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PurposeIn the absence of treatments for chemotherapy-induced peripheral neuropathy (CIPN), dose reductions (DR) and premature discontinuation (PD) are primary management strategies. However, decision-making guidance is insufficient and knowledge of factors associated with DR/PD is limited. We examined biopsychosocial factors associated with CIPN-related DR/PD in women undergoing taxane-based chemotherapy for early-stage breast cancer.Patients and methodsAs part of a longitudinal study of CIPN measurement, women completed assessments before the first taxane infusion and at the final infusion or within the originally expected timeframe for the final infusion. Participants completed self-report measures of CIPN, pain, and physical and psychosocial wellbeing, and underwent physical testing of lower limb disability and Quantitative Sensory Testing for sensation and pain threshold to thermal, vibration, and touch stimuli in the feet and hands. Sociodemographic and clinical data were collected. Logistic regression was used to identify factors associated with neuropathy-related DR/PD.ResultsAmong 121 participants, 66 (54.5%) received taxane-as-prescribed, 46 (38.0%) had neuropathy-related DR/PD, and 9 (7.4%) had DR/PD for other reasons. Factors associated with neuropathy-related DR/PD were receipt of paclitaxel (Odds Ratio [OR]=75.05, 95% Confidence Interval [CI] 2.56-2197.96]), lower pre-treatment pain catastrophizing (OR=0.72, 95% CI: 0.54 – 0.95), and higher post-treatment neuropathic pain (OR=10.77, 95% CI: 1.99 – 58.15) and sensitivity to cold pain in the hand (OR=1.64, 95% CI: 1.05 – 2.56).ConclusionCIPN-related DR/PD is associated with paclitaxel treatment and post-treatment neuropathic pain and cold pain sensitivity in the hands. CIPN communication to healthcare providers may be influenced by pain catastrophizing, suggesting symptom appraisal may be an important factor in communication. Findings could contribute to clinical practice recommendations to facilitate treatment decision-making.Lay summaryWe studied pre- and post-treatment factors associated with reduced taxane dose or early cessation due to chemotherapy-induced peripheral neuropathy in women undergoing chemotherapy for early-stage breast cancer. Reduced taxane dose or early cessation is associated with paclitaxel treatment, and high post-treatment neuropathic pain and sensitivity to cold pain stimuli in the hands. Communication of these experiences to healthcare providers may be influenced by pre-treatment thoughts and feelings about symptoms.Precis for use in the Table of Contentstwo concise sentences that state the significant conclusion(s) or message of the manuscript; Chemotherapy-induced peripheral neuropathy-related reduced taxane dose or premature discontinuation is associated with paclitaxel treatment and high post-treatment neuropathic pain and cold pain sensitivity in the upper limbs. Reporting of these experiences may be influenced by pre-treatment symptom appraisal and communication style.

Pain assessment and management continues to be challenging for many nurses. Single educational interventions have proven to be unsuccessful in knowledge retention. This study will assist leaders in nursing in understanding how a 4-day educational program delivered to self-selected pain resource nurses (PRNs) could improve pain assessment and management practices. A focus group study was undertaken at a trisite academic health science center to understand the role implementation of the PRNs and required resources to sustain the role at a unit level. To evaluate the PRN role, a qualitative descriptive study design using focus group interviews was used to answer the following questions: What was the experience of the PRN during role implementation? What barriers and enablers affected the implementation of this role? Organizational support, integration within the interdisciplinary team, and organizational role awareness were key themes highlighted in the focus group results. This article will describe how the three-site academic health science center used the PRN role to foster practice-related change and enhance current knowledge of evidence-based pain management.

BACKGROUND/OBJECTIVES: Pain-related misbeliefs among health care professionals (HCPs) are common and contribute to ineffective postoperative pain assessment. While standardized patients (SPs) have been effectively used to improve HCPs’ assessment skills, not all centres have SP programs. The present equivalence randomized controlled pilot trial examined the efficacy of an alternative simulation method – deteriorating patient-based simulation (DPS) – versus SPs for improving HCPs’ pain knowledge and assessment skills.METHODS: Seventy-two HCPs were randomly assigned to a 3 h SP or DPS simulation intervention. Measures were recorded at baseline, immediate postintervention and two months postintervention. The primary outcome was HCPs’ pain assessment performance as measured by the postoperative Pain Assessment Skills Tool (PAST). Secondary outcomes included HCPs knowledge of pain-related misbeliefs, and perceived satisfaction and quality of the simulation. These outcomes were measured by the Pain Beliefs Scale (PBS), the Satisfaction with Simulated Learning Scale (SSLS) and the Simulation Design Scale (SDS), respectively. Student’sttests were used to test for overall group differences in postintervention PAST, SSLS and SDS scores. One-way analysis of covariance tested for overall group differences in PBS scores.RESULTS: DPS and SP groups did not differ on post-test PAST, SSLS or SDS scores. Knowledge of pain-related misbeliefs was also similar between groups.CONCLUSIONS: These pilot data suggest that DPS is an effective simulation alternative for HCPs’ education on postoperative pain assessment, with improvements in performance and knowledge comparable with SP-based simulation. An equivalence trial to examine the effectiveness of deteriorating patient-based simulation versus standardized patients is warranted.

Research indicates that patients feel more satisfied and obtain better health outcomes when they are able to discuss their questions with their health professionals. A better understanding of cancer patients' questions may help guide interventions to address their information needs and improve pain management. This study sought to explore and describe the questions that women with breast cancer have about pain related to cancer. Semistructured interviews were conducted with women with pain related to breast cancer or its treatment, recruited from a large teaching hospital in Toronto, Canada. Interviews were audio recorded and fully transcribed. Data saturation was reached after 18 participants were interviewed. Analysis involved the identification of themes and the development of a taxonomy of questions about pain. In total, over 200 questions concerning seven main themes were identified: (1) understanding cancer pain, (2) knowing what to expect, (3) options for pain control, (4) coping with cancer pain, (5) talking with others with cancer pain, (6) finding help managing cancer pain, and (7) describing pain. The information collected suggests that formulating and articulating questions about pain is a context-dependent, time-intensive process that requires reflection, knowledge, and a good use of language. Patients have numerous and diverse questions about pain and its treatment, which may be difficult to address within the context of a typical consultation. To manage pain adequately, innovative efforts are needed to enable patients and health professionals to recognize, articulate, and answer such questions. Internet-based tools could provide some of these solutions.

Background The global paradigm shift resulting from radical transformations in knowledge and technology is significantly changing the context of healthcare delivery. In this changing environment, the contributions of health professions are vital in ensuring that the healthcare system adapts to meet the needs of today's patient. Advanced practice nurses (APNs) are clinical scholars and leaders in creating innovative approaches to patient care and organizational and professional leadership. Aims To develop a comprehensive conceptual framework for advanced nursing practice at University Health Network that will enhance role clarity by describing the complexity of these nursing roles and the significant contributions they make to patients and the healthcare system. Methods A critical review of the literature and a consultative process were undertaken to build consensus and develop a comprehensive framework for advanced nursing practice. Results The development of the University Health Network Framework for Advanced Nursing Practice (UHN-FANP), which clearly articulates all dimensions of advanced nursing practice roles. Conclusion As clinical leadership roles in nursing continue to evolve, utilization of a conceptual framework facilitates role clarity, role implementation and role evaluation.