Loma Linda University

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Elizabeth Bossert, PhD
Associate Dean, Academic Affairs, School of Nursing
School of Nursing
Associate Dean, Graduate Programs, School of Nursing
School of Nursing
Professor, Nursing - Graduate
School of Nursing
Member, Nursing, SN, Faculty of Graduate Studies
Publications    Scholarly Journals--Published
  • Van Cleve, L., Bossert, E., Beecroft, P., Adlard, K., Alvarez, O., Savedra, M. C. "The pain experience of children with leukemia during the first year after diagnosis. ." Nursing Research 53. (2004): 1-10-. ( 1/2004 )
    Background: Children with cancer experience pain related to the disease process, treatment, and associated procedures. For children with leukemia, the pain experienced after diagnosis has received scant attention. Objectives: The purpose of this study was to examine the pain experience, management strategies and outcomes during the first year following diagnosis of acute leukemia. Methods: Using a longitudinal descriptive approach, data were collected over 7 data points from 95 children, ages 4 to 17 years, and their parents, English and Spanish speaking, receiving care in 1 of 3 Southern California hospitals. Age appropriate instruments were used to examine the variables of pain intensity, location, pattern over time, quality, strategies to manage pain, perception of effectiveness of management strategies, and functional status. Results: All of the children reported pain over the course of the year. Pain intensity scores incorporated the full range of possible responses. For ages 4-7 years, the highest mean score, 2.0 (scale 0-4), occurred at interviews 4 and 5 and the lowest, 1.6, at interviews 2 and 3. For ages 8-17 years, the highest mean score, 50.1 (scale 0-100), occurred at the first interview and the lowest, 39.5, at the fourth interview. The most common location of pain was the legs (26.5%) in all 7 interviews. Other frequently noted sites were the abdomen (16.6%), head/neck (16.6%), and back (14.2%). The words used most frequently to describe pain by the older English and Spanish speaking children were ?uncomfortable? / ?incomodo? and ?annoying? / ?molesto?. Based on the interviews, the most frequently used strategy for pain management was stressor modification e.g. medication, sleep, hot/cold, and massage. The most frequently selected coping strategies from a Likert scale were ?watch TV? (n=426), lie down? (n=421), ?wish for it to go away? (n=417), and ? tell my mother or father? (n=416). Pain intensity scores following pain management were significantly lower for the younger children in 5 of the 7 interviews (p= .05 to .01) and in all 7 interviews (p= .01 to .001) for the older children. Functional status, the ability to engage in routine activities, for both the younger and older children was above the median score at seven interviews. Conclusions: Children with leukemia experience pain throughout the first year of treatment. The pain was responsive to the management strategies, used by the parents and children. Understanding the pain experience, effectiveness of management strategies, and subsequent outcomes clinicians can anticipate and effectively manage the pain.