Kanser Hastalarının Onkolojik Cerrahi Öncesi Ağrı Yönetiminde Kullandığı Nonfarmakolojik Yöntemlerin Belirlenmesi: Tanımlayıcı Araştırma

Öz

Amaç: Kanser ağrısı, hastalar tarafından farklı şiddetlerde yaşanan bir semptomdur. Bireyi rahatlatmak, yaşam kalitesini artırmak ve komplikasyonları azaltmak için ağrının kontrol altına alınması gerekmektedir. Bu nedenle araştırma, onkolojik cerrahi geçirecek olan kanser hastalarının ağrı yönetiminde nonfarmakolojik yöntemlere başvurma durumlarını belirlemek amacıyla yapılmıştır. Yöntemler: Tanımlayıcı nitelikteki araştırma, bir üniversite hastanesinin kemoterapi ünitesinde yatan 279 kanser hastası ile yürütülmüştür. Araştırma verilerinin toplanmasında Kişisel Bilgi Formu, Sözel Ağrı Değerlendirme Ölçeği ve araştırmacılar tarafından literatür doğrultusunda hazırlanan Nonfarmakolojik Yöntemler Formu kullanılmıştır. Bu formlar, araştırmaya katılmayı kabul eden hastalara yüz yüze görüşme yöntemi ile uygulanmıştır. Bulgular: Araştırmaya katılan hastaların yaş ortalamasının 57.30±12.92 olduğu, %64.5’inin kadın olduğu ve %37.3’ünün meme kanseri nedeniyle tedavi edildiği belirlenmiştir. Hastaların %51.6’sı şiddetli ağrı yaşadığını ve %87.1’i ağrı yönetiminde ilaç kullandığını belirtmiştir. Onkolojik cerrahi öncesinde ağrıyı hafifletmek amacıyla nonfarmakolojik yöntemlere başvuran hastaların %62,7'si fiziksel yöntemler arasından masajı, %53,8'i bilişsel-davranışsal yöntemler arasından olumlu düşünmeyi, %47'si psikososyal yöntemler arasından sohbet etmeyi ve %92,5'i manevi yöntemler arasından dua etmeyi tercih etmiştir. Nonfarmakolojik yöntemlerin ağrı şiddetine göre karşılaştırılmasında, şiddetli ağrı yaşayan hastaların masaj ve olumlu düşünme yöntemlerini, düşük ve orta düzeyde ağrı yaşayanlara göre daha fazla kullandığı; bu farkın istatistiksel olarak anlamlı olduğu tespit edilmiştir. Sonuç: Onkolojik cerrahi öncesinde ağrıyı hafifletmek amacıyla kanser hastaları, nonfarmakolojik yöntemler arasında en sık fiziksel yöntemlerden masajı, bilişsel-davranışsal yöntemlerden olumlu düşünmeyi, psikososyal yöntemlerden sohbet etmeyi ve manevi yöntemlerden dua etmeyi tercih etmiştir.

Anahtar Kelimeler

• Ağrı yönetimi
• kanser ağrısı
• hemşirelik bakımı
• hasta eğitimi.

Determination of Nonpharmacological Methods Used by Cancer Patients in Pain Management Before Oncological Surgery: A Descriptive Study

Öz

Objective: Cancer pain is a symptom experienced by patients in varying intensities. Controlling pain is crucial to alleviate individuals, enhance their quality of life, and reduce complications. The research aimed to identify the utilization of nonpharmacological methods in managing pain among cancer patients undergoing oncological surgery. Methods: A descriptive qualitative study was conducted with 279 cancer patients hospitalized in the chemotherapy unit of a university hospital. Data collection utilized a "Personal Information Form," "Verbal Pain Assessment Scale," and a "Nonpharmacological Methods Form" prepared by researchers based on the literature. These forms were applied through face-to-face interviews with consenting participants. Results: The mean age of the patients who participated in the study was 57.30±12.92 years, 64.5% were female and 37.3% were treated for breast cancer. 51.6% of the patients stated that they experienced severe pain and 87.1% of them used medication for pain management. Among patients who used nonpharmacological methods to relieve pain, 62.7% preferred massage among physical methods, 53.8% preferred positive thinking among cognitive-behavioral methods, 47% preferred conversation among psychosocial methods, and 92.5% preferred prayer among spiritual methods. In the comparison of nonpharmacologic methods according to pain intensity, it was found that patients with severe pain used massage and positive thinking methods more than those with low and moderate pain; this difference was statistically significant. Conclusion: In order to alleviate pain before oncologic surgery, cancer patients most frequently preferred massage from physical methods, positive thinking from cognitive-behavioral methods, conversation from psychosocial methods, and prayer from spiritual methods among nonpharmacological methods.

Anahtar Kelimeler

• Cancer pain
• pain management
• nursing care
• patient education.

Kaynakça

1. 1. Sung H, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: a cancer journal for clinicians 2021;71(3):209–249. https://doi.org/10.3322/caac.21660
2. 2. Ruano A, et al. Psychological and NonPharmacologic Treatments for Pain in Cancer Patients: A Systematic Review and Meta-Analysis. Journal of pain and symptom management 2022;63(5):e505–20. https://doi.org/10.1016/j.jpainsymman.2021.12.021
3. 3. Katta MR, et al. Nonpharmacological integrative therapies for chronic cancer pain. Journal of oncology pharmacy practice: official publication of the International Society of Oncology Pharmacy Practitioners 2022;28(8):1859–68. https://doi.org/10.1177/10781552221098437
4. 4. Sözeri Öztürk E, Kutlu Türkan S. Kanser Ağrısının Yönetiminde Opioidlerin Kullanımına Bağlı Gelişen Konstipasyonun Yönetimi. Acibadem Universitesi Saglik Bilimleri Dergisi 2018;9(2).
5. 5. Van den Beuken-van Everdingen MH, et al. Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis. Journal of pain and symptom management 2016;51(6):1070–90.e9. https://doi.org/10.1016/j.jpainsymman.2015.12.340
6. 6. World Health Organization. Palliative care. Fact sheet, reviewed August 2020. Available at: https://www.who.int/news-room/fact-sheets/detail/palliative-care
7. 7. Mert S, Göktaş S. Hemşirelerin Ameliyat Sonrası Ağrı Yönetiminde Nonfarmakolojik Yöntemleri Kullanma Durumlarının Belirlenmesi. Sağlık Bilimleri Üniversitesi Hemşirelik Dergisi 2019;1(2):76-83
8. 8. De Paolis G, et al. The effectiveness of progressive muscle relaxation and interactive guided imagery as a pain-reducing intervention in advanced cancer patients: A multicentre randomised controlled nonpharmacological trial. Complementary therapies in clinical practice 2019;34: 280–87. https://doi.org/10.1016/j.ctcp.2018.12.014

9. 9. Midilli TS, Eşer İ, Yücel Ş. Cerrahi kliniklerde çalışan hemşirelerin ağrı yönetiminde nonfarmakolojik yöntemleri kullanma durumları ve etkileyen faktörler. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 2019;10:60-66.
10. 10. Torralba A, Miquel A, Darba J. Situacion actual del dolor cronico en Espana: iniciativa “Pain proposal”. Rev Soc Esp Dolor 2014;21:16–22. https://doi.org/10.4321/S1134- 80462014000100003
11. 11. Sochor M, Slama O, Loucka M. Early integration of Palliative care into standard Oncology care − Benefits, limitations, barriers and types of palliative care. Klin Onkol 2015;28:171-76. https://doi.org/10.14735/amko2015171
12. 12. Katz J, Rosenbloom BN, Fashler S. Chronic Pain, Psychopathology, and DSM-5 Somatic Symptom Disorder. Can J Psychiatry. 2015;60(4):160-7. doi: 10.1177/070674371506000402.
13. 13. Swarm RA, et al. Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network J Natl Compr Canc Netw 2019;17(8):977-1007. https://doi.org/10.6004/jnccn.2019.0038
14. 14. Genç F, et al. Kanser hastalarının ağrı için kullandıkları nonfarmakolojik yöntemler. Koç Üniversitesi Hemşirelikte Eğitim ve Araştırma Dergisi (HEAD) 2018;15(2):88-93.
15. 15. Özveren YDDH. Ağrı Kontrolünde Farmakolojik Olmayan Yöntemler. HUHEMFAD 2011;18(1):83-92. https://dergipark.org.tr/tr/pub/hunhemsire/issue/7838/103252
16. 16. Su Gündüz C, Çalışkan N. Ağrı Kontrolünde Uygulanan Nonfarmakolojik Yöntemler: Etkinliği Hakkındaki Kanıtlar Yeterli mi? Tradit Complem Med 2018;1(2):76-81. DOI: 10.5336/jtracom.2018-60643
17. 17. Aslan G, Kılıc D. Yaşlı Bireylerde Ağrı Yönetiminde Kullanılan Farmakolojik ve Nonfarmakolojik Yöntemler. THDD 2022;3(1):49-58. https://dergipark.org.tr/tr/pub/thdd/issue/70212/984042
18. 18. Tola YO, Chow KM, Liang W. Effects of nonpharmacological interventions on preoperative anxiety and postoperative pain in patients undergoing breast cancer surgery: A systematic review. Journal of clinical nursing 2021;30(23-24):3369–84. https://doi.org/10.1111/jocn.15827
19. 19. Kulkarni AR, et al. Factors associated with acute postoperative pain following breast reconstruction. JPRAS Open 2017;11:1–13. https://doi.org/10.1016/j.jpra.2016.08.005.
20. 20. Evans H. Preoperative relaxation techniques for breast cancer patients undergoing breast-altering surgery: A systematic review. Iris Journal of Nursing & Care 2019;1(3):1-13. https://doi.org/10.33552/IJNC.2019.01.000512
21. 21. Greenlee H, et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: a cancer journal for clinicians 2017;67(3):194–232. https://doi.org/10.3322/caac.21397
22. 22. Cırık VA, Efe E. Orogastrik Tüp Takma İşlemindeki Ağrıyı Azaltmada Önerilen Nonfarmakolojik Yöntemlere Karşın Sınırlı Sayıda Çalışma: Literatür Değerlendirmesi. Türkiye Klinikleri Hemşirelik Bilimleri Dergisi 2020.
23. 23. Erdoğan S, Nahcıvan N, Esin, N. Hemşirelikte Araştırma Süreci, Uygulama ve Kritik. Nobel Kitapevleri, 2014
24. 24. Aydın A, Araz A, Aslan A. Visual analog scale and emotion lattice: Adaptation to our culture. Turkish Psychology Writings 2011; 14(27):1-13. https://scholar.google.com/scholar_lookup?title=Visual%20analog%20scale%20and%20emotion%20lattice%3A%20Adaptation%20to%20our%20culture&author=A.%20Ayd%C4%B1n&publication_year=2011&pages=1-13
25. 25. Begum MR, Hossain MA. Validity and reliability of visual analogue scale (VAS) for pain measurement. Journal of Medical Case Reports and Reviews 2019;2(11).
26. 26. Liu C, Chen X, Wu S. The effect of massage therapy on pain after surgery: A comprehensive meta-analysis. Complementary therapies in medicine 2022;71:102892. https://doi.org/10.1016/j.ctim.2022.102892
27. 27. Behzadmehr R, et al. Effect of complementary and alternative medicine interventions on cancer related pain among breast cancer patients: A systematic review. Complementary therapies in medicine 2020;49:102318. https://doi.org/10.1016/j.ctim.2020.102318
28. 28. Cole JS, Olson AD, Dupont-Versteegden EE. The Effects of Massage Therapy in Decreasing Pain and Anxiety in Post-Surgical Patients With Breast Cancer: A Systematic Review and Meta-Analysis. Glob Adv Integr Med Health 2024:16;13:27536130241245099. doi: 10.1177/27536130241245099.
29. 29. Zhang Y, et al. Massage therapy can effectively relieve cancer pain: A meta-analysis. Medicine 2023;102(27):e33939. https://doi.org/10.1097/MD.0000000000033939
30. 30. Epstein AS, et al. Acupuncture vs Massage for Pain in Patients Living With Advanced Cancer: The IMPACT Randomized Clinical Trial. JAMA Netw Open 2023;6(11):e2342482. doi: 10.1001/jamanetworkopen.2023.42482.
31. 31. Sharif Nia H, et al. The Relationship between Religious Well-Being, Existential Well-Being, Fear of Progression and Quality of Life in Patients with Cancer: The Mediating Role of Hope. Asian Pac J Cancer Prev 2024;25(3):1087-96. doi: 10.31557/APJCP.2024.25.3.1087.
32. 32. Shnayder S, et al. Psilocybin-assisted therapy improves psycho-social-spiritual well-being in cancer patients. Journal of affective disorders 2023;323:592-97. https://doi.org/10.1016/j.jad.2022.11.046
33. 33. Yang Y, Mischkowski D. Integrating intra- and interpersonal perspectives on chronic low back pain: the role of emotion regulation and attachment insecurity. Front Psychol 2024;12;15:1331227. doi: 10.3389/fpsyg.2024.1331227. 34. Yang Y, Grol-Prokopczyk H. Chronic Pain and Friendship Among Middle-Aged and Older U.S. Adults. The journals of gerontology. Series B, Psychological sciences and social sciences 2021;76(10):2131-42. https://doi.org/10.1093/geronb/gbaa185
34. 35. Albayrak A, et al. Kanser Hastalarında Yaşam Kalitesini Etkileyen Din Ve Maneviyat Üzerine Teorik Yaklaşımlar. Sakarya Üniversitesi İlahiyat Fakültesi Dergisi 2019;21/40:349-76. https://doi.org/10.17335/sakaifd.605552.
35. 36. Ozdemir S, et al. Advanced Cancer Patients' Prognostic Awareness and Its Association With Anxiety, Depression and Spiritual Well-Being: A Multi-Country Study in Asia. Clinical oncology (Royal College of Radiologists (Great Britain) 2022;34(6):368–75. https://doi.org/10.1016/j.clon.2021.11.041
36. 37. Putranto R, et al. The association of prognostic awareness with quality of life, spiritual well-being, psychological distress, and pain severity in patients with advanced cancer: Results from the APPROACH Study in Indonesia. Palliative & supportive care 2024;1–7. https://doi.org/10.1017/S1478951524000269
37. 38. Maria R, Waluyo A, Khamarudin K. Spiritual Care in Patient with Cancer Pain: Literature Review. Indonesian Journal of Global Health Research 2024;6(1):9-18. https://doi.org/10.37287/ijghr.v6i1.2562
38. 39. Yılmaz Karabulutlu E, Yaralı S, Karaman S. Evaluation of Distress and Religious Coping Among Cancer Patients in Turkey. Journal of religion and health 2019;58(3):881–890. https://doi.org/10.1007/s10943-017-0453-6
39. 40. Alsharif F. Discovering the Use of Complementary and Alternative Medicine in Oncology Patients: A Systematic Literature Review. Evidence-based complementary and alternative medicine 2021:6619243. https://doi.org/10.1155/2021/6619243.
40. 41. Guerra-Martín MD, Tejedor-Bueno MS, Correa-Casado M. Effectiveness of Complementary Therapies in Cancer Patients: A Systematic Review. International journal of environmental research and public health 2021;18(3):1017. https://doi.org/10.3390/ijerph18031017
41. 42. Jain PN, Sumitra G. Perioperative Pain Management for Onco-surgery 2021:377-383. doi: 10.1007/978-981-16-0006-7_27
42. 43. Mao JJ, et al. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2022;40(34):3998–4024. https://doi.org/10.1200/JCO.22.01357
43. 44. Pike K. The Role of Oncology Massage in Pain Management. Pain Management Nursing 2023;23(2):244-244. https://doi.org/10.1016/j.pmn.2023.02.011
44. 45. Eraslan D, Yeşilbalkan ÖU. Türkiye’de Kanserde Ağrıya Yönelik Yapılmış Hemşirelik Araştırmalarının İncelenmesi: Sistematik Derleme. Gevher Nesıbe Journal Of Medıcal And Health Scıences 2023;8(4):996-1009.
45. 46. Tunc Tuna P, et al. Factors Affecting Postoperative Pain Beliefs Among Surgical Patients in Türkiye: A Cross-Sectional Study. Pain management nursing : official journal of the American Society of Pain Management Nurses, 2024;25(3):e265–e270. https://doi.org/10.1016/j.pmn.2024.02.010
46. 47. Bağci N, Doğan R. The relationship between pain beliefs and pain severity in liver transplant patients. Transplant immunology 2022;72:101564. https://doi.org/10.1016/j.trim.2022.101564
47. 48. Zhang Y, et al. Massage therapy can effectively relieve cancer pain: A meta-analysis. Medicine (Baltimore) 2023; 7;102(27):e33939. doi: 10.1097/MD.0000000000033939.
48. 49. Kianpour Barjoee L, et al., Effectiveness of Positive Thinking Training on Perceived Stress, Metacognitive Beliefs, and Death Anxiety in Women with Breast Cancer: Perceived Stress in Women with Breast Cancer. Arch Breast Cancer [Internet]. 2024;9(2):195-203. https://www.archbreastcancer.com/index.php/abc/article/view/498
49. 50. Forte AJ, et al. The Impact of Optimism on Cancer-Related and Postsurgical Cancer Pain: A Systematic Review. Journal of pain and symptom management 2022;63(2):e203-11. https://doi.org/10.1016/j.jpainsymman.2021.09.008
50. 51. Ong J, et al. The Effectiveness of Mind-Body Therapies for Women With Gynecological Cancer: A Systematic Review and Meta-analysis. Cancer nursing 2023;10.1097/NCC.0000000000001231. https://doi.org/10.1097/NCC.0000000000001231
51. 52. Blasco-Belled A, Tejada-Gallardo C, Alsinet, C. Positive psychology interventions can improve mental health for chronic pain patients: a systematic review and meta-analysis. Psychology & health 2023;1–17. https://doi.org/10.1080/08870446.2023.2250382