Overcoming barriers to cancer pain management: an institutional change model.
Overcoming barriers to cancer pain management: an institutional change model.
复制标题
克服癌症疼痛管理的障碍：制度变革模型。
DOI：
10.1016/j.jpainsymman.2006.12.011
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发表时间：
2007
影响因子：
4.7
通讯作者：
Choi,Kyong
中科院分区：
文献类型：
--
作者：
Sun,VirginiaChih-Yi;Borneman,Tami;Ferrell,Betty;Piper,Barbara;Koczywas,Marianna;Choi,Kyong
1994年卫生保健政策和研究机构的疼痛指南承认疼痛是影响生活质量(QOL)的严重症状。达到最佳止痛效果的障碍分为三类：患者障碍、专业障碍和系统障碍。一项前瞻性的纵向临床试验正在进行中，以测试“Passport to Comfort”创新干预对疼痛和疲劳管理的效果。本文报告了与疼痛管理障碍相关的干预前的研究结果。被诊断为乳腺癌、肺癌、结肠癌或前列腺癌的癌症患者报告疼痛等级为≥4的患者被累加。受试者完成问卷，在基线和一个月和三个月的评估中评估总体生活质量、疼痛管理障碍和疼痛知识的主观评分。在一个月时进行图表审核，以记录与疼痛管理相关的客观数据。大多数受试者在发生疼痛时有中度疼痛(4-6分，0-10分)。患者对疼痛管理的障碍存在于对上瘾、耐受性和无法控制疼痛的态度和知识上。目前正在接受化疗的受试者不愿与医疗保健专业人员交流他们的痛苦。专业和系统障碍集中在筛查、记录、重新评估和疼痛的随访方面。还注意到缺乏对患者的支持性护理服务的转介。几个描述良好的患者、专业人员和系统障碍继续阻碍提供最佳疼痛缓解的努力。这项计划的第二阶段将尝试使用“护照”干预措施来消除这些障碍，以控制癌症疼痛。
The Agency for Health Care Policy and Research Pain Guidelines of 1994 recognized pain as a critical symptom that impacts quality of life (QOL). The barriers to optimum pain relief were classified into three categories: patient, professional, and system barriers. A prospective, longitudinal clinical trial is underway to test the effects of the “Passport to Comfort” innovative intervention on pain and fatigue management. This article reports on preintervention findings related to barriers to pain management. Cancer patients with a diagnosis of breast, lung, colon, or prostate cancer who reported a pain rating of ≥4 were accrued. Subjects completed questionnaires to assess subjective ratings of overall QOL, barriers to pain management, and pain knowledge at baseline and at one- and three-month evaluations. A chart audit was conducted at one month to document objective data related to pain management. The majority of subjects had moderate (4–6 on a 0–10 numeric rating scale) pain at the time of accrual. Patient barriers to pain management existed in attitudes and knowledge regarding addiction, tolerance, and not being able to control pain. Subjects who were currently receiving chemotherapy were reluctant to communicate their pain with health care professionals. Professional and system barriers were focused around screening, documentation, reassessment, and follow-up of pain. Lack of referrals to supportive care services for patients was also noted. Several well-described patient, professional, and system barriers continue to hinder efforts to provide optimal pain relief. Phase II of this initiative will attempt to eliminate these barriers using the “Passport” intervention to manage cancer pain.