NURSING INTERVENTIONS FOR ACUTE ORAL PAIN AND MUCOSITIS

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Acute oral pain and mucositis secondary to intensive cytoreductive therapy for cancer are a significant problem for many patients, yet no systematic nursing research exists. Using a unique multidimensional conceptualization of cancer pain, the primary aim of this research is to test in a randomized, two-group clinical trial effects of a nurse- administered psychoeducational intervention on selected outcomes in adults diagnosed with hematologic or solid tumor malignancies. The hypothesis to be tested is that a nurse-administered psychoeducational intervention used in conjunction with pain and oral care practice standards will decrease severity and duration of acute oral pain and mucositis, decrease emotional distress, and increase the use of cognitiv and behavioral coping strategies. Three secondary aims are to: 1) explore the integrated and interactive nature of six dimensions of the experience of pain, 2) examine the effects of interventions on these dimensions of pain, and 3) examine relationships between pain-related biologic markers and clinical measures of acute oral pain and mucosal tissue injury. The project will be conducted on two inpatient nursing units at Emory University Hospital, Atlanta, GA, by a research team representing the disciplines of nursing, medicine, dentistry, biostatistics, pharmacy, and clinical psychology. Consenting patients will be randomly assigned to the control group (receiving usual nursing and medical care) or to the experimental group (receiving a psychoeducational intervention consisting of concrete objective information and coping skills training given prior to initiation of cytoreductive therapy, and reinforcement teaching done throughout hospitalization). Acute pain and oral care practice standards will be used to manage symptoms in both study groups. Pain, mucositis, and othe relevant data will be collected daily on all patients from admission through at least 21 days after initiation of therapy. Results will provide guidance for clinical nursing practice, increase understanding of the multidimensional experience of pain and its relationship with interventions, and provide a beginning understanding of biologic markers of pain and mucositis.