consistently used within and across studies. Disparities in pain management were reported in relation to minority status, but the magnitudes of these disparities were mostly small. CONCLUSIONS: Greater clarity and consistency are needed in the use of the terms race, ethnicity, and minority. Groups were treated as if they were homogeneous, and details were lacking about whether subgroups of different races or ethnicities had been studied. Although reported disparities in pain management were small, they were consistent. Further research is needed to examine differences within groups and to explain possible reasons for disparities across groups.
Black or African American↗
Nursing and psychological treatments.
Presents a comment on "Psychological Treatments" by D. H. Barlow. In his article, Barlow pointed to the need "to solidify the identification of psychology as a health care profession" by changing the terminology of practice in the health care context from psychotherapy to psychological treatments and suggested that the only persons qualified to carry out such interventions are doctoral-level psychologists. Unfortunately, there was no discussion of the health care professionals who already provide psychological treatments in health care settings and their contribution to the evidence base supporting such treatment. The authors find several aspects of the article to be problematic. Overall, the authors feel that suggesting that psychology should claim treatment of psychological disorders and psychological components of physical disorders in health care settings as exclusively its own domain ignores the research and clinical contributions of others.
Humans↗
Effect of cancer pain on performance status, mood states, and level of hope among Taiwanese cancer patients.
The purposes of this study were: 1) to compare performance status, mood states, and level of hope between patients with cancer pain and patients without cancer pain; and 2) to determine the relationships of pain intensity and pain interference with daily life to performance status, mood states, and level of hope. A total of 233 Taiwanese cancer patients with pain and 251 without pain participated. The self report instruments consisted of the Chinese version of the Profile of Mood States (POMS) short form, the Chinese version of the Herth Hope Index, the Brief Pain Inventory-Chinese version (BPI-C), the Chinese version of the Karnorfsy Performance Scale (KPS), and a demographic questionnaire. The major findings of this study were that cancer patients with pain reported significantly lower levels of performance status and higher levels of total mood disturbance than did cancer patients who did not experience pain after controlling for sex, disease stage, and recruitment site. In addition, patients with cancer pain experienced significantly more anger, fatigue, depression, confusion, and lethargy than did patients without pain after controlling for sex, disease stage, and recruitment site. Among patients with pain, pain intensity was significantly correlated with performance status and mood state, but not with level of hope. Pain interference with daily life was significantly correlated both with performance status, mood state, and level of hope. Pain intensity and pain interference were significantly correlated with each mood state as well as with total mood disturbance. This study has demonstrated the effect of cancer pain on patients' physical, psychological, and spiritual life and has supported the multidimensional notion of the cancer pain experience in Taiwanese patients.
Activities of Daily Living↗
Patient-centered interventions.
Patient-centered care is valued in nursing. However, until recently, nurse-researchers have focused on testing the effects of standardized rather than patient-centered interventions (PCIs). The latter are those interventions that are altered to address selected patient characteristics (e.g., beliefs, habits, or goals). PCIs have been well received, and in some studies they have been associated with improved health outcomes. In this article we describe briefly the concept patient centered, summarize the development of research on PCIs, discuss kinds of PCIs, provide examples of PCIs and how they have been derived and implemented, and raise issues for theory and future research.
Forecasting↗
Application of the American Pain Society quality assurance standards.
The American Pain Society's (APS) patient outcome questionnaire was used to examine patient satisfaction with pain management in a quality assurance study of 217 adults and 31 children in a large university hospital. On a scale of 1-6, mean (S.D.) patient satisfaction with pain management provided by nurses was 5.37 (1.02) and by physicians was 5.10 (1.02). Many patients (84% of adults and 90% of children) reported that early in their hospital stay a nurse or physician had communicated the fact that treatment of pain is considered very important. The mean (S.D.) pain severity score (worst pain in the last 24 h) for adults was 6.62 (2.79) on a 0-10 scale and for children was 4.33 (0.85) on a 0-5 Faces scale. Analyses revealed little relationship between pain severity and satisfaction; even persons with high levels of pain were very satisfied with the pain management they received from nurses and physicians. Satisfaction was, however, related to whether nurses and physicians had communicated to the patient that pain management has a high priority. It appears that patients are satisfied if clinicians say they want to provide pain management regardless of whether they actually do. The data raise questions about the interpretation of patient satisfaction as an outcome variable in studies of the quality of pain management.
Adult↗
Patient-related barriers to management of cancer pain in Puerto Rico.
Two hundred and sixty-three ambulatory patients older than 21 years of age who were attending clinics at an oncology hospital in San Juan, Puerto Rico, were studied. They completed a questionnaire (BQ-PR) that measures 8 concerns about reporting pain and using analgesics, such as fears of addiction and tolerance and the belief that reporting pain can distract a physician from focusing on curing one's disease. Ninety percent of the patients had at least some concern about each of the 8 topics, and mean scores on the 8 subscales were near the midpoint on a 0-5 scale. There were significant inverse relationships between level of education, income, and BQ-PR total score. Those persons who experienced cancer-related pain on the day they completed the questionnaire were categorized as using adequate versus not adequate analgesic medication, a determination that was based on a comparison of their level of pain to the medication they were using. Those who were not using adequate analgesic medication had higher BQ-PR total scores than did those who were using adequate medication.
Adult↗
Patient-related barriers to management of cancer pain.
Patients' reluctance to report pain and to use analgesics are considered major barriers to pain management. To explore this problem, 270 patients with cancer completed a 27-item self-report questionnaire (BQ) that assessed the extent to which they have concerns about reporting pain and using pain medication. The 8 specific concerns included fear of addiction, beliefs that 'good' patients do not complain about pain, and concern about side effects. Patients also completed a measure of pain severity and pain interference (the BPI). The percentages of patients having concerns assessed by the BQ ranged from 37% to 85%. Those who were older, less educated, or had lower incomes were more likely to have concerns. Higher levels of concern were correlated with higher levels of pain. Based on their reports of pain medications used in the past week and on their reports of pain severity, patients were categorized as under-medicated versus adequately medicated. Those who were under-medicated reported significantly higher levels of concern. The data are discussed in terms of implications for research and practice.
Adult↗