Pain Assessment in Non-Communicative Palliative Care Patients

无法沟通的姑息治疗患者的疼痛评估

• 批准号: 7283747
• 负责人: DEBORAH B. MCGUIRE
• 金额: $ 48.97万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-05 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7283747
• 关键词: Acute; Acute Pain; Admission activity; Adult; Affect; Affective; Behavior; Behavioral; Caregivers; Caring; Cessation of life; Childhood; Clinical; Clinical Practice Guideline; Clinical Treatment; Cognitive; Communication; Communities; Condition; Continuity of Patient Care; Critical Care; Data; Documentation; Evaluation; Family; Goals; Healed; Health Professional; Home environment; Hospice Care; Hospitals; Human; Impaired cognition; Individual; Inpatients; Institutes; Intervention; Knowledge; Lead; Life; Long-Term Care; Measurement; Medical; Modeling; Morbidity - disease rate; Nurses; Outcome; Outcome Measure; Pain; Pain Assessment Tool; Pain Measurement; Pain management; Palliative Care; Patient Self-Report; Patients; Pharmaceutical Preparations; Physiological; Population; Postoperative Period; Process; Property; Psychometrics; Publishing; Quality of life; Range; Recovery; Research; Research Personnel; Risk; Sampling; Sensory; Series; Symptoms; Testing; United States Department of Veterans Affairs; Unlicensed Assistive Personnel; Validity and Reliability; Vulnerable Populations; base; design; end of life care; experience; healing; hospice environment; improved; instrument; medical specialties; older patient; patient home care; programs; statistics; theories; tool

DESCRIPTION (provided by applicant): Pain, the universal human experience, has been the focus of intense efforts to improve its management in ill clinical populations for years, but sadly, many people continue to suffer with inadequately managed pain. Good assessment is fundamental to managing pain, and is based on individual self-report because pain is subjective. People who cannot communicate their pain because of underlying medical conditions and treatments are at higher risk for unrecognized pain, unnecessary suffering, additional co-morbidities, poorer quality of life, and prolonged healing and recovery. Many of these individuals are receiving palliative care, which is now delivered in tertiary acute, hospice, long term, and home care settings. A major emphasis is pain management, yet no satisfactory pain assessment tools are available for non-communicative palliative care patients with pain. The research team's preliminary studies of the Multidimensional Objective Pain Assessment Tool (MOPAT), which uses behavioral and physiological indicators to assess pain, demonstrate initial evidence of reliability and validity. The specific aims of this study are to: 1) test the reliability and validity of the MOPAT for assessing acute pain in non-communicative patients in three different types of palliative care settings: 1) inpatient tertiary acute care hospital, 2) inpatient community hospice, and 3) inpatient Veterans Administration hospice; and 2) appraise the clinical utility of the MOPAT when used by nurses to assess acute pain in non-communicative patients in two different types of palliative care settings: 1) inpatient tertiary acute care hospital, and 2) inpatient community hospice. Using a methodologic design, the researchers will test the tool in 130 acute care inpatients (pre- and post-pain medication intervention) and 100 hospice inpatients (longitudinally for duration of admission) using observations by pairs of raters. Extensive demographic, clinical, and treatment data will also be collected. The analyses will use Generalizability Theory to evaluate reliability, a theoretical approach and causal measurement theory to evaluate validity, and descriptive statistics and mixed modeling to evaluate clinical utility. If this study is successful, knowledge of how to assess pain in this vulnerable population will be advanced. It should help facilitate the management of pain in non-communicative patients across palliative care settings and ultimately result in less suffering.

描述（由申请人提供）：疼痛是人类的普遍经历，多年来一直是改善临床疾病人群管理的重点，但遗憾的是，许多人继续遭受管理不当的疼痛之苦。良好的评估是控制疼痛的基础，并且基于个人的自我报告，因为疼痛是主观的。由于潜在的医疗状况和治疗而无法表达疼痛的人，遭受未被识别的疼痛、不必要的痛苦、额外的合并症、生活质量较差以及愈合和恢复时间延长的风险更高。其中许多人正在接受姑息治疗，目前在三级急症、临终关怀、长期和家庭护理机构中提供。主要重点是疼痛管理，但对于患有疼痛的非沟通姑息治疗患者来说，还没有令人满意的疼痛评估工具。研究小组对多维客观疼痛评估工具（MOPAT）的初步研究，利用行为和生理指标来评估疼痛，​​展示了可靠性和有效性的初步证据。本研究的具体目的是：1) 测试 MOPAT 在评估三种不同类型的姑息治疗机构中非沟通性患者急性疼痛方面的可靠性和有效性：1) 住院三级急性护理医院，2) 住院社区临终关怀中心，3) 住院退伍军人管理局临终关怀中心； 2) 评估护士使用 MOPAT 评估两种不同类型姑息治疗环境中非沟通性患者的急性疼痛时的临床效用：1) 住院三级急性护理医院，2) 住院社区临终关怀中心。研究人员将采用方法设计，通过一对评估者的观察，在 130 名急症护理住院患者（止痛药物干预前后）和 100 名临终关怀住院患者（入院期间的纵向）中测试该工具。还将收集广泛的人口统计、临床和治疗数据。这些分析将使用概括性理论来评估可靠性，使用理论方法和因果测量理论来评估有效性，并使用描述性统计和混合模型来评估临床效用。如果这项研究成功，关于如何评估这一弱势群体疼痛的知识将会得到提高。它应该有助于促进姑息治疗环境中无法沟通的患者的疼痛管理，并最终减少痛苦。