| BackgroundPain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Such kind of unpleasant feeling and emotional damage often cause mental stress, anxiety, fear and other intense and mental stimuli, which will bring a series of negative effects to the occurrence, progress and sequelae of the disease. Hippocrates once said that one who can kill pain is called genius. Melzack and Wall, the founder of Gate Control Theory, pointed out that pain is a problem of primary importance which is most worthy to struggle to relieve. Therefore, it is very necessary to solve the pain problem in the treatment of cancer patient.Cancer pain generally refers to the pain caused by the tumor directly. Tumor invades or compresses nerve root, neural stem, plexus or nerve, violating the brain and spinal cord, periosteum or bones, substantive organs and hollow organs, causing infringement or blockage of the vascular system, and leading to localized necrosis, ulcers, inflammation, etc, which may result in severe pain. The pain during cancer treatment is also considered to be cancer pain. Cancer pain is one of the main reasons causing the suffering in patients with advanced cancer. According to the statistics of World Health Organization, there are at least5.5million cancer patients in the world suffering from pain everyday,50%of patients with medium-term cancer having pain, 70%to90%of patients with advanced cancer experiencing pain, of which30%to45%with severe pain. Cancer pain has a significant impact in the long course of treatment of cancer patients.At present, there are6.3million patients died of cancer each year in the world, with a cancer patient in every200households, and one out of every five deaths died of cancer. The statistics of China’s Ministry of Health show that there are2.2million new cancer patients in China, and each year more than1.5million people die from it. Suffering from cancer and confronting death, patients and their families shoulder a heavy blow. Above all, patients need to endure the pain from chemotherapy and radiotherapy, fear of death, as well as huge economic pressure, which cause enormous harm to patients physically and mentally.The study on the quality of life has become an international hotpot in recent30years, especially for cancer patients, which has become the mainstream of quality of life research in the medical field. U.S. Food and Drug Administration (FDA) has defined the quality of life as one of the must for the evaluation on anticancer drug, which greatly promotes the process of the medical profession on the quality of life of cancer patients. Today, the tendency that one out of four will die of cancer will not change greatly in the short term, thus easing the symptoms in cancer patients becomes an important issue for modern medicine, but pain is one of the main symptoms of cancer, also the main factor to affect the patients’ quality of life (QOL), therefore, relieving pain and improving quality of life is one of the key objectives for the caring cancer patients.In2011, tumor standardized treatment ward (painless demonstration ward) began to be established nationwide under the supervision of the Ministry of Health. The oncology daycare ward in Nanfang Hospital of Southern Medical University was established in May2009, mainly for patients to do chemotherapy at daytime. In order to provide excellent service and answer the call to the establishment of the Good Pain Management Ward, we began the activity of high-quality nursing service in the whole hospital in April2011and created the oncology day ward as the painless demonstration ward of Oncology department in August2011in the spirit of the document of Ministry of Health. Purposes1. To study the nurses’awareness and attitude towards pain management after receiving pain specialist training.2. To figure out whether the quality of life has improved in cancer patients after getting pain specialist care.3. To study the effect of proper pain management on the quality of life in cancer patients.MethodsAccording to the6scopes for measuring quality of life regulated by World Health Organization (WHO) and combined with the reported literatures, we chose the cancer patients in oncology daycare ward to study quality of life after the establishment of Good Pain Management Ward and with care pain specialist. Appropriate questionnaire was made based on the impact of pain management on quality of life in cancer patients to analyze the relationship between pain management and quality of life in cancer patients.1. Investigation object1.1Investigation on nursesNine on-the-job nurses in oncology daycare ward were selected from Nanfang Hospital of Southern Medical University for cancer nurse specialist training.1.2Investigation on patientsThere were totally101suitable investigated inpatients in oncology daycare ward, aged over18, being in pain, who were expected to survive more than3months and could communicate normally. After signing informed consent, the patients were informed the purpose and significance of the study. Investigators handed out and collected scales in questionnaire to the patients on admission and discharge.2. Investigation time2.1Before pain nurse specialist training, they were given Questionnaire of paramedic knowledge and attitude regarding pain A and Questionnaire of paramedic knowledge and attitude regarding pain B before and after the training. Investigation duration was July to August2011. 2.2Both at admission and hospital discharge, patients were given Quality of life questionnaire and satisfactory questionnaire. Investigation duration was January to July2012.3. Investigation Methods3.1Questionnaire of paramedic knowledge and attitude regarding pain were handed out before and after the training in order to study their understanding and attitude towards pain management. Scoring method:The questionnaire was scored as1for correct answer,0for incorrect or empty answer, with the total score of15points of the objective terms in the questionnaire.3.2Each month,10discharged cancer pain patients were randomly chosen for satisfaction investigation, for evaluating their satisfaction degree, as a contrast to average satisfaction rate in2010.3.3Cancer pain patient were given FACT-G scale on the day of admission and discharge. The scales were filled and then collected for analysis.4. Statistical analysis:Data base were established using excel, independent-samples t-test was conducted with SPSS software.Results1. Elevation in pain management awareness and attitudeAfter adopting the Good Pain Management Ward paramedic working mode, pain management awareness and attitude of the nurses were scored as12.63±1.06points, showing a significant increase as compared with pre-training (9.37±2.20). Paired samples t-test indicated t=3.776, P=0.002, statistically significant.2. Improvement in quality of life of patients during hospitalizationFACT-G index evaluation of patients at admission and discharge were using Gronbach’s Alpha (CR). CR>0.6indicates consistence in the term scale (health condition, family condition, mood condition, work condition). Based on Table6, we can safely conclude that in the admission and discharge4-dimensional consistency rate CR>0.6, indicating that terms in the questionnaire responded the dimension well. As terms in the questionnaire responded the dimension well, we chose average score of terms in the same dimension as score of that dimension. Comparation of dimension score at admission and discharge was conducted, using independent-samples t-test. Table7demonstrated positive change in each dimension, with health condition score significantly improved from admission to discharge (t=5.280, P=0.000).3. Improvement in patients satisfactionOne hundred and one Satisfaction questionnaires were handed out with full hand in. Patients’satisfaction rate increased from90%in2011to96.6%in2012.4. Decrease of average hospitalizationDuring January to July,2011, average hospitalization duration was13.05±2.22days among195patients, comparing with13.05±2.22days during January to July,2012among565patients. In the2groups, independent-samples t-test indicated statistical differences (t=44.195, P<0.0001).Conclusions1. Establishment of Good Pain Management Ward plays a major part in answering "Three good and one satisfaction" activity" and "Quality care service" called by the military of health department. Oncology daycare ward in Nanfang Hospital established Good Pain Management Ward, and arranged nurses to participate in pain nurse specialist training program. In this turn, they gained new knowledge in pain management, changed attitude towards pain management, improved ability in helping patients correctly deal with pain.2. Pain, as the main symptom of cancer patient, severely compromises patients’ quality of life and medical activities. Pain nurse specialists are able to evaluate pain in cancer patient, cooperate with doctors, improve comfort of the patient, elevating their quality of life. Meanwhile, these specialists will provide the exact pain background information to patients and relatives, educating them, releasing their confusion, thus providing humanistic care to a larger extent.3. Through painless pass, nurses start educating patients and effective pain management at the start of admission. Other than that, they followed the patients up after discharge. Measures mentioned above provide strong back-up for treatment and rehabilitation, increasing satisfaction rate among cancer patients. In the present study, satisfaction rate increased significantly compared with that before the program.4. Because of the ideal pain management in cancer patient, hospitalization duration was reduced tremendously. Patients are able to return home for rehabilitation, enabling the enhancement in turnover rate. Average hospitalization duration reduction will reduce cost directly and indirectly, achieving resources and cost minimization in order to get comprehensive benefit of the hospital.This study showed realistic importance in rising quality of life and living time of cancer patients. Through the investigation, nurses had their pain knowledge awareness and attitude towards pain management increased greatly after the pain nurse specialist training, based on the questionnaire score. On the other hand, patients gained their skills in pain management, with their quality of life improved. |
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