These include: poor sleep, loss of appetite, decreased functioning, elevated levels of depression and anxiety and decreased quality of life (Twycross, 1994). The powerlessness and hopelessness expressed by patients experiencing moderate to severe pain is all too often mirrored by nurses who lack the appropriate knowledge and assessment skills to manage pain effectively (Clements and Cummings, 1991). Common barriers to effective pain management reported in the literature include: knowledge deficits; fear of addiction to opioid medication; and, lack of consistency in the systematic assessment and documentation of pain and the effectiveness of therapeutic interventions. (McCaffery and Ferrell, 1997)
Assessment is widely regarded in the literature as the cornerstone to effective pain management. Nurses spend more time with patients than any other member of the health care team and are thus in an optimal position to perform pain assessment. Through the integration of fundamental physiological knowledge, information on the patient's history and the comprehensive assessment of their pain, the nurse plays a major role in optimizing patient management.
In our society, information gathering is viewed almost uniformly as a good thing. (It is the "information age," after all.) Nowhere is this truer than in medicine. For doctors, more information is always better. In the past, most of our information came from the patient. Now it increasingly comes from machines.
Doctors like tests because we see them as objective and more reliable than our own subjective judgments. We also see tests as something tangible we can offer the patient at the end of a clinic visit. Patients like tests for the same reasons. Ordering a test validates their concerns and promises concrete information-a definitive diagnosis. Sometimes patients even perceive their care as substandard if they are not given some sort of test. While doctors and patients recognize that treatments may have side effects or lead to complications, both tend to view testing as something that can only help. The prevailing attitude seems to be it can't hurt just to gather a little information.
Cancer, however, is a diagnosis made by examining human tissue under the microscope. And the only way to look at tissue under the microscope is to do a biopsy: cut a small piece of tissue and remove it from the body. A biopsy is a small operation, and like any operation, it can be disruptive and painful and can lead to complications. So it's not the kind of test you want to perform on everyone.
The job of the cancer-screening test is to determine which patients should be biopsied. In other words, a screening test is a preliminary test. It is not a test to determine who has cancer; instead, it is a test to determine who should be tested further.
Can a negative screening test be wrong The answer is almost certainly yes, although it is very hard to prove. That is because we do not biopsy people with negative screening tests. The only way we ever come to suspect that a negative screening test might have been wrong is when a new cancer becomes clinically obvious soon after a person has a negative test.
Testing In The Real World
In the real world, cancer testing is more complex. Test results aren't just positive or negative; often