Patients' beliefs can act as barriers to optimal management of cancer pain. The Barriers Questionnaire (BQ) is a tool used to evaluate such barriers. Here, the BQ has been revised to reflect changes in pain management practices, resulting in the Barriers Questionnaire-II (BQ-II), a 27-item, self report instrument. This paper presents the results from two studies where the psychometric properties of the BQ-II were evaluated. In the first study, the responses of 27 nurses trained in pain management were compared to responses of a convenience sample of 12 patients with cancer. The results indicated that patients with cancer had higher mean scores on the BQ-II than did nurses trained in pain management. In the second study, a convenience sample of 172 patients with cancer responded to the BQ-II and a set of pain and quality of life (QOL) measures. A factor analysis supported four factors. Factor one, physiological effects, consists of 12 items addressing the beliefs that side effects of analgesics are inevitable and unmanageable, concerns about tolerance, and concerns about not being able to monitor changes in one's body when taking strong pain medications. Factor two, Fatalism, consists of three items addressing fatalistic beliefs about cancer pain and its management. Factor three, Communication, consists of six items addressing the concern that reports of pain distract the physician from treating the underlying disease, and the belief that 'good' patients do not complain of pain. The fourth and final factor, harmful effects, consists of six items addressing fear of becoming addicted to pain medication and the belief that pain medications harm the immune system. The BQ-II total had an internal consistency of 0.89, and alpha for the subscales ranged from 0.75 to 0.85. Mean (SD) scores on the total scale was 1.52 (0.73). BQ-II scores were related to measures of pain intensity and duration, mood, and QOL. Patients who used adequate analgesics for their levels of pain had lower scores on the BQ-II than did patients who used inadequate analgesics. The BQ-II is a reliable and valid measure of patient-related barriers to cancer pain management.

This randomized controlled trial tested an intervention, Sharing Patients' Illness Representations to Increase Trust (SPIRIT), designed to enhance communication regarding end-of-life care between African Americans with end-stage renal disease (ESRD) and their chosen surrogate decision makers (N = 58 dyads). We used surveys and semi-structured interviews to determine the feasibility, acceptability, and preliminary effects of SPIRIT on patient and surrogate outcomes at 1 week and 3 months post-intervention. We also evaluated patients' deaths and surrogates' end-oflife decision making to assess surrogates' perceptions of benefits and limitations of the SPIRIT while facing end-of-life decisions. We found that SPIRIT promoted communication between patients and their surrogates and was effective and well received by the participants. Keywordsend-stage renal disease (ESRD); African American; end-of-life care; decision making; representational intervention Randomized Controlled Trial of SPIRIT: An Effective Approach to Preparing African American Dialysis Patients and Families for End-of-LifeAdvances in medicine may extend life but often with decreasing quality and escalating dependence on medical technologies (Blank & Merrick, 2005). End-stage renal disease (ESRD) is an example of a chronic illness wherein a technology, dialysis, significantly extends patients' lives but does not necessarily improve the quality of that prolonged survival. The annual mortality rate in this population is high; of 450,000 patients with ESRD, more than 79,000 died in the United States in 2004 (U.S. Renal Data System, 2007. The Renal Physicians Association and American Society of Nephrology (2000) recommend that clinicians initiate timely and continuous discussions with dialysis patients and theirCorresponding author: Mi-Kyung Song, PhD, University of North Carolina at Chapel Hill, School of Nursing, 4108 Carrington Hall, CB # 7460, Chapel Hill, NC 27599-7460, Phone: 919.843.9496, Fax: 919.843.9900, Email: songm@email.unc.edu. The study was conducted at the University of Pittsburgh. NIH Public Access Author ManuscriptRes Nurs Health. Author manuscript; available in PMC 2009 August 3. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript families to assist them in expressing wishes about options in managing their illness and end of life. However, many such discussions are delayed until near death and are narrowly targeted to completion of advance directives (Cherlin, et al., 2005;Covinsky, et al., 2000) despite the widely documented limitations associated with advance directives (Fagerlin & Schneider, 2004;Perkins, 2007).Several factors contribute to the lack of timely end-of-life discussions. Patients and their families may not foresee that death is approaching. This lack of foresight may be due to patients' vacillating between focusing on the illness (having kidney disease) or on the relative wellness they experience from dialysis. Once acclimated to a life on dialysis, patients and their families may have a pe...

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A stress-coping model of relationships between patients' beliefs about pain, coping (analgesic use), pain severity, analgesic side-effects, and three quality of life (QOL) outcomes was tested. Participants were 182 men and women with cancer who completed valid and reliable self-report measures of relevant variables. Antecedent variables (age and education) showed expected relationships with beliefs. As predicted, beliefs were significantly related to analgesic use. Analgesic use was inversely related to pain severity, but was not related to side-effect severity. Analgesic use was inversely related to impairments in QOL before controlling for pain and side-effect severity, but not after these two variables were controlled. Both analgesic side-effects and pain severity were related to impaired QOL outcomes, including difficulty performing life activities, depressed mood, and poor perceived health status.

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