Ascertaining Design and Implementation Requirements for a Perioperative Neurocognitive Training Intervention for the Prevention of Persistent Pain After Surgery.
Ascertaining Design and Implementation Requirements for a Perioperative Neurocognitive Training Intervention for the Prevention of Persistent Pain After Surgery.
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确定预防手术后持续性疼痛的围手术期神经认知训练干预的设计和实施要求。
DOI：
10.1093/pm/pnab347
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Abraham,Joanna
中科院分区：
文献类型：
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作者：
Holzer,KatherineJ;Haroutounian,Simon;Meng,Alicia;Wilson,ElizabethA;Steinberg,Aaron;Avidan,MichaelS;Kozower,BenjaminD;Abraham,Joanna
背景：持续性术后疼痛（PPSP）是影响生活质量的常见并发症，通常需要长期阿片类药物治疗。某些神经认知因素，包括认知灵活性任务的表现下降，与PPSP的风险增加有关。我们检查了手术患者和临床医生对围手术期疼痛管理活动和需求的看法；患者接受和使用围手术期神经认知训练干预；以及实施的可行性。方法对某学术医疗中心胸外科患者和临床医生进行个体和焦点小组访谈。干预研究综合框架指导了访谈问题的发展，这些访谈问题与神经认知干预的采用和实施有关，以减轻PPSP。我们采用专题分析来分析这些回应。结果患者40例，临床医生15例。访谈显示，临床医生和患者之间关于PPSP的讨论很少。如果有证据证明其有效性，大多数参与者都接受神经认知干预来预防PPSP。神经认知训练项目采用的潜在障碍包括疲劳、认知超载、对提供干预的技术缺乏熟悉、术后即刻疼痛和压力。实施促进者将包括对患者进行干预教育，鼓励其使用，以及每日提醒。结论：本研究确定了一些指导原则，以解决患者和临床医生有效实施神经认知训练干预以减轻术后PPSP的障碍。为了确保预防PPSP的神经认知干预措施的可持续性，这些干预措施需要在围手术期适应患者和临床医生的需要。
BackgroundPersistent postsurgical pain (PPSP) is a common complication that impacts quality of life, often necessitating long-term opioid treatment. Certain neurocognitive factors, including reduced performance on cognitive flexibility tasks, are associated with increased risk of PPSP. We examine the perceptions of surgical patients and clinicians with regard to perioperative pain management activities and needs; patient acceptance and use of a perioperative neurocognitive training intervention; and implementation feasibility.MethodsWe conducted both individual and focus group interviews with patients undergoing thoracic surgery and clinicians in an academic medical center. The Consolidated Framework for Intervention Research guided the development of interview questions related to the adoption and implementation of a neurocognitive intervention to mitigate PPSP. A thematic analysis was used to analyze the responses.ResultsForty patients and 15 clinicians participated. Interviews revealed that there is minimal discussion between clinicians and patients about PPSP. Most participants were receptive to a neurocognitive intervention to prevent PPSP, if evidence demonstrating its effectiveness were available. Potential barriers to neurocognitive training program adoption included fatigue, cognitive overload, lack of familiarity with the technology used for delivering the intervention, and immediate postoperative pain and stress. Implementation facilitators would include patient education about the intervention, incentives for its use, and daily reminders.ConclusionThe study identified several guiding principles for addressing patients’ and clinicians’ barriers to effectively implementing a neurocognitive training intervention to mitigate PPSP after surgery. To ensure the sustainability of neurocognitive interventions for preventing PPSP, such interventions would need to be adapted to meet patients’ and clinicians’ needs within the perioperative context.