The impact on quality of life of patient-related barriers to pain management.

OBJECTIVE: Based on a stress-coping perspective, the present study was designed to examine links between patients' beliefs (barriers), coping (analgesic use), and quality of life (QOL) outcomes. DESIGN: Not given. SETTING: Outpatient clinic. POPULATION: Participants were outpatients from either a comprehensive cancer center or a private oncology clinic. Inclusion criteria for the parent (intervention) study were diagnosis of metastatic breast or prostate cancer, lung cancer or multiple myeloma. Three hundred sixteen persons were invited to join the study and 240 did so. Of those, 182 reported cancer-related pain; these are the participants involved in this report. Participants were 114 women and 68 men who ranged in age from 31 to 84 years. INTERVENTIONS: Eligible patients were approached by a nurse in the outpatient clinic. After consent, study personnel interviewed the patient to collect data about pain history and recent (past week) analgesic use. The patient was asked to complete the packet of self-report questionnaires while waiting to be seen by a clinician. The Barriers Questionnaire (BQ) is a 27-item instrument designed to measure the extent to which patients have concerns about reporting pain and using analgesics. Three items from the Brief Pain Inventory (BPI) were used to assess pain severity. Coping was operationalized as analgesic use and was measured with a revised version of the Pain Management Index (PMI). The Medication Side-Effect Checklist (MSEC) was used to assess severity of analgesic side-effects. Three facets of impaired QOL were examined. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depressed mood. MAIN OUTCOME MEASURE(S): Means for pain severity, barriers, side-effect severity, and interference with life activities were low to moderate. Depression scores were moderate to high. Perceived health varied, with 2 (1%) of the patients viewing their health as very poor, 25 (14%) seeing it as poor, 50 (28%) as fair, 87 (48%) as good, and 17 (9%) as excellent. Coping was inversely associated with pain severity: the more effective the analgesic use the lower was the patient's 'pain now' score. Unexpectedly, coping was not associated with side-effect severity. However, both pain severity and side effects were positively related to impairments in QOL, with the exception that pain severity was not significantly related to depression. RESULTS/CONCLUSIONS: Taken as a whole, the findings point to two areas in which interventions are needed in order to maximize QOL. First, it would be useful to test the impact of informational interventions on beliefs that are barriers to analgesic use. In addition, further attention should be given to refining a measure of coping. As recommended by current practice guidelines (U.S. Department of Health and Human Services, 1994), proactive management of analgesic side effects needs to become a routine facet of pain management. [CINAHL abstract] [ABSTRACT FROM AUTHOR]