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Objectives: To evaluate the feasibility and potential effects of patient‐centred self‐administered acupressure for alleviating fatigue and co‐occurring symptoms among Chinese advanced cancer patients receiving treatment. Methods: Thirty advanced cancer patients who screened positive for moderate/severe fatigue with symptoms of insomnia and/or pain were recruited from a hospital in Hong Kong. They were randomly assigned (1:1) to receive a 4‐week patient‐centred self‐administered acupressure intervention or health education. Fatigue (primary outcome) and secondary outcomes (sleep quality, pain, fatigue–sleep disturbance–pain symptom cluster severity, anxiety, depression and quality of life) were measured by questionnaires and actigraphy. Results: Twenty‐four participants (80%) completed the study. Adherence to self‐administered acupressure practice was satisfactory, with all retained participants attending all sessions and 90.9% practising acupressure daily. All completers rated the class as very enjoyable or quite enjoyable. Fatigue, pain, symptom cluster severity, anxiety, depression and quality of life appeared to improve from baseline to post‐intervention in the intervention group. Among these outcomes, only the between‐group difference in anxiety post‐intervention was significant. The group × time interaction effect was nonsignificant for all outcomes. Conclusions: Patient‐centred self‐administered acupressure appears to be feasible and acceptable among advanced cancer patients. A fully powered trial is warranted to confirm the intervention effect. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to explore the relationships among pain, sleep disturbance, and circadian rhythms in advanced cancer patients. Methods: This cross-sectional study was conducted in 68 cancer patients from the oncology inpatient unit of a teaching hospital. Their demographic and medical characteristics, questionnaire surveys, including Brief Pain Inventory-Chinese version and Pittsburgh Sleep Quality Index Taiwanese version, and sleep logs and actigraphic recordings in consecutive 3 days and nights were collected and analyzed. Results: The mean (SD) scores for autocorrelation coefficient at 24 h (r24) and dichotomy index (I

Abstract: The purpose of this research was to investigate the effectiveness of a patient and family pain education program on reducing cancer patients’ and their families’ barriers to (i.e., concerns or misconceptions about) cancer pain management, on increasing patients’ adherence to a prescribed analgesic regimen, and on decreasing pain intensity and pain interference with daily life. An experimental and longitudinal design was used. The experimental group consisted of 31 pairs of cancer outpatients and their family carers, while the control group consisted of 30 patient–family pairs (N =122). Patients and their family carers in the experimental group simultaneously received a pain management education program. Both groups had pretest data collection and after-test follow-ups on the second and fourth weeks at the outpatient clinics. Comparisons between those two groups were made using the Generalized Estimating Equations (GEE) method. Results revealed that at both the second and fourth weeks, patients and family carers in the experimental group showed a significantly greater reduction in barrier scores than did patients and family carers in the control group. At the second and fourth weeks, patients in the experimental group reported significantly better adherence to a scheduled analgesic regimen than did patients in the control group. In the fourth week, patients in the experimental group reported significantly lower levels of worst pain intensity and pain interference than did patients in the control group. This research provides evidence of the effectiveness of a patient and family pain education program. [Copyright &y& Elsevier]

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. [Copyright &y& Elsevier]

Abstract: Background: A comprehensive assessment of patient hesitancy to use analgesics and accurate knowledge related to the promotion of analgesic adherence is necessary for effective pain management. Unfortunately, there has been a lack of a short and concise questionnaire to assess patients’ hesitancy to use analgesics in clinical practice. Objective: This paper is a report of the development and psychometric properties of the short version of the Barriers Questionnaire-Taiwan form (S-BQT). Design: This study employed a descriptive design. Setting: A convenience sample was recruited from oncology clinics at two medical centers in Taiwan. Participants: One hundred and eighty-three (N =183) patients receiving analgesics for cancer pain participated in the study. Methods: Instruments included the Barriers Questionnaire-Taiwan form (BQT), the Taiwanese version of the Morisky Medication Adherence Measure-Taiwan form (MMAM-T). Two self-administered questionnaires were performed at the same time, and the ratio of analgesic usage was computed over a two-week period. Reliability was established by calculating Cronbach''s α and test–retest reliability. The validity was estimated by construct validity, criterion-related validity, and known group validity. Results: To develop the S-BQT, we used reliability analysis to extract nine items from nine subscales. Internal consistency of the S-BQT was indicated by a Cronbach''s alphas score of 0.86. Test–retest reliability was assessed as 0.83 over a two-week interval. Factor analysis revealed two factor structures. Criterion-related validity was examined by correlating the S-BQT score, and MMAM-T score, and the ratio of analgesic use. Known group validity was examined by comparing the S-BQT scores of patients with hesitancy to report pain and take analgesics vs. patients demonstrating no such hesitancy in the previous week. Known group validity was also established by comparing the S-BQT scores among patients with low, moderate, and high adherence to the usage of medication. Conclusions: The S-BQT shows excellent reliability and validity. The use of this instrument can help to improve communication between patients and clinicians regarding the use of analgesics in the management of pain. [Copyright &y& Elsevier]

Context: No study has examined the varying family experience of palliative sedation therapy (PST) for terminally ill patients in different settings.Objectives: To examine and compare family concerns about PST use and its effect on the grief suffered by terminally ill patients' families in palliative care units (PCUs) or intensive care units (ICUs).Methods: A total of 154 family members of such patients were recruited in Taiwan, of whom 143 completed the study, with 81 from the PCU and 62 from the ICU. Data were collected on their concerns regarding PST during recruitment. Grief levels were assessed at three days and one month after the patient's death with the Texas Revised Inventory of Grief.Results: Families' major concern about sedated patients in the PCU was that "there might be other ways to relieve symptoms" (90.2%), whereas families of ICU sedated patients gave the highest ratings to "feeling they still had something more to do" (93.55%), and "the patient's sleeping condition was not dignified" (93.55%). Family members recruited from the ICU tended to experience more grief than those from the PCU (P = 0.005 at Day 3 and < 0.001 at Month 1). PST use predicted higher levels of grief in family members recruited from the PCU (P < 0.001 at Day 3 and Month 1).Conclusion: Family experiences with the use of PST in terminally ill patients varied in different settings. Supportive care should address family concerns about PST use, and regular attention should be paid to the grief of individuals at higher risk. [ABSTRACT FROM AUTHOR]

Abstract: The purposes of this study were (1) to examine the psychometric properties of the Taiwanese version of the Morisky Medication Adherence Measure (MMAM), including its validity and reliability, (2) to investigate levels of analgesic regimen adherence, and (3) to explore the predictors of adherence to the analgesic regimen in a sample of Taiwanese cancer patients with pain. One hundred thirty-five patients receiving analgesics for cancer pain participated in this study. Instruments consisted of the Taiwanese version of the MMAM, the Barriers Questionnaire-Taiwan form, the Chinese version of the Brief Pain Inventory, the American Pain Society Outcome Questionnaire, Karnofsky Performance Status, and a demographic questionnaire. Analgesic use ratios were calculated. The Taiwanese version of the MMAM had good psychometric properties for measuring adherence with the analgesic regimens taken by Taiwanese cancer pain patients. Reliability was supported by good internal consistency Cronbach α and test-retest coefficients. Validity was corroborated by good known group validity, construct validity, and criterion-related validity. The majority of the patients (51%) showed low levels of medication adherence. The significant predictors for the medication adherence score were age, the Barriers Questionnaire score, and satisfaction with pain management by clinicians after entering pain severity, pain interference with daily life, age, gender, education, types of analgesics used, functional status, and satisfaction with pain management as independent variables. The model accounted for 63% of the variance in the medication adherence score. The Taiwanese version of the MMAM shows excellent reliability and validity. The use of this reliable, valid, simple, and easily administered tool can improve communication between patients and clinicians about use of analgesics and further improve the analgesic regimen adherence. [Copyright &y& Elsevier]

Abstract: Cancer pain is commonly believed to be a unique type of pain and dissimilar to noncancer pain; however, only limited research efforts have been directed at examining this belief. The aim of this study was to explore whether patients with chronic daily headache (CDH) and patients with chronic cancer pain (CCP) present with different pain, mood, and sleep quality profiles. Forty-seven patients diagnosed with CDH were matched by age and gender with 47 patients with CCP. The research instruments included the Brief Pain Inventory-Chinese version, the Profile of Mood States Short Form, and the Pittsburgh Sleep Quality Index-Taiwan Form (PSQI-T). Results revealed that there was no difference in pain intensity between the patients with CDH and those with CCP; however, the CCP group reported significantly higher mean levels of pain interference with daily life than did the CDH group. These two groups did not differ on the Total Mood Disturbance score; however, the CCP group reported significantly lower mean levels of vigor than did the CDH group. Moreover, there was no difference on the PSQI-T total score between these two groups; however, the CDH group reported higher mean scores of sleep disturbance, higher mean scores of use of sleep medications, lower mean scores of sleep efficiency, and lower mean scores of daytime dysfunction than did the CCP group. Despite some differences between these two groups, pain, mood, and sleep quality profiles in these two types of pain groups are similar. [Copyright &y& Elsevier]