Pain and Hope in Patients With Cancer: A Role for Cognition

Mei-Ling Chen, PhD, RN


Cancer Nurs. 2003;26(1) 

In This Article


After categorization, 91 patients (40.2 %) were in the pain group and 135 patients (59.8%) were in the pain-free group. The distributions of demographic and disease and treatment characteristics for the pain and pain-free patients are presented in Table 1 .

The two groups were similar except for four variables: functional status, disease stage, treatment received, and perceived treatment effect. The patients in the pain group had poorer functional status (mean, 73.8 ± 12.27) than the patients in the pain-free group (mean, 86.44 ± 8.59). More patients in the pain group (76.9%) had metastatic disease than in the pain-free group (44.4%). Almost 90% of the patients in the pain-free group were receiving chemotherapy, as compared with 74.7% in the pain group. Approximately 25% of the pain group patients were receiving other treatments, including palliative management. A majority (66.7%) of the patients in the pain-free group believed that treatment had improved their condition, whereas only 49.5% of the patients with pain reported such belief.

The mean hope score for the whole sample was 37.28 ± 5.26, and the HHI scores between the pain and pain-free patients did not differ significantly ( Table 2 ). The results of one-way ANOVA indicated that HHI scores were different among different levels of perceived treatment effect ( Table 2 ). Tukey post hoc comparison showed that those who perceived their disease as 'improved' had a significantly higher mean hope score than those who perceived their disease as 'not improved.' No significant difference was found between mean hope scores for the patients who perceived their disease had 'improved' and those whose treatment effect was 'unknown.' Although the mean hope score for the patients who perceived their disease as 'unknown' was higher than for those who perceived their treatment effect as 'not improved,' this difference was not significant. Because perceived treatment effect is a subjective factor, disease stage was chosen as a more objective indicator of disease severity. The patient's disease stage was classified as either metastatic or local. No significant difference in HHI scores was found between patients with metastatic disease and those with local disease ( Table 2 ).

For the patients with pain (n = 91), the means and standard deviations of various pain measures are presented in Table 3 . The Serlin et al[32] categorization of pain severity using a scale of 0 to 10 scale rates 0 to 4 as mild pain, 5 to 6 as moderate pain, and more than 6 as severe pain. In the current study, therefore, the mean of current pain intensity (2.92) was mild, the mean of worst pain intensity (7.43) was severe, and the mean of typical pain intensity (4.23) was between mild and moderate.

To determine which pain characteristics were associated with level of hope, Pearson correlations were examined. No pain sensory characteristics were associated with hope scores except bearable pain intensity ( Table 3 ), which had a small positive correlation (r = .24; P < .05) to level of hope. In other words, the more pain a patient could tolerate, the higher the level of hope he or she reported. Three cognitive meanings ascribed to pain were associated with hope scores. Challenge was positively correlated with hope scores (r = .44), whereas Loss and Threat were negatively correlated with hope scores (r = -.33 and -.40, respectively).


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