Building Bridges to Hospice and Rural Appalachia

描述（由申请人提供）：姑息治疗，特别是疼痛问题的管理，是肯塔基州阿巴拉契亚农村一个重要而未被充分研究的问题。尽管人们试图提高对这一问题的认识，但慢性疼痛患者，包括那些疾病晚期和生命末期的患者，对疼痛的治疗仍然不足。随着对处方药滥用和转移的担忧加剧，这种情况只会恶化。该应用程序旨在在肯塔基大学（英国）和蓝草临终关怀医院（HOB）之间创建一个功能齐全的社区参与式研究（CBPR）实体。这种关系的一个主要成果是对一线护理工作者（即护士、护士、社会工作者）进行正式的基于需求的评估，这些护理工作者必须处理以处方药滥用和转移问题而著名的农村人口的疼痛问题。数据将用于确定有效治疗的障碍，并为未来的干预性研究收集初步数据。需求评估将透过焦点小组、主要资讯提供者访谈，以及对医院前线护理人员的评估来进行。将特别注意提供者关于适当使用阿片类镇痛药的知识库中的缺陷。为了达到这一目的，评估工具将包括工人人口统计、他们的知识基础和对疼痛管理态度的调查、工作满意度调查和一般自我效能的测量。将编写一份关于阿片类药物知识和使用恐惧的额外调查，以及一份病例小品，以进一步完善评估包。作为最后一步，该研究将通过在HOB进行机构范围内的调查来完成基于需求的评估，以确定未来应用研究的领域，以解决与HOB及其患者群体相关的临床研究需求的应用。

DESCRIPTION (provided by applicant): Palliative care, and specifically the management of pain issues, is an important and understudied issue in rural Appalachian Kentucky. Despite attempts to increase awareness on this issue, pain continues to be under-treated for chronic pain patients, including those with advanced disease and at end-of-life. This will only worsen as fears grow concerning prescription medication abuse and diversion. The application is designed to create a fully functioning community-based participatory research (CBPR) entity between the University of Kentucky (UK) and Hospice of the Bluegrass (HOB). One major outcome of this relationship is to conduct a formal needs-based assessment of frontline care workers (i.e., nurses, CNAs, social workers) who have to manage pain issues in a rural population noted for issues with prescription drug abuse and diversion. Data will be used for the purpose of identifying barriers to effective treatment and to gather initial data for a future interventional study. The needs assessment will be conducted through focus groups, key informant interviews, and assessment of frontline care workers at HOB. Specific attention will be paid to deficits in the knowledge base of providers regarding the appropriate use of opioid analgesics. To meet this end, assessment instruments will include worker demographics, a survey of their knowledge base and attitudes about pain management, a job satisfaction survey, and a measure of general self-efficacy. An additional survey on opioid knowledge and fear of use, along with a case vignette, will be developed to further round out the assessment package. As a final step, the study will conclude the needs-based assessment by conducting an agency wide survey at HOB to target future areas for applied research that address the application of clinical research needs pertinent to HOB and their patient population.