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Evidence-Based Practice
Carlton G. Brown, PhD, RN, AOCN®, FAAN—Associate Editor
Guided Imagery for Pain Control Peggy Burhenn, MS, CNS, AOCNS®, Jill Olausson, RN, MSN, CDE, Griselda Villegas, RN, OCN®, and Kathy Kravits, MA, RN, HNB-BC, LPC, NCC, ATR-BC
Evidence-based practice is integral to the delivery of effective and efficient nursing care. However, translating evidence into practice remains a challenge in health care. To overcome this challenge, the Oncology Nursing Society developed a program, the ONS Foundation Institute for Evidence-Based Practice Change, to provide nurses with the tools they need to translate evidence-based practice to their units. This article reviews the process of implementing the evidence-based practice of guided imagery for pain management on a medical oncology inpatient unit at a comprehensive cancer center. Peggy Burhenn, MS, CNS, AOCNS®, is a professional practice leader in the Department of Clinical Practice and Education, Jill Olausson, RN, MSN, CDE, is a PhD student and a senior research specialist in the Division of Nursing Research and Education, Griselda Villegas, RN, OCN®, is a charge nurse in the Department of Nursing, and Kathy Kravits, MA, RN, HNB-BC, LPC, NCC, ATR-BC, is a senior research specialist in the Division of Nursing Research and Education, all at City of Hope National Medical Center in Duarte, CA. The authors take full responsibility for the content of the article. The authors did not receive honoraria for this work. No financial relationships relevant to the content of this article have been disclosed by the authors or editorial staff. Burhenn can be reached at [email protected], with copy to editor at [email protected]. Key words: guided imagery; evidence-based nursing; evidence-based practice; pain; oncology Digital Object Identifier: 10.1188/14.CJON.501-503
P
ain is a significant burden to patients with cancer and one of the most feared symptoms of the disease (Swarm et al., 2010). In a systematic review of 28 epidemiologic surveys of cancer pain, 14%–100% of patients reported pain symptoms (Goudas, Bloch, Gialeli-Goudas, Lau, & Carr, 2005; Montgomery et al., 2007). Because pain is so prevalent in the cancer population, organizations, such as the National Comprehensive Cancer Network ([NCCN], 2013), have developed guidelines for appropriate evidence-based cancer pain management (Swarm et al., 2010). These guidelines suggest rating pain intensity, determining goals of treatment, and instituting pain-management methods that primarily focus on pharmacologic interventions. Nonpharmacologic interventions for pain management are recommended by the NCCN (2013), National Cancer Institute ([NCI], 2012) and the American Cancer Society (2014).
Guided imagery is considered a nonpharmacologic modality as well as complementary and alternative medicine, as listed by NCI. NCI (2012) describes it as “imagining scenes, pictures, or experiences to help the body heal” (Mind-Body Medicines section). A typical guided imagery intervention uses relaxation techniques and a description of mental images (Astin, Shapiro, Eisenberg, & Forys, 2003). Significant evidence exists to support the use of guided imagery in the management of cancer-related pain (acute and chronic), as well as cancer treatment–related anxiety, nausea and vomiting, and depression (Kwekkeboom, Cherwin, Lee, & Wanta, 2010; Portenoy, 2011; Roscoe, Morrow, Aapro, Molassiotis, & Olver, 2011). A comprehensive meta-analysis by Deng and Cassileth (2013) found evidence of efficacy in the use of guided imagery as adjunct therapy for disease- and treatment-related cancer symptoms.
Clinical Journal of Oncology Nursing • Volume 18, Number 5 • Evidence-Based Practice
Problem Identification Managing pain is a top priority for oncology nurses. Pain medications, as a single mode of therapy, may fail to eliminate pain; a combination of approaches is needed for relief (Gatlin & Schulmeister, 2007). Therefore, adjunct methods are frequently recommended (Pasero & McCaffery, 2011). The policy and procedure on pain control for the authors’ institution notes, “Use non-drug interventions such as exercise, positioning, heat/cold, music, imagery, etc., as part of the pain relief program” (City of Hope, 2013, p. 4). To evaluate how well pain is managed, the authors conducted a periodic pain survey throughout the year of 2012. As a part of this survey, inpatients were interviewed and asked questions about how well their pain was managed while in the hospital, and the survey showed that 42% of patients were offered non-medication options for pain relief. This question prompted interest in offering guided imagery to patients. When asked why alternative methods were not being offered, some nurses stated that they were aware of other methods to control pain but were uncertain of how to implement them. Nurses expressed a desire to learn about alternative modalities. Recognizing this knowledge deficit as a barrier to evidence-based practice, the authors developed the pilot program described in the current article.
Methods The authors’ aim was to test the feasibility of a nurse-led guided imagery intervention on two medical oncology inpatient units. Seven nurses responded to an email invitation and volunteered to participate in the pilot. The project 501
content expert, a certified hypnotherapist, developed a curriculum for the guided imagery training. The one-day course was held in a classroom setting with interaction and hands-on practice, and it focused on (a) the biologic basis for guided imagery, (b) the evidence supporting the use of guided imagery for pain control, (c) the technique of delivering the intervention, and (d) practice time to deliver the intervention to other course participants. At the end of the course, nurses were able to provide a 15-minute guided imagery intervention. An intervention binder was developed and kept on each medical oncology unit to hold the pilot materials. The guided imagery binder included (a) a scripted introduction to explain the guided imagery intervention to the patient, (b) a 15-minute guided imagery intervention written out for the nurse to read, (c) a short data-collection tool to document pain levels, (d) a handout to give patients describing guided imagery, and (e) a laminated “please do not disturb; relaxation in progress” sign to hang on the patient’s door. The goals of the pilot were to provide guided imagery to 20 medical oncology patients and to use pre- and postsurvey information to assess the success of the intervention. The authors presented the project to the medical oncology interdisciplinary team during medical oncology rounds. The team was supportive of the project and referred patients who could have benefitted from the intervention. This project was carried out as quality improvement and did not meet the definition of research per the U.S. Department of Health and Human Services (2009); therefore, institutional review board approval was not required or requested.
Findings Guided imagery was conducted by the trained nurses and documented for a total of 24 sessions during the pilot. Three sessions were excluded from evaluation because the guided imagery intervention was used for a symptom other than pain relief (i.e., anxiety and dyspnea). Despite training seven nurses, only three nurses were able to commit to providing the intervention. The average time spent with the patient was 17.4 minutes (range = 10–30, SD = 502
4.6). The script was TABLE 1. Pain Scores Pre- and Post-Guided Imagery translated into Span— ish, and two nurses Variable X Median SD Range were able to deliver Preintervention (N = 21) 5.12 5 2.31 0–9 t he i nte r ve nt ion i n Spa n ish. Fa m Immediately postintervention 3.39 3.75 3.09 0–10 ily caregivers were (N = 18) encouraged to stay One hour postintervention 4.69 4.75 1.58 2–8 and participate in (N = 18) the guided imagery Note. Scores ranged from 0–10, with higher scores indicating more pain. intervention in the Note. Patients were also administered analgesics during this time. patient’s room. The primary aim of the pilot study was not to test the ery. The other four nurses did not have efficacy of guided imagery because that adequate time to complete the intervenhas been previously documented in the tion. The average implementation time literature (Astin et al., 2003; Deng & Casfor providing the intervention was 17.4 sileth, 2013; Kwekkeboom et al., 2010; minutes, and nurses cited a lack of time Portenoy, 2011). The aim of the project during their shift. No formal communicawas to test the feasibility of a nurse-led tion system existed, making it difficult to guided imagery intervention. Patient pain contact a nurse trained in guided imaglevels were measured preintervention, ery. Some patients who were approached immediately postintervention, and one for guided imagery were not interested hour postintervention (see Table 1). On in the intervention. Some physicians average, patients experienced a decrease wanted to be notified prior to the nurse in pain level immediately postintervenoffering guided imagery to their patients tion, and, in some cases, the effect was to ensure that the patients were well sustained one hour later. suited for the intervention. This created In addition, patients were asked about delays and often prevented that patient the experience of guided imagery. Of the from receiving guided imagery. 47 comments offered by the participants, the majority of the comments were positive. When asked what could improve the experience, most stated that it should be The authors were able to implement done more often or for a longer duration evidence-based practice in nursing care. and available on demand. Only one paThe inter vention was supported by tient commented that it was hard to focus the interdisciplinary team, and most and did not find it helpful. Based on this patients were receptive to the interfeedback, guided imagery and relaxation vention. In retrospect, the efforts to sessions have been recorded in English and bring guided imagery to patients in the Spanish and have been added to the inpaauthors’ institution could have been tient television at the authors’ institution. improved. Time to provide the interThey are available on demand and include vention was not always allocated, and relaxing music and scenic images. a clear mechanism for referral and conThe nurses who provided guided imtacting the trained nurses did not exist. agery stated that their experiences were Solutions to these barriers could include positive and that they noted a reciprocal obtaining a beeper for a trained nurse to benefit from guided imagery that included be contacted or creating a schedule of personal calmness and relaxation, as well when a guided imagery nurse was availas a feeling of internal satisfaction from able. The authors had strong leadership providing high-quality care to patients. support, and the institution’s culture They also expressed satisfaction and benwas supportive of the efforts. The proefit from participating in the intervention. gram provided critical reflection and a development experience for nurses. The pilot resulted in a mechanism to bring guided imagery to all patients via the Only three of the seven trained nurses inpatient television system. participated in providing guided imag-
Discussion
Barriers to Implementation
October 2014 • Volume 18, Number 5 • Clinical Journal of Oncology Nursing
More research could be done to determine additional uses of guided imagery in the inpatient oncology setting. One nurse used the technique to provide relaxation prior to starting an IV. Guided imagery preprocedure could reduce anxiety, but research needs to be done on that topic. Three patients were offered guided imagery for symptoms aside from pain. A follow-up pilot could review the effectiveness of guided imagery for other symptoms, such as nausea, anxiety, dyspnea, and insomnia.
Conclusions The project was successful in showing that inpatient medical oncology nurses can be taught to provide guided imagery for pain control. The authors met the target of the pilot by providing 24 guided imagery sessions. Oncology nurses are in a unique position to intervene on behalf of patients with cancer who are in pain. Nurses can be successfully trained to provide guided imagery for pain control. Nurses, patients, and family caregivers found guided imagery to be beneficial. Oncology nurses were open and interested in learning how to apply evidencebased practice to the care of their patients. A barrier to providing this care was finding time to conduct guided imagery. Based on the success of this intervention, the team worked to bring guided imagery to the inpatient population on demand by adding guided imagery to the inpatient television system. This was a direct outcome of the pilot project to bring evidence-based practice to the bedside. The authors found that performing quality improvement on a pilot basis allowed nurses to identify facilitators and barriers to practice change on a small scale prior to broader implementation.
References American Cancer Society. (2014). Complementary and alternative methods and cancer. Retrieved from http://www.can cer.org/acs/groups/cid/documents/web content/acspc-041660-pdf.pdf Astin, J.A., Shapiro, S.L., Eisenberg, D.M., & Forys, K.L. (2003). Mind-body medicine: State of the science, implications for practice. Journal of the American Board of Family Practice, 16, 131–147. City of Hope. (2013). Pain management standard of care: Policy and procedure manual. Duarte, CA: Author. Deng, G., & Cassileth, B. (2013). Complementary or alternative medicine in cancer care—Myths and realities. Nature Reviews. Clinical Oncology, 10, 656–664. doi:10.1038/nrclinonc.2013.125 Gatlin, C.G., & Schulmeister, L. (2007). When medication is not enough: Nonpharmacologic management of pain. Clinical Journal of Oncology Nursing, 11, 699–704. doi:10.1188/07.CJON.699-704 Goudas, L.C., Bloch, R., Gialeli-Goudas, M., Lau, J., & Carr, D.B. (2005). The epidemiology of cancer pain. Cancer Investigation, 23, 182–190. Kwekkeboom, K.L., Cherwin, C.H., Lee, J.W., & Wanta, B. (2010). Mind-body treatments for the pain-fatigue-sleep disturbance symptom cluster in persons with cancer. Journal of Pain and Symptom Management, 39, 126–138. doi:10.1016/j.j painsymman.2009.05.022 Montgomery, G.H., Bovbjerg, D.H., Schnur,
J.B., David, D., Goldfarb, A., Weltz, C.R., . . . Silverstein, J.H. (2007). A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. Journal of the National Cancer Institute, 99, 1304–1312. National Cancer Institute. (2012). Types of complementary and alternative medicine (CAM). Retrieved from http://www.can cer.gov/cancer topics/cam/thinking -about-CAM/page5 National Comprehensive Cancer Network. (2013). NCCN Clinical Practice Guidelines: Adult cancer pain [v.2.2013]. Retrieved from http://www.nccn.org/ professionals/physician_gls/pdf/pain.pdf Pasero, C., & McCaffery, M. (2010). Pain assessment and pharmacologic management. Maryland Heights, MO: Mosby. Portenoy, R.K. (2011). Treatment of cancer pain. Lancet, 377, 2236–2247. doi:10.1016/ S0140-6736(11)60236-5 Roscoe, J.A., Morrow, G.R., Aapro, M.S., Molassiotis, A., & Olver, I. (2011). Anticipatory nausea and vomiting. Supportive Care in Cancer, 19, 1533–1538. doi:10.1007/s00520-010-0980-0 Swarm, R., Abernethy, A.P., Anghelescu, D.L., Benedetti, C., Blinderman, C.D., Boston, B., . . . Weinstein, S.M. (2010). Adult cancer pain. Journal of the National Comprehensive Cancer Network, 8, 1046–1086. U.S. Department of Health and Human Services. (2009). Protection of human subjects, 45 C.F.R. § 46. Retrieved from http://1.usa.gov/YhOzHD
Do You Have an Interesting Topic to Share?
Clinical Journal of Oncology Nursing • Volume 18, Number 5 • Evidence-Based Practice
503
Copyright of Clinical Journal of Oncology Nursing is the property of Oncology Nursing Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Evidence-Based Practice
Carlton G. Brown, PhD, RN, AOCN®, FAAN—Associate Editor
Guided Imagery for Pain Control Peggy Burhenn, MS, CNS, AOCNS®, Jill Olausson, RN, MSN, CDE, Griselda Villegas, RN, OCN®, and Kathy Kravits, MA, RN, HNB-BC, LPC, NCC, ATR-BC
Evidence-based practice is integral to the delivery of effective and efficient nursing care. However, translating evidence into practice remains a challenge in health care. To overcome this challenge, the Oncology Nursing Society developed a program, the ONS Foundation Institute for Evidence-Based Practice Change, to provide nurses with the tools they need to translate evidence-based practice to their units. This article reviews the process of implementing the evidence-based practice of guided imagery for pain management on a medical oncology inpatient unit at a comprehensive cancer center. Peggy Burhenn, MS, CNS, AOCNS®, is a professional practice leader in the Department of Clinical Practice and Education, Jill Olausson, RN, MSN, CDE, is a PhD student and a senior research specialist in the Division of Nursing Research and Education, Griselda Villegas, RN, OCN®, is a charge nurse in the Department of Nursing, and Kathy Kravits, MA, RN, HNB-BC, LPC, NCC, ATR-BC, is a senior research specialist in the Division of Nursing Research and Education, all at City of Hope National Medical Center in Duarte, CA. The authors take full responsibility for the content of the article. The authors did not receive honoraria for this work. No financial relationships relevant to the content of this article have been disclosed by the authors or editorial staff. Burhenn can be reached at [email protected], with copy to editor at [email protected]. Key words: guided imagery; evidence-based nursing; evidence-based practice; pain; oncology Digital Object Identifier: 10.1188/14.CJON.501-503
P
ain is a significant burden to patients with cancer and one of the most feared symptoms of the disease (Swarm et al., 2010). In a systematic review of 28 epidemiologic surveys of cancer pain, 14%–100% of patients reported pain symptoms (Goudas, Bloch, Gialeli-Goudas, Lau, & Carr, 2005; Montgomery et al., 2007). Because pain is so prevalent in the cancer population, organizations, such as the National Comprehensive Cancer Network ([NCCN], 2013), have developed guidelines for appropriate evidence-based cancer pain management (Swarm et al., 2010). These guidelines suggest rating pain intensity, determining goals of treatment, and instituting pain-management methods that primarily focus on pharmacologic interventions. Nonpharmacologic interventions for pain management are recommended by the NCCN (2013), National Cancer Institute ([NCI], 2012) and the American Cancer Society (2014).
Guided imagery is considered a nonpharmacologic modality as well as complementary and alternative medicine, as listed by NCI. NCI (2012) describes it as “imagining scenes, pictures, or experiences to help the body heal” (Mind-Body Medicines section). A typical guided imagery intervention uses relaxation techniques and a description of mental images (Astin, Shapiro, Eisenberg, & Forys, 2003). Significant evidence exists to support the use of guided imagery in the management of cancer-related pain (acute and chronic), as well as cancer treatment–related anxiety, nausea and vomiting, and depression (Kwekkeboom, Cherwin, Lee, & Wanta, 2010; Portenoy, 2011; Roscoe, Morrow, Aapro, Molassiotis, & Olver, 2011). A comprehensive meta-analysis by Deng and Cassileth (2013) found evidence of efficacy in the use of guided imagery as adjunct therapy for disease- and treatment-related cancer symptoms.
Clinical Journal of Oncology Nursing • Volume 18, Number 5 • Evidence-Based Practice
Problem Identification Managing pain is a top priority for oncology nurses. Pain medications, as a single mode of therapy, may fail to eliminate pain; a combination of approaches is needed for relief (Gatlin & Schulmeister, 2007). Therefore, adjunct methods are frequently recommended (Pasero & McCaffery, 2011). The policy and procedure on pain control for the authors’ institution notes, “Use non-drug interventions such as exercise, positioning, heat/cold, music, imagery, etc., as part of the pain relief program” (City of Hope, 2013, p. 4). To evaluate how well pain is managed, the authors conducted a periodic pain survey throughout the year of 2012. As a part of this survey, inpatients were interviewed and asked questions about how well their pain was managed while in the hospital, and the survey showed that 42% of patients were offered non-medication options for pain relief. This question prompted interest in offering guided imagery to patients. When asked why alternative methods were not being offered, some nurses stated that they were aware of other methods to control pain but were uncertain of how to implement them. Nurses expressed a desire to learn about alternative modalities. Recognizing this knowledge deficit as a barrier to evidence-based practice, the authors developed the pilot program described in the current article.
Methods The authors’ aim was to test the feasibility of a nurse-led guided imagery intervention on two medical oncology inpatient units. Seven nurses responded to an email invitation and volunteered to participate in the pilot. The project 501
content expert, a certified hypnotherapist, developed a curriculum for the guided imagery training. The one-day course was held in a classroom setting with interaction and hands-on practice, and it focused on (a) the biologic basis for guided imagery, (b) the evidence supporting the use of guided imagery for pain control, (c) the technique of delivering the intervention, and (d) practice time to deliver the intervention to other course participants. At the end of the course, nurses were able to provide a 15-minute guided imagery intervention. An intervention binder was developed and kept on each medical oncology unit to hold the pilot materials. The guided imagery binder included (a) a scripted introduction to explain the guided imagery intervention to the patient, (b) a 15-minute guided imagery intervention written out for the nurse to read, (c) a short data-collection tool to document pain levels, (d) a handout to give patients describing guided imagery, and (e) a laminated “please do not disturb; relaxation in progress” sign to hang on the patient’s door. The goals of the pilot were to provide guided imagery to 20 medical oncology patients and to use pre- and postsurvey information to assess the success of the intervention. The authors presented the project to the medical oncology interdisciplinary team during medical oncology rounds. The team was supportive of the project and referred patients who could have benefitted from the intervention. This project was carried out as quality improvement and did not meet the definition of research per the U.S. Department of Health and Human Services (2009); therefore, institutional review board approval was not required or requested.
Findings Guided imagery was conducted by the trained nurses and documented for a total of 24 sessions during the pilot. Three sessions were excluded from evaluation because the guided imagery intervention was used for a symptom other than pain relief (i.e., anxiety and dyspnea). Despite training seven nurses, only three nurses were able to commit to providing the intervention. The average time spent with the patient was 17.4 minutes (range = 10–30, SD = 502
4.6). The script was TABLE 1. Pain Scores Pre- and Post-Guided Imagery translated into Span— ish, and two nurses Variable X Median SD Range were able to deliver Preintervention (N = 21) 5.12 5 2.31 0–9 t he i nte r ve nt ion i n Spa n ish. Fa m Immediately postintervention 3.39 3.75 3.09 0–10 ily caregivers were (N = 18) encouraged to stay One hour postintervention 4.69 4.75 1.58 2–8 and participate in (N = 18) the guided imagery Note. Scores ranged from 0–10, with higher scores indicating more pain. intervention in the Note. Patients were also administered analgesics during this time. patient’s room. The primary aim of the pilot study was not to test the ery. The other four nurses did not have efficacy of guided imagery because that adequate time to complete the intervenhas been previously documented in the tion. The average implementation time literature (Astin et al., 2003; Deng & Casfor providing the intervention was 17.4 sileth, 2013; Kwekkeboom et al., 2010; minutes, and nurses cited a lack of time Portenoy, 2011). The aim of the project during their shift. No formal communicawas to test the feasibility of a nurse-led tion system existed, making it difficult to guided imagery intervention. Patient pain contact a nurse trained in guided imaglevels were measured preintervention, ery. Some patients who were approached immediately postintervention, and one for guided imagery were not interested hour postintervention (see Table 1). On in the intervention. Some physicians average, patients experienced a decrease wanted to be notified prior to the nurse in pain level immediately postintervenoffering guided imagery to their patients tion, and, in some cases, the effect was to ensure that the patients were well sustained one hour later. suited for the intervention. This created In addition, patients were asked about delays and often prevented that patient the experience of guided imagery. Of the from receiving guided imagery. 47 comments offered by the participants, the majority of the comments were positive. When asked what could improve the experience, most stated that it should be The authors were able to implement done more often or for a longer duration evidence-based practice in nursing care. and available on demand. Only one paThe inter vention was supported by tient commented that it was hard to focus the interdisciplinary team, and most and did not find it helpful. Based on this patients were receptive to the interfeedback, guided imagery and relaxation vention. In retrospect, the efforts to sessions have been recorded in English and bring guided imagery to patients in the Spanish and have been added to the inpaauthors’ institution could have been tient television at the authors’ institution. improved. Time to provide the interThey are available on demand and include vention was not always allocated, and relaxing music and scenic images. a clear mechanism for referral and conThe nurses who provided guided imtacting the trained nurses did not exist. agery stated that their experiences were Solutions to these barriers could include positive and that they noted a reciprocal obtaining a beeper for a trained nurse to benefit from guided imagery that included be contacted or creating a schedule of personal calmness and relaxation, as well when a guided imagery nurse was availas a feeling of internal satisfaction from able. The authors had strong leadership providing high-quality care to patients. support, and the institution’s culture They also expressed satisfaction and benwas supportive of the efforts. The proefit from participating in the intervention. gram provided critical reflection and a development experience for nurses. The pilot resulted in a mechanism to bring guided imagery to all patients via the Only three of the seven trained nurses inpatient television system. participated in providing guided imag-
Discussion
Barriers to Implementation
October 2014 • Volume 18, Number 5 • Clinical Journal of Oncology Nursing
More research could be done to determine additional uses of guided imagery in the inpatient oncology setting. One nurse used the technique to provide relaxation prior to starting an IV. Guided imagery preprocedure could reduce anxiety, but research needs to be done on that topic. Three patients were offered guided imagery for symptoms aside from pain. A follow-up pilot could review the effectiveness of guided imagery for other symptoms, such as nausea, anxiety, dyspnea, and insomnia.
Conclusions The project was successful in showing that inpatient medical oncology nurses can be taught to provide guided imagery for pain control. The authors met the target of the pilot by providing 24 guided imagery sessions. Oncology nurses are in a unique position to intervene on behalf of patients with cancer who are in pain. Nurses can be successfully trained to provide guided imagery for pain control. Nurses, patients, and family caregivers found guided imagery to be beneficial. Oncology nurses were open and interested in learning how to apply evidencebased practice to the care of their patients. A barrier to providing this care was finding time to conduct guided imagery. Based on the success of this intervention, the team worked to bring guided imagery to the inpatient population on demand by adding guided imagery to the inpatient television system. This was a direct outcome of the pilot project to bring evidence-based practice to the bedside. The authors found that performing quality improvement on a pilot basis allowed nurses to identify facilitators and barriers to practice change on a small scale prior to broader implementation.
References American Cancer Society. (2014). Complementary and alternative methods and cancer. Retrieved from http://www.can cer.org/acs/groups/cid/documents/web content/acspc-041660-pdf.pdf Astin, J.A., Shapiro, S.L., Eisenberg, D.M., & Forys, K.L. (2003). Mind-body medicine: State of the science, implications for practice. Journal of the American Board of Family Practice, 16, 131–147. City of Hope. (2013). Pain management standard of care: Policy and procedure manual. Duarte, CA: Author. Deng, G., & Cassileth, B. (2013). Complementary or alternative medicine in cancer care—Myths and realities. Nature Reviews. Clinical Oncology, 10, 656–664. doi:10.1038/nrclinonc.2013.125 Gatlin, C.G., & Schulmeister, L. (2007). When medication is not enough: Nonpharmacologic management of pain. Clinical Journal of Oncology Nursing, 11, 699–704. doi:10.1188/07.CJON.699-704 Goudas, L.C., Bloch, R., Gialeli-Goudas, M., Lau, J., & Carr, D.B. (2005). The epidemiology of cancer pain. Cancer Investigation, 23, 182–190. Kwekkeboom, K.L., Cherwin, C.H., Lee, J.W., & Wanta, B. (2010). Mind-body treatments for the pain-fatigue-sleep disturbance symptom cluster in persons with cancer. Journal of Pain and Symptom Management, 39, 126–138. doi:10.1016/j.j painsymman.2009.05.022 Montgomery, G.H., Bovbjerg, D.H., Schnur,
J.B., David, D., Goldfarb, A., Weltz, C.R., . . . Silverstein, J.H. (2007). A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. Journal of the National Cancer Institute, 99, 1304–1312. National Cancer Institute. (2012). Types of complementary and alternative medicine (CAM). Retrieved from http://www.can cer.gov/cancer topics/cam/thinking -about-CAM/page5 National Comprehensive Cancer Network. (2013). NCCN Clinical Practice Guidelines: Adult cancer pain [v.2.2013]. Retrieved from http://www.nccn.org/ professionals/physician_gls/pdf/pain.pdf Pasero, C., & McCaffery, M. (2010). Pain assessment and pharmacologic management. Maryland Heights, MO: Mosby. Portenoy, R.K. (2011). Treatment of cancer pain. Lancet, 377, 2236–2247. doi:10.1016/ S0140-6736(11)60236-5 Roscoe, J.A., Morrow, G.R., Aapro, M.S., Molassiotis, A., & Olver, I. (2011). Anticipatory nausea and vomiting. Supportive Care in Cancer, 19, 1533–1538. doi:10.1007/s00520-010-0980-0 Swarm, R., Abernethy, A.P., Anghelescu, D.L., Benedetti, C., Blinderman, C.D., Boston, B., . . . Weinstein, S.M. (2010). Adult cancer pain. Journal of the National Comprehensive Cancer Network, 8, 1046–1086. U.S. Department of Health and Human Services. (2009). Protection of human subjects, 45 C.F.R. § 46. Retrieved from http://1.usa.gov/YhOzHD
Do You Have an Interesting Topic to Share?
Clinical Journal of Oncology Nursing • Volume 18, Number 5 • Evidence-Based Practice
503
Copyright of Clinical Journal of Oncology Nursing is the property of Oncology Nursing Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
