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980 GIVING FORM TO FEELING: TOUCHING THE PAIN
Topic H: ETHICAL, LEGAL FINANCIAL & EDUCATION
S253
977 NEGATIVE INTERPRETATIONS OF AMBIGUOUS INFORMATION IN RELATION TO VULNERABILITY TRAITS FOR PAIN
Topic H: ETHICAL, LEGAL FINANCIAL & EDUCATION
L.M.G. Vancleef ° , M.L. Peters. Department of Medical, Clinical and Experimental Psychology, Maastricht University, Maastricht, The Netherlands
H01 ASSISTED SUICIDE
Background and Aims: According to the cognitive behavioural account of pain, emotional and behavioural responses to pain are determined by the cognitive appraisal and interpretation of a situation. Furthermore, research has identified several personality traits, e.g. Trait anxiety (TA), Anxiety sensitivity (AS), Injury/illness sensitivity (IS), Fear of pain (FoP), and pain catastrophizing (PC) to play a role in the chronic course of pain. The current study was set up to investigate the presence of a negative interpretation bias for ambiguous pain-related situations in individuals showing elevated levels of the aforementioned vulnerability traits. Furthermore, we examined the specificity of negative interpretation biases. Methods: Negative interpretations were assessed with the Body Sensations Interpretation Questionnaire (BSIQ), consisting of 27 ambiguous descriptions and their possible explanations (2 neutral, 1 negative) on four subscales: (1) panic-related sensations; (2) other bodily sensations; (3) external events and (4) social events. Probability ratings have to be assigned to each explanation, and ratings on the negative alternatives provide negative interpretation scores. 154 Healthy participants completed the BSIQ and several self-report measures assessing pain-related vulnerabilities and fear of negative evaluation (FNE). Results: All trait measures correlated positively with negative interpretations on the BSIQ. Regression analyses showed specific prediction of vulnerability traits for the specific subscales of the BSIQ. Conclusions: Vulnerability traits for pain are specifically predictive of negative interpretations of ambiguous situations implying specific threats. Acknowledgements: This study is supported by Grant no. 015–001−050 of the Netherlands Organisation for Scientific Research (NWO).
979 PALLIATIVE CARE – LEGAL AND MEDICAL POINT OF VIEW B. Strazisar1 ° , B. Strazisar2 . 1 Faculty of Economics, Ljubljana, 2 Institute of Oncology, Ljubljana, Slovenia Palliative care is a very important topic for terminally ill patients, but often neglected from the state regulation and self-regulation of the professional medical bodies. It’s a part of medical service which doesn’t falls into the frame of economics of the public health system. Presentation is divided into four parts. In first part the definition of palliative care is examined from the medical and legal point of view. The second part deals with the key players in palliative care and their tasks and powers. The active role of doctor, patient, patient’s family and/or the independent patient’s guardian is important for effective palliative care. The third and the key part is the proposal for the palliative care legislative framework. In this part the relation between the self-regulation and state regulation is closely examined especially from the constitutional point of view. This relationship is important to prevent possible lawsuits deriving from (under)regulation or even wrong regulation of palliative care. This part analyses proposed legal structure and the pro and con for such solutions. This part bases on the slovenian legislation and on intenational documents. Fourth part is a conclusion given the proposal of legislation solution. H02 EDUCATION: PROFESSIONAL AND LAY 980 GIVING FORM TO FEELING: TOUCHING THE PAIN
978 EVERYDAY PROBLEM SOLVING IN CHRONIC PAIN
Y. Kerner ° , B. Huliehl, G. Yahya. Soroko University Medical Center, Beer-Sheva, Israel
K. Venselaar ° . VRC Private Practice, Utrecht, The Netherlands
Background and Aims: As caregivers we must show sensitivity, patience and empathy to patients in pain. Questions are asked how caregivers routinely exposed to pain and suffering can develop and keep the necessary tolerance and patience. 1. Raising awareness and sensitivity among staff members and improving the quality of pain care. 2. Creating an organizational framework to support these processes. Method: 1. Agents: It was assumed that delegating responsibility and authority would empower the staff and aid in establishing change. 2. The Training Plan: A course composed of theoretical and clinical aspects of pain assessment and care including the patients’ and caregivers’ emotional involvement. This was implemented in a workshop employing creative activities (soft clay) based on the phenomena approach. Participants filled out questionnaires at the beginning and end of the course and half a year later. Results: Participants felt that the workshop contributed in the following way: • Raised sensitivity and awareness of patients pain 92%, better able to treat pain 96%, staff more aware and sensitive to pain 83%. • Surgical and pediatric wards routinely perform pain assessment and treatment with protocols written by multidisciplinary staff members as part of general care. A similar process has begun in the gynecological and obstetrics division. Conclusion: The pain advocates’ training process sharpened staff sensitivity and functioning. The phenomenological workshop was an important link in turning pain advocates into active agents for change in pain care on their wards.
Background and Aims: The aim of this study is to investigate how people with chronic pain cope with everyday problems. Methods: Subjects (202 men and 323 women) were patients with chronic pain referred to a rehabilitation unit. The Utrecht Coping List (dutch version of the WCC-ways of coping checklist) was used to measure their coping style at referral. It has 7 factors: approach and avoidance, palliative behaviour, social support, depressive/passive reaction, expressing emotion and comforting cognitions. Results: Men with chronic pain have lower scores on active problem solving behaviour, and higher scores on palliative behaviour and depressive reaction than men without pain (p < 0.001). Women with chronic pain have also lower scores on active problem solving behaviour than women without pain, but also on social support and expressing emotion. Like the men scores for women are higher on palliative behaviour (p < 0.001) and depressive reaction (p < 0.01), but also on avoidant behaviour (p < 0.01) and comforting cognitions (p < 0.001). Data shows that women with pain have higher scores than men with pain on all scales, except for expressing emotion. Differences on palliative behaviour, avoidant behaviour, social support and comforting cognitions are significant (p < 0.001). Conclusions: People – women as well as men – with chronic pain show less active coping behaviour, have a higher score on depressive reaction on problems and use more palliative behaviour in problem situations than people without somatic complaints. It is important to stress the differences between women and men with chronic pain in problem solving behaviour.
S253
977 NEGATIVE INTERPRETATIONS OF AMBIGUOUS INFORMATION IN RELATION TO VULNERABILITY TRAITS FOR PAIN
Topic H: ETHICAL, LEGAL FINANCIAL & EDUCATION
L.M.G. Vancleef ° , M.L. Peters. Department of Medical, Clinical and Experimental Psychology, Maastricht University, Maastricht, The Netherlands
H01 ASSISTED SUICIDE
Background and Aims: According to the cognitive behavioural account of pain, emotional and behavioural responses to pain are determined by the cognitive appraisal and interpretation of a situation. Furthermore, research has identified several personality traits, e.g. Trait anxiety (TA), Anxiety sensitivity (AS), Injury/illness sensitivity (IS), Fear of pain (FoP), and pain catastrophizing (PC) to play a role in the chronic course of pain. The current study was set up to investigate the presence of a negative interpretation bias for ambiguous pain-related situations in individuals showing elevated levels of the aforementioned vulnerability traits. Furthermore, we examined the specificity of negative interpretation biases. Methods: Negative interpretations were assessed with the Body Sensations Interpretation Questionnaire (BSIQ), consisting of 27 ambiguous descriptions and their possible explanations (2 neutral, 1 negative) on four subscales: (1) panic-related sensations; (2) other bodily sensations; (3) external events and (4) social events. Probability ratings have to be assigned to each explanation, and ratings on the negative alternatives provide negative interpretation scores. 154 Healthy participants completed the BSIQ and several self-report measures assessing pain-related vulnerabilities and fear of negative evaluation (FNE). Results: All trait measures correlated positively with negative interpretations on the BSIQ. Regression analyses showed specific prediction of vulnerability traits for the specific subscales of the BSIQ. Conclusions: Vulnerability traits for pain are specifically predictive of negative interpretations of ambiguous situations implying specific threats. Acknowledgements: This study is supported by Grant no. 015–001−050 of the Netherlands Organisation for Scientific Research (NWO).
979 PALLIATIVE CARE – LEGAL AND MEDICAL POINT OF VIEW B. Strazisar1 ° , B. Strazisar2 . 1 Faculty of Economics, Ljubljana, 2 Institute of Oncology, Ljubljana, Slovenia Palliative care is a very important topic for terminally ill patients, but often neglected from the state regulation and self-regulation of the professional medical bodies. It’s a part of medical service which doesn’t falls into the frame of economics of the public health system. Presentation is divided into four parts. In first part the definition of palliative care is examined from the medical and legal point of view. The second part deals with the key players in palliative care and their tasks and powers. The active role of doctor, patient, patient’s family and/or the independent patient’s guardian is important for effective palliative care. The third and the key part is the proposal for the palliative care legislative framework. In this part the relation between the self-regulation and state regulation is closely examined especially from the constitutional point of view. This relationship is important to prevent possible lawsuits deriving from (under)regulation or even wrong regulation of palliative care. This part analyses proposed legal structure and the pro and con for such solutions. This part bases on the slovenian legislation and on intenational documents. Fourth part is a conclusion given the proposal of legislation solution. H02 EDUCATION: PROFESSIONAL AND LAY 980 GIVING FORM TO FEELING: TOUCHING THE PAIN
978 EVERYDAY PROBLEM SOLVING IN CHRONIC PAIN
Y. Kerner ° , B. Huliehl, G. Yahya. Soroko University Medical Center, Beer-Sheva, Israel
K. Venselaar ° . VRC Private Practice, Utrecht, The Netherlands
Background and Aims: As caregivers we must show sensitivity, patience and empathy to patients in pain. Questions are asked how caregivers routinely exposed to pain and suffering can develop and keep the necessary tolerance and patience. 1. Raising awareness and sensitivity among staff members and improving the quality of pain care. 2. Creating an organizational framework to support these processes. Method: 1. Agents: It was assumed that delegating responsibility and authority would empower the staff and aid in establishing change. 2. The Training Plan: A course composed of theoretical and clinical aspects of pain assessment and care including the patients’ and caregivers’ emotional involvement. This was implemented in a workshop employing creative activities (soft clay) based on the phenomena approach. Participants filled out questionnaires at the beginning and end of the course and half a year later. Results: Participants felt that the workshop contributed in the following way: • Raised sensitivity and awareness of patients pain 92%, better able to treat pain 96%, staff more aware and sensitive to pain 83%. • Surgical and pediatric wards routinely perform pain assessment and treatment with protocols written by multidisciplinary staff members as part of general care. A similar process has begun in the gynecological and obstetrics division. Conclusion: The pain advocates’ training process sharpened staff sensitivity and functioning. The phenomenological workshop was an important link in turning pain advocates into active agents for change in pain care on their wards.
Background and Aims: The aim of this study is to investigate how people with chronic pain cope with everyday problems. Methods: Subjects (202 men and 323 women) were patients with chronic pain referred to a rehabilitation unit. The Utrecht Coping List (dutch version of the WCC-ways of coping checklist) was used to measure their coping style at referral. It has 7 factors: approach and avoidance, palliative behaviour, social support, depressive/passive reaction, expressing emotion and comforting cognitions. Results: Men with chronic pain have lower scores on active problem solving behaviour, and higher scores on palliative behaviour and depressive reaction than men without pain (p < 0.001). Women with chronic pain have also lower scores on active problem solving behaviour than women without pain, but also on social support and expressing emotion. Like the men scores for women are higher on palliative behaviour (p < 0.001) and depressive reaction (p < 0.01), but also on avoidant behaviour (p < 0.01) and comforting cognitions (p < 0.001). Data shows that women with pain have higher scores than men with pain on all scales, except for expressing emotion. Differences on palliative behaviour, avoidant behaviour, social support and comforting cognitions are significant (p < 0.001). Conclusions: People – women as well as men – with chronic pain show less active coping behaviour, have a higher score on depressive reaction on problems and use more palliative behaviour in problem situations than people without somatic complaints. It is important to stress the differences between women and men with chronic pain in problem solving behaviour.