Effectiveness of a pain management programme for Chinese adults undergoing a major thoracotomy operation

Abstract

Background: A major thoracotomy operation can cause patients to experience an extremely distressing amount of pain. Unrelieved acute post-thoracotomy pain greatly increases the risks of postoperative complications and compromises the quality of life of patients in the long run. There are reports in the literature about the effectiveness of nurse-led pain education interventions in the management of postoperative pain. Educating patients does not, in itself, seem an adequate way to resolve the various conflicting issues related to increasing knowledge and actual behaviors in pain management or to relieve patients from pain suffering in clinical practice. Aim: The purpose of the study was to investigate the effectiveness of a pain management programme on the postoperative experience of pain, barriers to pain management, pain management behaviours, and clinical outcomes related to a major thoracotomy operation for Chinese adult patients. Method: A randomized controlled trial with a single-blinded design was adopted for the present study and conducted in a tertiary general hospital in mainland China. A total of 108 patients who were scheduled to undergo a major thoracotomy were recruited and 94 participants (N=94) completed the study (48 participants in the experimental group, and 46 participants in the comparison group). Preoperative pain education was provided to both groups, while the postoperative pain round was performed only for the experimental group from postoperative day 1 until the patient was discharged. Pain intensity and the interference of pain with daily activities were measured by the Brief Pain Inventory-Chinese version (BPI-C). The concerns of patients about reporting pain and taking analgesics were assessed using the Barrier Questionnaire Taiwan Form-Surgical version (BQT-S). Pain management behaviors (using drug and non-drug methods to relieve pain) were documented by a log-record. Objective clinical outcomes (including the length of hospital stay, and the postoperative recovery from thoracic surgery as the first day to initiate ambulation, length of chest tube insitu, and the occurrence of postoperative complications) were collected from the patients' medical records. Data collection was conducted before preoperative pain education and throughout the entire period of postoperative hospitalization. Results: The experimental group reported significant lower scores on pain severity and the interference of pain with activities than did the comparison group from postoperative day 1 till day7 (p < 0.05). The experimental group's scores on the total BQT-S and the subscales of BQT-S were lower than those of the comparison group (p < 0.05), except for the subscales of "fear of injections" and "fatalism" (p > 0.05). Patients in the experimental group used more non-drug methods to relieve pain than those in the comparison group from postoperative day 1 to 7 (p < 0.05); and there were no significant differences found here between the experimental group and the comparison group regarding the total amount of analgesic use or using PCA for pain in the postoperative period (p > 0.05). Comparisons of the two group's clinical outcomes did not significantly differ (p > 0.05), including the length of hospital stay, days of chest drain retention, and the occurrence of postoperative complications. However, the experimental group initiated out-of-bed activities much earlier than did the comparison group, with the difference being significant (p < 0.05). The study also tested the relationships between pain intensity, pain interference, barrier scores, and the use of drug or non-drug methods for pain relief. The patients' scores on pain intensity and the interference of pain with daily activities were significantly positively correlated to their barrier scores; but were significantly negatively correlated to the use of drug or non-drug methods for pain relief in the postoperative period. Conclusion: The findings of the present study provide positive evidence of the effectiveness of nurse-led educational interventions in reducing patient-related barriers to pain management, improving pain management behaviors, and relieving patients from pain suffering after surgery. A pain management programme based on the PRECEDE framework, which integrated preoperative pain education and a reinforcing intervention, can lead to a new model of care to improve the outcomes of postoperative care. This study also provides insights on developing the role of advanced nursing practice to address issues of safety and cost-effectiveness in pain care in mainland China.