Comparison of the Faces and Numeric Pain Scales for Use in Long-term Ventilator Patients with Chronic Pain

Chronic pain is a major cause of illness, disability, and is poorly understood and undertreated by hea h care professionals. Numerous misconceptions regarding chronic pain in older individuals has led certain health care agencies to require the use of pain scales for pain evaluation in all health are patients. yet, there is research lacking as to which pain scales are appropriate for use with chronic pain, ventilator-dependent, older individuals. The Wong-Baker Faces Scale and Numeric Pain Scale wa administered to a onvenience sample of male/female patients in a Southeastern, 44-bed, long-term care ventilator hospital. The purpose of this study was to compare the two scales for: (1) pain score agreement, and (2) patient preference for use in expressing pain. Significant findings will validate, refine, and generate nursing knowledge regarding chronic pairi, improve nurs g assessment of the chronic pain ventilator patient, and add to nursing theory and practice. CHAPTER ONE INTRODUCTION Background and Significance 2 Breast cancer remains the most commonly diagnosed cancer in women of all racial groups (Josyln & West, 2000). In the United States, 30 % of all cancers diagnosed are breast cancer; the mortality is second only to lung cancer in women (16% vs 25% respectively) (Josyln & West, 2000). According to the American Cancer Society (2003), the overall incidence of breast cancer has increased since 1980. Interestingly, between 1992 and 2000, the incidence rate for Caucasians has increased at a rate of 0.9% per year, and the rates among African American women has stabilized (American Cancer Society, 2003). Despite the overall rise in breast cancer incidences, the mortality rate declined from 1992 to 2000. The decline for Caucasians was at a rate of 2.6% per year and the rate of mortality decline for African Americans was 1.1 %. The disparity in breast cancer mortality between African American and Caucasian women began to widen in the 1980s, and in 2000, there has been over 30% excess deaths among African Americans compared to Caucasians (American Cancer Society, 2003). African American women have the highest mortality from breast. cancer than any other racial group, even though Caucasians have a higher incidence. The National Cancer Institute (2002) reported for years 1996-2000, the breast cancer incidence per year per 100,000 females in African American women compared to Caucasians was 121.7 versus 140.8. The mortality rate was 35.9 for African Americans compared to 27.2 for Caucasians. According to the existing data, there are serious gaps in breast cancer survival between African American women and Caucasians that warrant further research. The disparity cannot be ignored by the nursing profession. Nurses must be aware of critical health trends that exist in the population. If nurses are aware of the disparity, interventions can be designed to address the problem through education and potential treatment alterations based upon race. Problem Statement The problem that exists is that research consistently demonstrates that African American women have higher breast cancer mortality rates than Caucasian women. To date, despite the substantial number of studies that have focused on this problem, the origin of the disparity has not been identified. Purpose of Study The purpose of this study is to assess if the mortality disparity between African American and Caucasian women diagnosed with breast cancer exist in our sample and if present, then further explore how survival is impacted by potential contributing variables to the mortality difference. Research Question 1. Is there a mortality disparity between African American and Caucasian women diagnosed with breast cancer in our sample? 2. If the disparity exists, is the difference in survival related socioeconomic status, age, stage at presentation or presenting pathological features of the tumors at diagnosis? 3