CANCER PAIN MANAGEMENT IN COMMUNITY BASED RURAL SETTINGS

当前提案的目的是开发多组件 旨在改善门诊患者癌痛管理的干预措施 在以农村为基础的社区环境中接受护理。多元组分 干预措施将针对医疗保健专业人员、患者/家庭- 相关的、系统的和治疗的障碍，将包括：L)癌症 利用互动为医疗保健专业人员提供疼痛教育计划 媒体技术；2)病人和家庭教育计划；3)办公室 将提供工具和提醒系统以增强癌症的促进者 医生办公室的疼痛管理；以及4)疼痛缓解网络 由达特茅斯-希区柯克医疗中心的疼痛专家热线组成 中心为医疗保健提供咨询和持续的角色示范 专业人士和病人。在项目开发之后，一个结果是 研究将由随机试验组成，在 将指派医生实践来接收多组件 干预或通常传播AHCPR临床实践指南 对癌症疼痛管理患者的评估将在 干预和干预后的纵向跟踪。有耐心的 将使用疼痛相关变量的测量来评估结果 (简明的疼痛清单和疼痛和用药记录)，生活质量 措施(癌症治疗的功能评估-概述，简介 情绪状态、症状苦恼程度)和患者疼痛障碍 管理(障碍问卷)。实践符合AHCPR 癌症疼痛管理指南将通过Record进行评估 回顾、患者结果问卷以及知识和态度 问卷调查。这项随机试验旨在测试两种主要的 假设：L)实践组治疗的患者接受多项治疗 组件干预将报告更好的疼痛管理和更高的 生活质量与接受实践小组治疗的患者的比较 通常的传播干预和2)暴露于 多组分干预将证明更符合 记录确定的治疗癌痛的AHCPR指南 回顾和患者结果问卷与实践组的比较 接受通常的传播干预。其次，我们预测 L)患者接受严格遵守 AHCPR指南将报告更好的疼痛管理和更高质量的 与遵从性水平较低的实践小组相比， 2)疼痛管理的改善和更高的生活质量 患者将与减少患者对以下方面的担忧相关 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.