Research On The Influential Factor And Nursing Intervention Of The Cancer Pain Self-Efficacy

The pain is common in cancer patients, and every day there are more than five million cancer patients suffering from pain in the world. Cancer pain not only causes a series of pathophysiologic reaction, but also evokes anxiety, depression, insomnia and other psychological problems, increasing great physical and mental suffering, and seriously affecting the patients'quality of life. To improve their health condition, cancer pain management research has been one of the hot medical spot home and abroad. Pain self-efficacy is the belief that one has the capabilities to manage their pain,cope with the pain-correlated symptoms and carry out the daily activities, which is highly related to one's pain control,mental health and physical function, becoming a new research direction of the pain management. So incorporating pain self-efficacy into cancer pain management study has significant impact on its theory development and clinical practice to control cancer pain and improve cancer pain patients'physical and mental health condition.At present, there have been a lot of studies on the self-efficacy of the chronic non-cancer pain abroad, but a few of cancer pain self-efficacy, which is limited in the descriptive study. Its influential factors need thorough discussion, and there is no report about how to apply cancer pain self-efficacy to cancer pain medical treatment and nursing intervention. In our country, there is no scale to evaluate cancer pain self-efficacy; the overview of the self-efficacy and the influential factors are unknown; and whether the nursing intervention of cancer pain can improve the pain control by enhancing the patients'self-efficacy are also needed to study. This study has three parts: the first one is to study the rectification of the chronic pain self-efficacy scale to evaluate cancer pain self-efficacy; the second one is to study the influential factors of cancer pain self-efficacy, while the third one is to observe the effect of the nursing intervention on cancer pain self-efficacy.Research on the Development of the Chronic Pain Self-Efficacy Scale's Chinese Version Objective To rectify Anderson's chronic pain self–efficacy scale(CPSS) as the evaluation scale of the cancer pain self-efficacy.Methods (1) Revising CPSS. Firstly,translating the scale into Chinese as the first draft, and then getting the second draft by summarizing the first draft and the back translated scale. Secondly,developing the third draft after the experts'discussion and modification. Then testing the scale in ten cancer pain patients and rectifying the scale according to the patients'understanding, and then developing the formal scale. (2) Analyzing the revised CPSS's reliability and validity. Using the revised CPSS to investigate 170 cancer pain patients and analyzing the results'reliability and validity. Reliability including internal consistency, split-half reliability, test-retest reliability. Validity including content validity,construct validity and criterion validity.Results (1)The internal consistency Cronbach'sαcoefficients of the total and sub-scales ranged from 0.836 to 0.951, the Guttmann split-half coefficients were between 0.760 and 0.904, the test-retest correlation coefficients were 0.819～0.904. (2)The correlated coefficients between total scale and subscales were 0.834～0.948; and that of the CPSS with the numeric rating scal(eNRS) were -0.411～-0.477;factor analysis results indicated that the scale included three common factors, i.e., self-efficacy for pain management(PSE), self-efficacy for physical function(FSE), self-efficacy for coping with symptoms(CSE), which could explain 62.51% of total variance, and the factor loading of the common factors were powerful in related items(0.532～0.819).Conclusions The reliability and validity of the revised CPSS is satisfactory, and it can be used to evaluate the cancer pain self-efficacy in our country.Research on the Influential Factors of Cancer Pain Self-EfficacyObjective To identify factors affecting the cancer pain's self-efficacy, providing theory fundation of the nursing intervention study.Methods 170 cancer pain patients are included. The patients'basic information,pain and health condition,social psychological data are collected; pain self-efficacy has been evaluated by revised CPSS. Independent sample t test,single factor variance analysis,rank correlation analysis and multiple regression analysis are used to determine factors affecting the cancer pain's self-efficacy.Results (1)The factors affecting the self-efficacy for pain management are ECOG score,the current most pain score,working condition,the condition of taking oral opioid drugs,the activity condition after ill. (2)The factors affecting self-efficacy for physical function are ECOG score,the current most pain score,the activity condition after ill,character type,age. (3)The factors affecting self-efficacy for coping with symptom are ECOG score,the current most pain score,character type,health education condition,the activity condition after ill,age,the condition of taking oral opioid drugs. (4)The factors affecting the total score of cancer pain self-efficacy are ECOG score,the current most pain score,character type,the activity condition after ill,age,health education condition,the condition of taking oral opioid drugs,working condition.Conclusions (1) sex, disease type,educational background,economic status,exercise condition before ill,time of obvious pain,medicine side effects,pain position,the chronicity of pain,the most pain score before hospitalizing,the average pain score before hospitalizing,the pain persisting time before hospitalizing,the current average pain score,and the current pain persisting time are not the cancer pain self-efficacy influential factors. (2)physical ability condition,the most pain score at the present stage,working condition,the state of taking oral opioid,the activity state after ill,age,character type,and the health education state are the cancer pain self-efficacy influential factor.Research on the Nursing Intervention of Cancer Pain Self-EfficacyObjective To observe the effect of nursing intervention on cancer pain self-efficacy and control, and establishing foundation for further clinical study and application.Methods The study includes 20 cancer pain patients. The study includes two stages: the first stage, from the first day to the seventh day, is the usual nursing stage; second stage, from the eighth day to the twenty first day, is the cancer pain nursing intervention stage on the basis of the usual care. The cancer pain management includes cancer pain health education,skill learning,exercising,emotional support. The health education and skill learning are three times per week, carrying out by the same researcher using face to face instruction, thirty minutes every time. Before and after health education, patients need to appraise the cancer pain control obstacle change by BQ-L. The patients need to take relaxing training,exercising and finish the pain diary before sleeping. They also need to take the pain appraisal,CPSS evaluation, analgesic drug analysis on the first day,the seventh day and the twenty first day. Analyze the data by variance analysis,chi-square criterion,t-test. Results (1) The total score of the patients'pain control barriers significantly cut down. (2)At the end of the first stage the dosage of morphine,the number of patients taking drugs on time increase obviously that compares with the baseline. Pain self-efficacy,pain intensity have no significant statistics discrepancy, but the pain persisting time decreases obviously; at the end of the second stage the dosage of morphine,the number of patients taking drugs on time increase obviously than the end of first stage. Pain self-efficacy has been enhanced significantly and the pain intensity,pain persisting time decrease obviously.Conclusions The nursing intervention of cancer pain management enhances patients'cancer pain self-efficacy and patients'pain control obviously and promotes patients'health.