Self-efficacy For Pain Management Research Articles

Evaluation of the relationship between intensive care nurses' pain management self-efficacy and perceptions of opioid drug administration

Evaluation of the relationship between intensive care nurses' pain management self-efficacy and perceptions of opioid drug administration

Development and feasibility of a mindfulness-based dance/movement therapy intervention for chronic low back pain.

Responding to the need for innovative, multi-modal, non-pharmacological strategies in chronic low back pain (cLBP) care, this article presents the development and a mixed methods feasibility trial of a manualized Mindfulness-based Dance/Movement Therapy (M-DMT) program for cLBP. The 12-week program is designed as a group therapy, integrating mindfulness principles, creative/expressive dance and movement, and psychoeducational content focused on cLBP management. This holistic program seeks to cultivate nonjudgmental awareness of pain experiences, challenge maladaptive pain-related beliefs, enhance emotional well-being, foster social support, and promote effective coping strategies for the daily challenges associated with cLBP. The 12-week M-DMT intervention was administered to individuals with non-specific cLBP (N = 18, aged 51.7 ± 13.9 years, 72% female, 55% Black and 39% White). We assessed feasibility and acceptability through monitoring enrollment and retention rates, attendance, and adverse events. Moreover, we measured the intervention's credibility/expectancy, participants' perception of changes, and overall satisfaction. Additionally, we collected qualitative data, capturing participants' perspectives on the intervention's usefulness and perceived benefits. Specific benchmarks were established to gauge the successful feasibility and acceptability of the program. The adherence rate stood at 80%, with a perfect retention rate of 100%. The study successfully met the benchmarks for treatment acceptability and satisfaction criteria, with 61% of participants reporting "feeling better" or a "great deal better" after the intervention. No adverse events were observed. Participants found the intervention enjoyable and reported that it provided effective tools for cLBP and related symptoms. Notably, participants reported a decrease in fear-avoidance behaviors, increased motivation for physical activity, and a boost in self-efficacy for pain management. These encouraging findings establish a strong basis for considering the M-DMT intervention as a promising approach for cLBP management, warranting further investigation in larger-scale studies.

Mediating Effect of Self-Efficacy in Pain Management between Knowledge and Attitude of Pain toward Pain Management Practice among Nurses in Indonesia

Nurses' knowledge and attitudes significantly influence pain management practices. Higher levels of self-efficacy in pain management are associated with improved pain. This study explored the relationships between nurses’ knowledge and attitudes toward pain, self-efficacy in pain management, and actual pain management practices. This study employed a cross-sectional study which conducted at Sultan Agung Islamic Hospital, Indonesia, involving 249 nurses selected based on predefined criteria. Participants responded to an online survey encompassing demographic queries and standardized tools, namely the Knowledge and Attitude Survey Regarding Pain (KASRP-IDN), the Pain Management Self-Efficacy Questionnaire (PMSEQ-IDN), and the Nurse Behavior Questionnaire in Pain Management (NBQ-P). Mediation analysis was further conducted using the PROCESS add-on to discern the mediating effect of self-efficacy in pain management between knowledge and attitude of pain toward pain management practice among nurses. The study showed significant positive relationships among Knowledge and Attitude Survey Regarding Pain (KASRP), Pain Management Self-Efficacy (PMSE), and Pain Management Practice. However, the mediation analysis depicted that self-efficacy exerted a relatively modest mediating effect between KASRP and pain management practice (K2=0.17, CI= 0.05-0.27). The findings manifest the positive associations between knowledge-attitude regarding pain, self-efficacy in pain management, and pain management practices among nurses. In the future, in-service programs related to pain management should increase the nurses’ knowledge and attitude and enhance their confidence, resulting in actual practice in pain management. However, the mediation effect of self-efficacy is modest, indicating the plausible existence of other contributory variables or factors warranting further exploration and elucidation.

Online Learning to Improve Nurses’ Knowledge, Attitudes, and Self-Efficacy About Managing Postoperative Pain in Older Adults

BackgroundOlder adults undergoing total knee arthroplasty may develop chronic pain without effective postoperative pain management. Increasing nurses’ knowledge, changing their attitudes, and developing their pain management self-efficacy could improve the effectiveness of pain management. AimTo determine the effectiveness of an online learning program to help registered nurses to manage postoperative pain in older adults undergoing total knee arthroplasty. DesignA quasi-experimental pre-test–post-test design with intervention and control groups. MethodSix inpatient units were randomly selected at a large tertiary care medical center. Sixty nurses were evenly divided between intervention and control groups to participate in online learning about postoperative pain management in patients undergoing total knee arthroplasty. The content was based on Kolb's experiential learning theory. Data were collected on nurses’ knowledge and attitudes toward pain management and pain management self-efficacy at baseline and after completion. Data were analyzed using descriptive statistics, chi-square tests, paired t-tests, and independent t-tests. ResultsThe knowledge and attitudes about pain management and pain management self-efficacy toward older adults undergoing total knee arthroplasty of nurses in the intervention group significantly improved compared to the baseline and were also significantly higher than in the control group. ConclusionsAn online learning program improves nurses’ understanding and ability to manage pain in older adults undergoing total knee arthroplasty. This was therefore an effective learning method.

Effect of educational booklet and role-playing on the mothers’ knowledge and self-efficacy in newborn pain management: A quasi-experimental study

AimThis study was conducted to determine and compare the effect of training using the educational booklet and role-playing on mothers’ knowledge and perception of self-efficacy in newborn pain management. BackgroundAccording to studies conducted in Iran, mothers lack knowledge about newborn pain management; as a result, their self-efficacy in this field is questioned. DesignThis is a quasi-experimental study in which 111 mothers of hospitalized infants were allocated into three groups' control,’ ‘role-playing,’ and ‘educational booklet.’ The data were collected using the non-parallel method. The group order to collect the data was determined through drawing. The control group received routine training, including general information about comforting the baby by the mother. In the second group, in addition to routine care, mothers were provided with an educational booklet on newborn pain management, and in the third group, in addition to routine care, mothers were trained educational content through role-playing during two 90-min sessions. Mothers' perception of self-efficacy was measured using a researcher-made questionnaire. Analysis of variance and post hoc tests were used to analyze the data. ResultsThe results showed a significant difference between mothers' knowledge in role-playing and educational booklet groups compared to the control group (P < 0.00). Moreover, there was a significant difference in mothers’ self-efficacy in the role-playing group compared to the control group and the educational booklet group (P < 0.00). ConclusionAccording to the findings of this study, educational booklets and role-playing can be used to enhance mothers' knowledge levels. However, practical methods such as role-playing are recommended to increase mothers’ self-efficacy levels.

Pain Management Education for Rural Hospice Family Caregivers: A Pilot Study With Embedded Implementation Evaluation.

Assessing and managing hospice patients' pain is a common source of anxiety among hospice family caregivers (HFCGs), especially caregivers in rural communities who face special challenges including distance, limited access, and concerns about opioid misuse. To pilot test Ready2Care, a pain management education intervention for rural HFCGs. We sought to determine whether there was a signal of benefit for clinically-relevant outcomes and to identify contextual factors pertinent to conducting a future randomized clinical trial of Ready2Care. We conducted a multi-method, single-arm study, enabling completion of paired t-tests comparing pre- and post-intervention measures of caregiver anxiety, pain management self-efficacy, barriers to pain management, and reports of patient pain intensity and corresponding patient and caregiver distress. We concurrently conducted an embedded implementation evaluation via calculation of descriptive statistics (recruitment and retention data) and directed content analysis of brief caregiver interviews. Twenty-seven (n = 27) HFCGs participated; 15 completed the study. Among completers, significant improvement was observed in patient pain intensity (average 1.4 points decrease on 0-10 scale) and in overall pain experience. No statistically significant changes were detected in caregiver anxiety, barriers to pain management, or pain management self-efficacy. Facilitators to successful conduct of a future clinical trial included high acceptability of Ready2Care, driven by its perceived clarity and relevance to caregivers' concerns. Barriers included lower-than-anticipated accrual and an attrition rate of nearly 44%. A multisite clinical trial of Ready2Care is warranted; however, its success may require more effective recruitment and retention strategies for rural caregiver participants.

Translation and validation of the Vietnamese version of the Pain Self-Efficacy Questionnaire in patients with cancer

Background: The Pain Self-Efficacy Questionnaire (PSEQ) measures self-efficacy for pain management in patients with chronic pain, including cancer pain. Although the questionnaire has been translated into many other languages, it has not yet been translated and tested in Vietnam. Objective: This study aimed to translate and validate the PSEQ into Vietnamese. Methods: The PSEQ was translated into Vietnamese using Brislin’s model. Next, the Vietnamese version of the questionnaire (Viet-PSEQ) was evaluated for content validity by six experts using the Item-Content Validity Index (I-CVI) and the Scale-Content Validity Index (S-CVI). The reliability of the questionnaire was examined with 30 patients with cancer, using test-retest reliability (Intra-Class Correlation - ICC) and internal consistency (Cronbach’s α). Results: The I-CVI values ranged from 0.5 to 0.88, and the S-CVI value was 0.93. The Cronbach's alpha was 0.91, and the ICC was 0.99 (95% CI: 0.949 – 0.997, p &lt;0.001). Conclusion: The Viet-PSEQ was found to be valid and reliable. Healthcare professionals can use this instrument to measure self-efficacy for pain management in patients with cancer in Vietnam.

Impairment in sleep health in young adults with chronic pain: a modifiable risk factor

BackgroundImpairments in sleep health are associated with the development or worsening of chronic pain. Further, chronic pain can cause sleep health disruption by impacting sleep onset, sleep maintenance, sleep quality, and causing daytime somnolence. However, the association between chronic pain and sleep disturbances in the young adult population is unclear.AimWe describe our initial experience in establishing and running a clinic for managing sleep health and chronic pain in young adults. We also describe the prevalence and the pattern of sleep disruption as well as its relationship with self-efficacy in pain management, depression, and quality of life in this cohort.MethodsAfter approval from the Institutional Review Ethics board, chart review and data extraction were conducted for patients who presented at the Young Adult Clinic (YAC) at Women’s College Hospital from March 1, 2018 to April 30, 2019.ResultsMedical charts of 55 patients were reviewed with the majority being females (71%). Chronic widespread pain was the most common pain syndrome diagnosed in our patients. Insomnia was the most common sleep-health related diagnosis in our patients. Patients with disorders of sleep were more likely to report lower self-efficacy for managing pain as compared to those with no sleep disorders (p = 0.023) but there was no significant difference between these two groups as regards risk for pain-related catastrophizing.ConclusionImpairments in sleep health may be an important modifiable risk factor for alleviating pain in young adults with chronic pain. Sleep disorders should be evaluated and addressed in this population.

Interventions for supporting self-management in people with musculoskeletal pain, including focus on varying levels of health literacy: A systematic overview of reviews

Background: Musculoskeletal (MSK) pain is a major cause of disability globally, affecting one in three adults. Self-management is a core recommendation for managing MSK pain; however, most self-management programmes require a high level of patient engagement, which may be partly influenced by health literacy levels. This overview aims to summarise current evidence on supported self-management and the influence of varying levels of health literacy in people with MSK pain. Methods: A systematic search was conducted for relevant systematic reviews in databases (Cochrane Library, Medline, EMBASE, CINAHLPlus, AMED, and PsycInfo). Data on study populations (including markers of health literacy), characteristics, and outcomes of supported self-management such as self-efficacy in pain management were extracted. Quality of systematic reviews was assessed using AMSTAR 2, and strength of evidence rated using a modified GRADE approach. Results: In total, 40 systematic reviews contributed evidence to this overview. Based on intervention components and mode of delivery, three main self-management intervention approaches were indicated: structured self-management education programmes (10 reviews), self-directed self-management (four reviews), and combined self-management activity and education programmes (26 reviews). MSK patients with low health literacy levels were found to have poorer outcomes with current self-management interventions. The strength of evidence for self-efficacy in pain management was assessed as low (across the three approaches). Only one review systematically extracted data on measures or markers of health literacy, highlighting an important gap in evidence. Conclusions: A comprehensive summary and critical assessment of current evidence on supported self-management and the influence of health literacy levels among patients with MSK pain was presented. There is a gap in evidence regarding potential mediators of the effects of supported self-management among people with musculoskeletal conditions and low levels of health literacy, thereby limiting the opportunity to positively influence outcomes.

Military Veterans’ Perspectives on Postoperative Opioid Use: A Secondary Analysis of Qualitative Data

PurposeThis qualitative analysis of interviews with surgical patients who received a brief perioperative psychological intervention, in conjunction with standard medical perioperative care, elucidates patient perspectives on the use of pain self-management skills in relation to postoperative analgesics. DesignThis study is a secondary analysis of qualitative data from a randomized controlled trial. MethodsParticipants (N = 21) were rural-dwelling United States Military Veterans from a mixed surgical sample who were randomized to receive a manual-based, telephone-based Perioperative Pain Self-management intervention consisting of a total of four pre- and postoperative contacts. Semi-structured qualitative interviews elicited participant feedback on the cognitive-behavioral intervention. Data was analyzed by two qualitative experts using MAXQDA software. Key word analyses focused on mention of analgesics in interviews. FindingsInterviews revealed a dominant theme of ambivalence towards postoperative use of opioids. An additional theme concerned the varied ways acquiring pain self-management skills impacted postoperative opioid (and non-opioid analgesic) consumption. Participants reported that employment of pain self-management strategies reduced reliance on pharmacology for pain relief, prolonged the time between doses, took the “edge off” pain, and increased pain management self-efficacy. ConclusionsPerioperative patient education may benefit from inclusion of teaching non-pharmacologic pain self-management skills and collaborative planning with patients regarding how to use these skills in conjunction with opioid and non-opioid analgesics. Perianesthesia nurses may be in a critical position to provide interdisciplinary postoperative patient education that may optimize postoperative pain management while minimizing risks associated with prolonged opioid use.

Determinants of quality of life among Omani family caregivers of adult patients with cancer pain.

The study aimed to explore the determinants of quality of life (QoL) among Omani family caregivers (FCGs) of adult patients with cancer pain. A descriptive cross-sectional design, measures of caregiver reaction, knowledge about cancer pain, self-efficacy for cancer pain and other symptom management, QoL, and patient functional status were used to collect data from 165 FCGs and patients. Descriptive, correlation, and regression analyses were performed. Most patients had intermittent (83%) and severe (50.9%) cancer pain. The FCGs had low QoL (58.44±17.95), and this mostly impacted support and positive adaptation (55.2%). Low QoL was associated with low self-rated health, low confidence in the ability to control the patient's pain, low self-efficacy, high perceived distress due to patient pain, and a high impact of caregiving on physical health. The level of caregiver distress due to the patient's pain (p<0.01), patient's functional status (p<0.01), and perceived impact of caregiving on health (p<0.05) were significant predictors of overall QoL. Omani FCGs of patients with cancer pain suffer a negative impact on their QoL, and this is related to the patient's level of pain and functional status, caregiver's health, and self-efficacy in cancer pain and symptom management. The FCGs' QoL may be enhanced by augmenting their skills and self-efficacy in cancer pain and symptom management and by health promotion programs.

Family Caregivers of Adult Cancer Patients in Oman: Predictors of Caregivers' Self-efficacy for Cancer Pain and Related Symptom Management at Home.

Family caregivers (FCGs) contribute significantly to the management of pain and other symptoms experienced by their family member with cancer and may not receive preparation to meet the changing patient needs. The aim of this study was to identify the predictors of FCG self-efficacy (SE) for pain and related symptom management of adult family members with cancer. Data were collected from 165 Omani FCGs. The questionnaire comprised the caregiver cancer pain and related symptom management SE scale, the Katz index, Caregiver Reaction Assessment, and Family Pain Questionnaire. Electronic medical records provided data on patients' cancer diagnosis, pain, and symptoms. Predictors of SE were examined using linear regression analysis. Most FCGs were female (58.2%) and children of the patient (53.9%). Most patients were on chemotherapy or palliative care (82.4%) and had at least stage 3 cancer (58.8%). Family caregivers reported average SE. The predictors of SE were as follows: patients' functional status (β = 40.90, P = .001), patients' pain intensity (β = -15.10, P = .036), FCGs' confidence in controlling the patients' pain (β = 28.80, P = .000), FCGs' self-rated health (β = -25.90, P = .038), and interaction of FCGs' knowledge level with patients' pain intensity (β = -1.31, P = .008), caregiving hours (β = -0.10, P = .025), and impact of caregiving on FCGs' physical health (β = 1.29, P = .031). Family caregivers' health status, knowledge, caregiving demands, patient functional status, and pain intensity have a significant effect on caregivers' symptom management. A deliberate model of care that includes supportive interventions to enhance the abilities of FCGs with symptom management is needed in Oman.

Influence of Pain Management Knowledge, Pain Management Self-Efficacy, and Empathic Capacity on Pain Management Performance of Nurses in Orthopedic Units

Background: The purpose of this study was to examine the influence of pain management knowledge, pain management self-efficacy, and empathic capacity on the pain management performance of orthopedic unit nurses.Methods: This study employed a cross-sectional design using the survey. Participants were 110 orthopedic unit nurses from five university hospitals located in the B, U, and I metropolitan cities. Data collection was carried out from February 1, 2019 to March 6, 2019. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson’s correlation coefficient, and multiple regression analysis with IBM SPSS WIN 25.0 program.Results: Pain management performance had statistically significant positive relationships with pain management self-efficacy (r=.46, p＜.001) and empathic capacity (r=.38, p＜.001). Regarding the factors that have an influence on pain management performance, pain management self-efficacy β=.33, p=.001), empathic capacity β=.21, p=.024), and experience in pain management education β=.18, p=.032) were the significant factors. These variables explained 26.1% of the pain management performance in orthopedic unit nurses.Conclusions: The findings would be used as a basis for effective strategies for pain management by orthopedic unit nurses in the future.

Factors affecting how parents cope with their preterm infant's pain: A cross-sectional study.

This study examined the relationships between parents' catastrophising about their infants' pain, parental self-efficacy in the management of their infants' pain, perceived social support and the parental coping strategies for their infants' pain-related stress. Preterm infants hospitalised in the neonatal intensive care unit experience painful procedures causing stress to their parents. Coping with stress may be emotion- or problem-focused. Adults' coping with their own pain has been associated with pain catastrophising, pain management self-efficacy and social support. However, little is known about the associations between parents' catastrophising, their self-efficacy to manage, their perceived social support and their coping strategies when dealing with their infants' pain. This was a cross-sectional, correlational study design. The STROBE guidelines for cross-sectional studies were followed. Participants included 149 parents of preterm infants hospitalised in a neonatal intensive care unit. They completed measures to assess infant pain catastrophising, self-efficacy regarding infant pain management, social support and emotion- and problem-focused coping. Positive associations were found between parental self-efficacy regarding infant pain management, social support, parental catastrophising about their infants' pain and problem-focused coping. Parental catastrophising was positively associated with emotion-focused coping. Gender moderated the relationships between parental self-efficacy regarding infant pain management and emotion-focused coping. Specifically, amongst mothers, the higher their level of self-efficacy, the lower their emotion-focused coping. Amongst fathers, the relations were reversed. Parents coping with their preterm infants' pain were associated with catastrophising about their infants' pain, self-efficacy regarding infant pain management and social support. Mothers had different ways to cope emotionally to that of fathers in relation to their self-efficacy in managing their infants' pain. Nursing interventions that provide support to parents and promote parental self-efficacy in managing their infants' pain may allow parents to more effectively cope with their infants' pain. Patients or public were not involved in setting the research question, the outcome measures and the design or implementation of the study. Parents of preterm infants answered the research questionnaires.

Internet-delivered management of pain among cancer treatment survivors (IMPACTS WF-1901).

TPS12151 Background: Pain is a common symptom among cancer patients and often is inadequately treated. Treatment guidelines recommend patients have access to behavioral interventions that educate about pain and pain management. Pain coping skills training (PCST) accomplishes these goals through teaching cognitive and behavioral coping skills shown to reduce pain. When delivered in in-person, PCST can substantially improve chronic pain conditions. Yet, these interventions are underused due to myriad barriers (high costs, shortage of therapists, travel needs). There is a critical need for improved options to help reduce cancer-related pain and related impairment that should include evidence-based PCST interventions capable of overcoming access barriers. To address this need, we developed a web-based PCST program using a novel expert systems approach that retains critical features of in-person PCST in an automated program that requires no therapist. PainTRAINER, is an 8-week, interactive PCST program using tailoring algorithms, a knowledge database, and a virtual coach to guide development of essential skills for coping with chronic pain. Methods: With funding from the NIH HEAL Initiative, we have undertaken a randomized, prospective, comparative effectiveness trial through the Wake Forest NCI Community Oncology Research Program (NCORP) Research Base to determine the impact of painTRAINER on pain outcomes when compared to Enhanced Usual Care (EUC). Participants have a documented diagnosis of invasive cancer who are undergoing anticancer therapy or within 5 years of completing all cancer therapy. Participants must report cancer-related pain most days of the week of 4 or greater on the PROMIS Pain Intensity Scale; with pain of new onset or significantly exacerbated since cancer diagnosis. All participants receive usual care provided by their physician along with pain education materials. PainTRAINER arm participants have access to the painTRAINER program and a tutorial on how to use the program, and complete the painTRAINER modules on their own (1 session/week for 8 weeks). To enhance study access, patients without internet availability are provided a WiFi/cellular-enabled tablet during the intervention period. This trial examines short- and long-term outcomes measured immediately post-intervention and 3- and 6- months post-intervention. Primary outcomes are: pre- to post-intervention change in pain interference/severity. Secondary outcomes are: pain severity/interference at 3- and 6-month follow-up, opioid/analgesic use, health-related quality of life, and pain management self-efficacy. Qualitative interviews are conducted with a random sample of diverse participants who have completed the painTRAINER, and all who exit the study early, to subjectively assess experiences with pain and the clinical trial. Enrollment for this trial has begun (n = 36 of 456 patients enrolled) and is ongoing at 12 sites. Clinical trial information: NCT04462302.

Pain, depressive symptoms, and self-efficacy for pain management: examination in African-American women with breast cancer.

African-American women with breast cancer face significant disparities, including high levels of pain. Depressive symptoms and self-efficacy for pain management impact how women with breast cancer manage pain, yet little is known about how these variables relate to pain specifically for African-American women with breast cancer. Baseline linear regression analyses were conducted using a sample of women (n = 98) with stage I-III breast cancer identifying as Black or African-American who were part of a larger intervention trial. Linear regressions explored the effect of depressive symptoms on pain (i.e., severity and interference), and the effect of self-efficacy for pain management on pain. Covariates were age (M = 57.22, SD = 10.76), cancer stage (50% = stage 1), and education level (36% = some college). Participants reported moderate levels of pain severity and interference. Higher depressive symptoms were related to both higher pain severity and interference; (B = 0.06, p < 0.01, 95% CI [0.02,0.09]) and (B = 0.13, p < 0.001, 95% CI [0.09, 0.17]) respectively. Likewise, lower self-efficacy for pain management was also related to both higher pain severity and interference; (B = - 0.04, p < 0.001, 95% CI [- 0.05, - 0.02]) and (B = - 0.06, p < 0.001, 95% CI [- 0.08, - 0.04]) respectively. Women reporting less than a high school diploma endorsed significantly higher pain severity and interference than women reporting some college. Age and cancer stage were not significantly related to pain. Pain for African-American women with breast cancer may be influenced by depressive symptoms and self-efficacy for pain management, in addition to other important variables. Attending to better assessment and treatment of depressive symptoms and self-efficacy for pain management may improve outcomes.

Role of self-efficacy for pain management and pain catastrophizing in the relationship between pain severity and depressive symptoms in women with breast cancer and pain

Purpose This study evaluated the relationship between pain and depressive symptoms through pain self-efficacy and pain catastrophizing in breast cancer patients with pain. Design Secondary analysis of a randomized trial investigating a cognitive-behavioral pain management protocol. Sample Females (N = 327) with stage I–III breast cancer and report of at least moderate pain. Methods Pain severity, pain self-efficacy, pain catastrophizing, and depressive symptoms were measured. The proposed model was assessed using structural equation modeling. Results Higher pain severity was significantly related to lower pain self-efficacy and higher pain catastrophizing. Lower pain self-efficacy and higher pain catastrophizing were significantly related to more depressive symptoms. Higher pain severity was significantly associated with more depressive symptoms through lower pain self-efficacy and higher pain catastrophizing. The association between pain severity and depressive symptoms was not significant when specified as a direct effect. Conclusion Pain severity related to depressive symptoms in breast cancer patients via pain self-efficacy and pain catastrophizing. Implications for psychosocial providers Measurement of pain self-efficacy and pain catastrophizing should be incorporated into comprehensive pain assessments for women with breast cancer, as these variables may be relevant therapeutic targets. Psychosocial symptom management interventions should include strategies that increase pain self-efficacy and decrease pain catastrophizing because these pain-related cognitive variables appear to drive the relationship between pain severity and depressive symptoms.

Randomized clinical trial to evaluate a cancer pain self-management intervention for outpatients

ObjectiveUnrelieved pain is common in patients with advanced cancer. Although psychoeducational interventions were found to decrease pain, effects were moderate. The purpose of this study was to evaluate the efficacy of a pain self-management intervention compared with usual care and to explore participants’ experiences with pain management and study participation. MethodsA multicenter randomized controlled trial design with post-trial interviews was used. Outpatients with cancer pain and their family caregivers were recruited from three Swiss university hospitals. The intervention group (IG) received the six-week intervention consisting of education, skills building, and nurse coaching. The control group (CG) received usual care. Outcome variables were analyzed using multilevel models. Interpretive description guided the qualitative study part. ResultsTwenty-one patients with advanced cancer and seven family caregivers completed the study. The group x time effect showed a statistically significant decrease in average pain (P ​= ​0.04), but no significant group x time effect for worst pain (P ​= ​0.06). Pain scores, pain-related knowledge, Pain Management Index, self-efficacy, and performance status improved in the IG (P ​< ​0.05). Almost all of the interviewed participants perceived the pain management diary, tailored intervention sessions, and weekly support as useful. None experienced study participation as burdensome. ConclusionsThis study was the first to test the efficacy of a psychoeducational cancer pain self-management intervention in a German-speaking context, with most patients receiving palliative care. Clinicians can recommend the use of pain management diaries. Tailoring interventions to an individual's situation and dynamic pain trajectory may improve patients' pain self-management. Registration numberThis study has been registered via ClinicalTrials.gov: NCT02713919.https://clinicaltrials.gov/ct2/show/NCT02713919?term=NCT02713919&draw=2&rank=1.

Adaptation of the pain management self-efficacy questionnaire into Turkish.

The aim of this study is to examine the Turkish validity and reliability of the Pain Management Self-Efficacy Ques-tionnaire (PMSEQ). The study was carried out descriptively and methodologically between September and December 2018 with 214 nurses and 248 nursing students. The data were collected using the descriptive characteristics form and the PMSEQ. Cronbach's alpha internal consistency coefficient was 0.90 in the total scale. In repeated measurements to test time reliability, there was no statistically significant difference between the two measurements (t=0.320, p=0.751), and there were a high power and positively highly significant relationship (r=0.997, p<0.001). Turkish version of the PMSEQ can be used as a valid and reliable scale in assessing the self-efficacy of clinical nurses and nursing students in pain management.

Exploring learning processes associated with a cancer pain self-management intervention in patients and family caregivers: A mixed methods study

AimExplore learning processes associated with a psychoeducational pain selfmanagement intervention. BackgroundSelf-management of cancer pain is challenging for patients and their family caregivers (FCs). While psychoeducational interventions can support them to handle these tasks, it remains unclear how learning processes are hampered or facilitated. MethodsA convergent parallel mixed methods design with qualitative data collection embedded in a randomized controlled trial (RCT) was used. Outpatients with cancer and FCs were recruited from three Swiss university hospitals. The six-week intervention consisted of education, skills building, and nurse coaching. Quantitative data on pain management knowledge and self-efficacy were analyzed using multilevel models. Patients and FCs were interviewed post-RCT regarding their learning experiences. Qualitative data analysis was guided by interpretive description. Finally, quantitative and qualitative data were integrated using case level comparisons and a meta-matrix. ResultsTwenty-one patients and seven FCs completed this study. The group-by-time effect showed increases in knowledge (p = 0.035) and self-efficacy (p = 0.007). Patients' and FCs' learning through experience was supported by an intervention nurse, who was perceived as competent and trustworthy. After the study, most intervention group participants felt more confident to implement pain self-management. Finally, data integration showed that declining health hampered some patients' pain self-management. ConclusionsCompetent and trustworthy nurses can support patients' and FCs' pain self-management by providing individualized interventions. Using a diary, jointly reflecting on the documented experiences, and addressing knowledge deficits and misconceptions through the use of academic detailing can facilitate patients' and FCs' learning of critical skills.