CANCER PAIN MANAGEMENT IN COMMUNITY BASED RURAL SETTINGS

本提案的目的是制定一个多组成部分 旨在改善门诊患者癌症疼痛管理的干预措施 在农村和社区接受护理。多组分 干预将针对医疗保健专业人员、患者/家属- 相关的和系统的治疗障碍，将包括：l）癌症 疼痛教育计划的卫生保健专业人员利用互动 媒体技术; 2）患者和家庭教育计划; 3）办公室 促进者将提供工具和提醒系统，以提高癌症 医生办公室的疼痛管理;以及4）疼痛缓解网络 包括一条热线， 中心提供咨询和持续的角色模型，以医疗保健 专业人士和患者。在项目开发之后， 将进行一项随机试验，其中 将指定医生诊所接收多组分 AHCPR临床实践指南的干预或传播 对于癌症疼痛管理，患者将在 干预后纵向随访。患者 将利用疼痛相关变量的测量来评估结果 （简明疼痛量表和疼痛和药物记录），生活质量 癌症治疗的功能评估--一般简介 情绪状态，症状困扰量表）和患者疼痛障碍 障碍问卷（Barriers Questionnaire）。实践遵守AHCPR 癌症疼痛管理指南将通过记录进行评估 回顾、患者结局问卷以及知识和态度 问卷调查这项随机试验旨在测试两个主要的 假设：l）接受多项治疗的实践小组治疗的患者 组件干预将报告更好的疼痛管理和更高的 生活质量与实践组治疗的患者相比， 传播干预和2）接触的实践群体 多组分干预将证明更符合 根据记录确定的AHCPR癌症疼痛治疗指南 与实践组相比的回顾和患者结局问卷 接受了生殖传播干预。其次，我们预测 （1）由严格遵守《医疗卫生法》的实践团体治疗的患者 AHCPR指南将报告更好的疼痛管理和更高质量的 生活相比，实践组具有低水平的遵守， 2)报告的疼痛管理改善和生活质量提高 患者将减少患者对以下方面的担忧 疼痛管理

The purpose of the current proposal is to develop a Multi-Component Intervention designed to improve cancer pain management for outpatients receiving care in rural, community-based settings. The Multi-Component Intervention will target health care professional, patient / family- related, and systems barriers to treatment and will include: l) a cancer pain education program for health care professionals utilizing interactive media technology; 2) a patient and family education program; 3) an office facilitator who will provide tools and a reminder system to enhance cancer pain management in the physicians' office; and 4) a Pain Relief Network consisting of a hotline to pain experts at the Dartmouth-Hitchcock Medical Center to provide consultation and ongoing role modeling to health care professionals and patients. Following program development, an outcome study will be conducted which will consist of a randomized trial where physician practices will be assigned to receive the Multi-Component Intervention or Usual Dissemination of AHCPR Clinical Practice Guidelines for Cancer Pain Management Patients will be assessed prior to the intervention and followed longitudinally post-intervention. Patient outcomes will be assessed utilizing measures of pain-related variables (Brief Pain Inventory and pain and medication logs), quality of life measures (Functional Assessment of Cancer Therapy-General, Brief Profile of Mood States, Symptom Distress Scale), and patient barriers to pain management (Barriers Questionnaire). Practice compliance with AHCPR Guidelines for cancer pain management will be assessed through record review, Patient Outcome Questionnaire and knowledge and attitude questionnaires. The randomized trial is designed to test two primary hypotheses: l) Patients treated by practice groups receiving the Multi- Component Intervention will report better pain management and higher quality of life compared to patients treated by practice groups in the Usual Dissemination Intervention and 2) Practice groups exposed to the Multi-Component Intervention will demonstrate a closer compliance with the AHCPR guidelines for the treatment of cancer pain as determined by record review and patient outcome questionnaire compared to the practice groups that receive the Usual Dissemination Intervention. Secondarily, we predict that: l)Patients treated by practice groups that closely comply with the AHCPR Guidelines will report better pain management and higher quality of life compared to practice groups that have a low level of compliance and 2) Improvement in pain management and higher quality of life reported by patients will be associated with a reduction in patient concerns regarding pain management.