Adherence to Analgesics Among Outpatients Seriously Ill With Cancer.
Adherence to Analgesics Among Outpatients Seriously Ill With Cancer.
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DOI：
10.1097/ncc.0000000000001064
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发表时间：
2022-09-01
期刊：
影响因子：
2.6
通讯作者：
Wilkie DJ
中科院分区：
文献类型：
--
作者：
Stapleton SJ;Dyal BW;Boyd AD;Suarez ML;Ezenwa MO;Yao Y;Wilkie DJ
对于患有癌症疼痛的重病患者，坚持使用处方止痛药对于舒适度至关重要。确定癌症重症患者的镇痛依从性及其与临床和人口统计学特征的相关性。横断面研究。在家中，202例接受临终关怀/姑息治疗的癌症患者（平均年龄59.9±14.2岁，58%为女性，48%为黑人，42%为白色）完成了五项测量：PAINReportIt®、症状困扰量表、情绪状态项、匹兹堡睡眠质量指数项和疼痛管理指数（PMI）。平均当前疼痛强度为4.4±2.9，过去24小时内平均最严重疼痛为7.2±2.7。超过一半的参与者（54%）对他们的疼痛水平不满意，并报告他们的疼痛在过去24小时内超过他们想要忍受的18小时（51%）。只有12%的人没有得到与疼痛强度相适应的止痛药。依从率各不相同：NSAIDs（0.63 ± 0.50）、佐剂（0.93 ± 0.50）、世界卫生组织第2级阿片类药物（0.63 ± 0.49）和第3级阿片类药物（0.80 ± 0.40）。在模型中的设置/临床/人口统计学变量中，给药间隔小于8小时与较低的依从性相关（p<.001）。即使在免费提供镇痛药的情况下，在改善镇痛药依从性方面也没有取得什么进展。需要研究的重点是针对止痛剂剂量间隔和与成本无关的障碍。≥8小时的给药间隔与较高的依从率显著相关，因此，使用长效镇痛药是改善生命终了时疼痛控制的一种策略。
Adherence to prescribed analgesics for patients seriously ill with cancer pain is essential for comfort. To determine the analgesic adherence in seriously ill patients with cancer and its association with clinical and demographic characteristics. Cross-sectional study. At home, 202 patients with cancer (mean age 59.9±14.2 years, 58% female, 48% Black, 42% White) admitted to hospice/palliative care completed measures on a pentablet: PAINReportIt®, Symptom Distress Scale, mood state item, Pittsburgh Sleep Quality Index item, and Pain Management Index (PMI). The mean current pain intensity was 4.4±2.9, and mean worst pain in the past 24 hours was 7.2±2.7. More than one-half of participants were not satisfied with their pain level (54%) and reported their pain was more intense than they wanted to tolerate for ≥18 hours in the last 24 hours (51%). Only 12% were not prescribed analgesics appropriate for the intensity of their pain. Adherence rates were variable: NSAIDs (.63±.50), adjuvants (.93±.50), World Health Organization step 2 opioids (.63±.49), and step 3 opioids (.80 ± .40). With setting/clinical/demographic variables in the model, dose intervals less than 8 hours were associated with less adherence (p<.001). Little progress has been made toward improving analgesic adherence even in settings providing analgesics without cost. Research is needed focused on targeting analgesic dose intervals and barriers not related to cost. Dose intervals of ≥8 hours were significantly associated with higher adherence rates, therefore, use of longer-acting analgesics is one strategy to improve pain control at end of life.