Implementing guidelines for cancer pain management: Results of a randomized controlled clinical trial
Implementing guidelines for cancer pain management: Results of a randomized controlled clinical trial
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DOI：
10.1200/jco.1999.17.1.361
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发表时间：
1999-01-01
影响因子：
45.3
通讯作者：
Syrjala, K
中科院分区：
文献类型：
--
作者：
Du Pen, SL;Du Pen, AR;Syrjala, K
目的：疼痛和症状管理是肿瘤学临床实践的一个组成部分。已经制定了许多指南来帮助临床医生优化舒适护理。我们在社区环境中实施了癌症疼痛管理的临床指南，并评估了这些指南是否改善了护理。 患者和方法：81 名年龄在 37 至 76 岁之间的癌症患者被纳入一项前瞻性、纵向、随机对照研究，该研究来自华盛顿西部地区的 26 名门诊肿瘤学家。将基于卫生保健政策和癌症疼痛管理研究指南的多级治疗算法与社区肿瘤学家使用的标准实践（控制）疼痛和症状管理疗法进行比较。主要关注的结果是疼痛（简要疼痛量表）；感兴趣的次要结局是所有其他症状（记忆症状评估量表）和生活质量（癌症治疗功能评估量表）。结果：与标准社区实践相比，随机分配到疼痛算法组的患者通常疼痛强度（以斜率分数衡量）出现了统计学上显着的降低（P < .02）。同步化疗和患者对治疗的依从性是最严重疼痛的重要调节因素。两个治疗组之间的其他症状或生活质量没有显着差异。结论：该指南实施研究支持在癌痛管理中使用算法决策。这些发现表明，全面的疼痛评估和基于证据的镇痛决策过程确实可以增强通常的疼痛结果。J Clin Oncol 17：361-370。 (C) 1999 年，美国临床肿瘤学会。
Purpose: Pain and symptom management is an integral part of the clinical practice of oncology. A number of guidelines have been developed to assist the clinician in optimizing comfort care. We implemented clinical guidelines for cancer pain management in the community setting and evaluated whether these guidelines improved care.Patients and Methods: Eighty-one cancer patients, aged 37 to 76 years, were enrolled onto a prospective, longitudinal, randomized controlled study from the outpatient clinic settings of 26 western Washington-area medical oncologists. A multilevel treatment algorithm based on the Agency for Health Care Policy and Research Guidelines for Cancer Pain Management was compared with standard-practice (control) pain and symptom management therapies used by community oncologists. The primary outcome of interest was pain (Brief Pain Inventory); secondary outcomes of interest were all other symptoms (Memorial Symptom Assessment Scale) and quality of life (Functional Assessment of Cancer Therapy Scale).Results: Patients randomized to the pain algorithm group achieved a statistically significant reduction in usual pain intensity, measured as slope scores, when compared with standard community practice (P < .02). Concurrent chemotherapy and patient adherence to treatment were significant mediators of worst pain. There were no significant differences in other symptoms or quality of life between the two treatment groups.Conclusion: This guideline implementation study supports the use of algorithmic decision making in the management of cancer pain. These findings suggest that comprehensive pain assessment and evidence-based analgesic decision-making processes do enhance usual pain outcomes.J Clin Oncol 17:361-370. (C) 1999 by American Society of Clinical Oncology.