Significant knowledge deficits regarding currently accepted principles of pain management practice as well as beliefs that could interfere with optimal care, mandate a need for educational interventions. Significant differences by profession, clinical practice area, and hospital setting reflect populations to be targeted for interventions. Unwarranted fear of addiction is a misunderstood and important concept that needs to be addressed.

The contribution of patient factors to nonadherence with self-administered cancer chemotherapy along with its prevalence was studied. Fifty-one patients with breast cancer enrolled in protocols that included the orally administered medications Cytoxan (cyclophosphamide) and/or prednisone were interviewed and assessed at five points in time over a 6-month period. Two summary measures of patient nonadherence derived by self-report were developed: (1) dosage, the overall percentage of drug missed during 26 weeks of treatment; and (2) behavioral, the percentage of behavioral events or prescribing occasions on which a criterion level of drug was missed. Twenty-two patients (43%) met criteria for noncompliance according to both behavioral and dosage definitions. Univariate analyses showed more nonadherence in the clinic and private community settings than in the academic setting. Stepwise multiple logistic regression analyses assessed the contribution of patient demographic, psychologic, and physical symptom factors on patient noncompliance. In the regression analyses patient noncompliance was associated with (1) treatment location, more nonadherence in the private community-based treatment sector than in the academic setting; and (2) income, more nonadherence among those having lower incomes. In assessing total dose requirements in clinical research trials, rates of patient nonadherence need to be considered, and treatment location controlled.

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Our results suggest that lavender aromatherapy can be used to reduce the demand for opioids in the immediate postoperative period. Further studies are required to assess the effect of this therapy on clinically meaningful outcomes, such as the incidence of respiratory complications, delayed gastric emptying, length of hospital stay, or whether this therapy is applicable to other operations.

This paper reviews the most commonly used pain management interventions with patients who have carcinoma of the pancreas. Prior research has focused on the use of celiac plexus block. Other methods such as pain medication as well as chemical and surgical splanchnicectomy are also reviewed. Results of this review point to very successful pain relief rates with celiac plexus block and the urgent need for vigorous evaluation studies of pain management techniques in patients with pancreatic carcinoma.

Thirty-eight patients with a diagnosis of malignant mesothelioma participated in a semi-structured interview to evaluate asbestos exposure, acquisition of increased risk information, and retrospective reporting of cognitive and behavioral reactions (particularly smoking behavior) to risk information. Twenty-eight patients (74%) had direct occupational contact with asbestos, and six patients (16%) reported indirect nonoccupational exposure to asbestos. Only two (10%) of the directly exposed patients acquired risk information from professional sources prior to diagnosis of mesothelioma. The most frequently reported reaction to learning of increased risk of cancer was a denial of the risk by minimizing personal exposure. Few patients reported being concerned about the information of increased risk. Smoking behavior did not change as a result of risk information, nor was there any increase in visits to physicians. Guidelines for psychosocial management of at-risk groups are recommended.

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