Our previous research similarly to the results obtained in
Our previous research, similarly to the results obtained in this study, also showed no differ-ences in terms of QoL (in physical and emotional aspects), tiredness, or experiencing pain among patients treated in different palliative care settings (inpatient unit, home, and day care center).2 Other authors similarly emphasize similarities in the effectiveness of the 2 types of palliative care (in-patient and home) in different parameters, including QoL and pain.18-20
Please cite this article as: A. Zdun-Ryzewska,˙ G. Chojnacka-Szawłowska and K. Basinski´ et al., Cognitive and emotional representations of pain in cancer patients at an inpatient unit and home palliative care, Current Problems in Cancer, https://doi.org/10.1016/j.currproblcancer.2019.01.005
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6 A. Zdun-Ryzewska,˙ G. Chojnacka-Szawłowska and K. Basinski´ et al. / Current Problems in Cancer xxx (xxxx) xxx
With the verified in numerous studies substantial similarity of pain treatment effectiveness between the 2 kinds of care, the differences in patients’ individual beliefs assume greater im-portance. Patients receiving treatment at home are convinced about higher treatment control in relation to pain, but they also experience significantly greater emotional distress related to beliefs about pain.
Patients’ locus of control in therapeutic processes often defines their sense of safety and level of stress. Feeling of control can positively modify psychological process of coping with pain. Antonovsky developed the concept of coherence referring to perceived comprehensiveness and sensibility of experience as well as to resourcefulness and ability to cope, which all play impor-tant role in the process of maintaining health.21 More recently, a study on a group of cancer patients under stationary and home care indicated that significantly higher feeling of control over the effects of illness, medical care, and received treatment was characteristic of patients staying at home. The authors attribute it Streptozocin to a greater independence and freedom in this group, compared to patients in stationary care. The same study showed that a greater control over all aspects of the disease (along with better health condition and lower level of depressive symp-toms) works as a predictor of a better QoL.22
Higher level of emotional distress related to pain, experienced by patients staying at home can bring an adverse effect. It was demonstrated in several studies that a stable and moder-ately strong connection between negative affect and reporting of somatic symptoms. The results are typically described as a connection between a characteristic of high negative affect and an elevated level of vigilance, with focusing on somatic sensations and lower pain threshold. Pa-tients with low negative effect tend to ignore somatic sensations. According to Leventhal model, patients with high negative effect manifest a wider range of somatic symptoms of an illness representation due to their more intense emotional distress related to chronic disease. Also ac-cording to this model, in patients with chronic disease and with a higher level of negative affect, distress related to life events may activate illness representations and may dispose toward more frequent reporting of somatic symptoms.23
Many authors who base their research on the theory and model of self-regulation emphasize positive aspects of patients’ active participation in the process of treatment where the patient is able to create an accurate representation of illness in relation to its name, duration, conse-quences, and their ability to control treatment. Research results confirm advantages of employ-ing the theory also in treating patients with the most complex limitations.24,25 Patients who strongly experience the diagnosis of their disease, its chronic presence, and incurability are able to understand its impact on their everyday life. For that reason, specific diagnosis of beliefs about pain seems as important as measuring the intensity of pain, especially in older patients. The results of our study also suggest that older patients with more severe pain intensity deserve special attention as these 2 variables correlate with perceived lower level of treatment control related to pain.