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PubMed2004

A survey of cancer pain management knowledge and attitudes of British Columbian physicians.

INTRODUCTION: There are many potential barriers to adequate cancer pain management, including lack of physician education and prescription monitoring programs. The authors surveyed physicians about their specific knowledge of pain management and the effects of the regulation of opioids on their prescribing practices. METHODS: A questionnaire was mailed out to British Columbia physicians who were likely to encounter cancer patients. The survey asked for physicians' opinions about College of Physicians and Surgeons of British Columbia regulation and other issues related to their prescribing practices, and assessed basic knowledge of cancer pain management. RESULTS: There was a 69% return rate with a total of 4618 evaluable responses. There was a significant difference among medical disciplines, years in practice, number of chronic pain patients seen and size of community of practice. The highest knowledge scores were achieved by oncologists and the lowest scores were from surgeons. Those who practiced in smaller communities had a higher average knowledge score. Those who felt their knowledge about cancer pain was inadequate scored lower than those who felt their knowledge was adequate. The questions most frequently answered incorrectly (or by "don't know") were those about equianalgesic dosing (68%) and adequate breakthrough dosing (45%), revealing knowledge deficiencies that would significantly impair a physician's ability to manage cancer pain. CONCLUSIONS: The details of opioid prescribing are crucial areas to target education for cancer pain management. The surveyed physicians accepted the need for regulation of opioid prescribing with very few being fearful of scrutiny from the College of Physicians and Surgeons of British Columbia. However, the inconvenience of the triplicate prescription pad was more of a barrier to prescribing, it being of concern to 20% of respondents, particularly surgeons and medical specialists.

Analgesics, Opioid↗
PubMed1991

Physician acquisition of cancer pain management knowledge.

Insufficient physician education in cancer pain management (CPM) is one of the major factors contributing to inadequate pain relief of cancer patients throughout the world. A survey of all physicians in direct patient care in Duluth, MN, (N = 243) was conducted to determine where they learned about CPM and how they would like to further their knowledge. Responses from 150 physicians (62%) have been analyzed, especially focusing on physician age and specialty. Statistically significant differences (p less than 0.001) document that residency training programs have been including CPM in their curricula since 1978 and that medical schools have not. Additional significant sources of CPM have been consultations with expert physicians, conferences and the literature. When asked how they would like to learn more about CPM, 84% of all physicians indicated that local conferences would be most effective. Physicians in various specialties indicated their differing preferences, too. This study suggests that improvements in CPM can occur through these mechanisms.

Clinical Competence↗
PubMed1996

Pain management knowledge, attitudes and clinical practice: the impact of nurses' characteristics and education.

This study examined the knowledge, attitudes, and clinical practice of registered nurses (N = 120) regarding pain management. Data were collected from nine varied clinical units in a large, university-affiliated, teaching hospital in an urban area of the Northeast. Demographic information was also collected to explore the relationship between nurses' characteristics, including previous pain education, clinical experience, area of clinical practice, and other variables, and knowledge, attitudes, and clinical practice. Three instruments were used in the study: (a) the Pain Management: Nurses' Knowledge and Attitude Survey; (b) a 12-item demographic questionnaire; and (c) a Pain Audit Tool (PAT) to gather data regarding pain assessment, documentation, and treatment practices from charts. Mean scores from the nursing knowledge and attitudes survey on pain revealed knowledge deficits and inconsistent responses in many areas related to pain management (mean, 62%; range, 41%-90%). The top two nurse-ranked barriers to pain management were related to patient reluctance to report pain and to take opioids for pain relief. Demographic data revealed that education about pain was most inadequate in the following areas: nonpharmacological interventions to relieve pain, the difference between acute and chronic pain, and the anatomy and physiology of pain. Chart audits with the Pain Audit Tool revealed that 76% of the charts (N = 82) lacked documentation of the use of a patient self-rating tool by nurses to assess pain, despite a high reported use (76%) of such a self-rating tool. Adjunct medications were ordered with some consistency, but appeared to be underutilized. This was especially true of nonsteroidal anti-inflammatory agents (mean use, 1%). Ninety percent of the charts had no documentation of the use of nonpharmacological interventions to relieve pain. Although this clinical setting has policies and resources in place regarding the management of pain, it would appear that they are not optimal. Practical recommendations are presented for increasing nurses' knowledge about pain management; improving the quality and the consistency of the assessment, documentation and treatment of pain; and disseminating pain management information.

Attitude of Health Personnel↗
PubMed2003

Effects of 'pain-advisers': district nurses' opinions regarding their own knowledge, management and documentation of patients in chronic pain.

This study investigated whether district nurses' opinions changed after the education and introduction of district nurses as 'pain-advisers' at primary health care centres (PHCCs) regarding working conditions and satisfaction with pain control management at their PHCCs, their own knowledge of pain control and satisfaction with their own pain control management, pain assessment and nursing documentation of patients with chronic pain conditions. A study area (SA) with five PHCCs and a control area (CA) with seven PHCCs were selected. In the SA, 28 and in the CA, 25 district nurses answered a questionnaire both before and after the introduction of the 'pain-advisers' into the SA. The district nurses in both areas in 1996 and 1998 considered many aspects of pain management to be unsatisfactory. According to the district nurses in the SA, several statistically significant improvements were achieved after the introduction of the 'pain-advisers'; more district nurses reported that pain policies or other written information were now available at their PHCCs, that they were more satisfied with present overall routines at their PHCCs, that a better pain control was applied at their PHCCs regarding patients with leg ulcers, that they themselves to a greater extent performed individual pain assessments of the patients and that they more often used pain visual analogue scales to assess the patients' pain and to evaluate the results of the pain treatment. They also reported an increased satisfaction with their own nursing documentation. Although much remains to be done, it must be acknowledged that the 'pain-advisers', with relatively small resources, managed to make significant improvements.

Attitude of Health Personnel↗
PubMed2004

Lymphoedema management knowledge and practices among patients attending filariasis morbidity control clinics in Gampaha District, Sri Lanka.

BACKGROUND: Little information is available on methods of treatment practiced by patients affected by filarial lymphoedema in Sri Lanka. The frequency and duration of acute dematolymphangioadenitis (ADLA) attacks in these patients remain unclear. This study reports the knowledge, practices and perceptions regarding lymphoedema management and the burden of ADLA attacks among patients with lymphoedema. METHODS: A semi-structured questionnaire was used to assess morbidity alleviation knowledge, practices and perceptions. The burden of ADLA attacks was assessed using one-year recall data. RESULTS: 66 patients (22 males, 44 females) with mean age 51.18 years (SD +/- 13.9) were studied. Approximately two thirds of the patients were aware of the importance of skin and nail hygiene, limb elevation and use of footwear. Washing was practiced on a daily and twice daily basis by 40.9% and 48.5% respectively. However, limb elevation, exercise and use of footwear were practiced only by 21-42.4% (while seated and lying down), 6% and 34.8% respectively. The majority of patients considered regular intake of diethylcarbamazine citrate (DEC) important. Approximately two thirds (65.2%) had received health education from filariasis clinics. Among patients who sought private care (n = 48) the average cost of treatment for an ADLA attack was Rs. 737.91. Only 18.2% had feelings of isolation and reported community reactions ranging from sympathy to fear and ridicule. CONCLUSIONS: Filariasis morbidity control clinics play an essential role in the dissemination of morbidity control knowledge. Referral of lymphoedema patients to morbidity control clinics is recommended.

Journal Article↗
PubMed2001

Data warehousing: toward knowledge management.

With rapid changes taking place in the practice and delivery of health care, decision support systems have assumed an increasingly important role. More and more health care institutions are deploying data warehouse applications as decision support tools for strategic decision making. By making the right information available at the right time to the right decision makers in the right manner, data warehouses empower employees to become knowledge workers with the ability to make the right decisions and solve problems, creating strategic leverage for the organization. Health care management must plan and implement data warehousing strategy using a best practice approach. Through the power of data warehousing, health care management can negotiate bettermanaged care contracts based on the ability to provide accurate data on case mix and resource utilization. Management can also save millions of dollars through the implementation of clinical pathways in better resource utilization and changing physician behavior to best practices based on evidence-based medicine.

Benchmarking↗
PubMedDate not supplied

The pain management knowledge of nurses practicing in a rural midwest retirement community.

Pain is a significant health issue, especially among hospitalized patients and elders. Nurses are the key to effective pain management; however, several studies over the past 20 years have demonstrated that nurses lack the knowledge necessary to manage pain effectively. Staff development educators have used a number of education methods to address this deficit. Additionally, educators in staff development have the task of providing education in an effective and cost-efficient manner. The purpose of this study was to assess the pain knowledge scores of a group of nurses practicing in a rural Midwest retirement community before and at two points after a pain education intervention to determine the effectiveness of Knowles' Adult Learning Theory in increasing and sustaining rural nurses' pain knowledge scores.

Analysis of Variance↗
PubMed1997

Making effective referrals: a knowledge-management approach.

Patients and physicians often choose specially consultants with only limited knowledge of the available options. Access to information about specialists that was directly relevant to patient and clinician preferences could improve the effectiveness of the referral process. We have developed a prescriptive representation of the process of selecting consultants. This "referral map," based on decision theory, uses patient and provider preferences elicited through a literature review and interviews with physicians and provides a formal framework for representing referral knowledge and for evaluating referral options. Our method suggests that the goals and processes of selecting consultants can be managed more systematically using explicit repositories. Such systematic management promises to have a beneficial impact on the delivery of health care, as well as on patient satisfaction.

Decision Support Techniques↗
PubMed1998

Disaster management knowledge attitude & practice of urban slum dwellers.

A KAP study was done in the area of Disaster Management in urban slums of Pune City. The Youth Organisations' members and the members of Mahila Mandals were the study subjects. It was found that there was marked improvement in the knowledge and attitudes of these subjects towards disasters. It is recommended that members of Mahila Mandals and members of Youth Organisations can act as 'frontline workers' in the situations of disasters after imparting some training in disaster management.

Adolescent↗
PubMed2005

Managing knowledge to support the patient journey in NHS Scotland: strategic vision and practical reality.

BACKGROUND: The strategy for NHS Scotland Knowledge Services is set in the context of a global transition to a networked model of management within health services. OBJECTIVES: Development planning for NHS Scotland aims to establish strategic vision and operational delivery systems which meet the needs of this changing health environment. METHODS: Analysis of knowledge needs at strategic organizational level and through consultation with healthcare staff form the basis of a vision of seamless knowledge support throughout all stages of the patient journey, based on a hybrid model of complementary human- and technology-based knowledge networks. RESULTS: The central role of the NHS Scotland e-library as a system-wide technology infrastructure facilitating management of both explicit and tacit knowledge is described. The implementation pathway and approaches to evaluation are outlined, based on practical steps to translate the concept of knowledge networks into a working reality. CONCLUSIONS: The model emerging is that of a knowledge matrix, with the primary delivery system comprising inter-dependent human, organizational and technology-based networks focused on the overriding common purpose of improving patient care.

Computer Communication Networks↗
PubMed2005

Customized document validation to support a flexible XML-based knowledge management framework.

This paper describes a validation architecture used within Intermountain Health Care's Clinical Knowledge Repository (CKR). The architecture provides additional functionality that complements XML Schema validation, producing user-friendly error messages and enabling validation rules reuse. The validation architecture helps document authors to fix their own errors. As a result, less than 1% of all documents in the CKR are considered invalid.

Information Management↗
PubMed1999

Lymphedema prevention and management knowledge in women treated for breast cancer.

PURPOSE/OBJECTIVES: To describe what women treated for breast cancer know about upper extremity lymphedema, what they recall being told to help prevent lymphedema, what preventive strategies they used, and, if lymphedema occurred, factors related to its occurrence and strategies they used to manage it. DESIGN: Descriptive, correlational survey. SETTING: Survivor-established Breast Cancer Resource Center. SAMPLE: 72 women with breast cancer who returned a mailed questionnaire that was enclosed with a quarterly newsletter. METHODS: A survey instrument, the Lymphedema Knowledge Scale, developed from National-Lymphedema Network guidelines to prevent upper extremity lymphedema. Data that was analyzed using descriptive statistics, chi square, and t-tests. MAIN RESEARCH VARIABLES: Lymphedema knowledge, lymphedema occurrence, and lymphedema prevention and management strategies. FINDINGS: Although many respondents were aware of their risk for lymphedema, their knowledge and use of prevention strategies were poor. Most knowledge was obtained from surgeons, reading materials, and breast cancer survivors. Occurrence of lymphedema was significantly associated only with radiation therapy to breast and axilla and use of any prevention strategy. The 27 women experiencing lymphedema used several management strategies to control the condition. CONCLUSIONS: The few women who had knowledge of most of the recommended guidelines for lymphedema prevention and management did not recall nurses as resources. Research in a larger sample is needed to better examine the association between preventive practices and lymphedema occurrence. IMPLICATIONS FOR NURSING PRACTICE: Nurses could do more to inform patients before and during breast cancer treatment about their risk for lymphedema and the need for prompt diagnosis and treatment of the condition. Until strategies for lymphedema prevention are researched further, nurses should be cautious in counseling about lymphedema prevention.

Breast Neoplasms↗