Pain Assessment in Non-Communicative Palliative Care Patients

描述（由申请人提供）：疼痛是人类普遍的体验，多年来一直是改善临床疾病人群疼痛管理的重点，但遗憾的是，许多人继续遭受疼痛管理不足的痛苦。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。由于潜在的医疗条件和治疗而无法表达自己疼痛的人，面临无法识别的疼痛、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较长等更高风险。其中许多人正在接受姑息治疗，目前在三级急症、临终关怀、长期和家庭护理环境中提供姑息治疗。一个主要的重点是疼痛管理，但没有令人满意的疼痛评估工具可用于非沟通姑息治疗患者的疼痛。研究小组对多维客观疼痛评估工具（MOPAT）的初步研究表明，该工具使用行为和生理指标来评估疼痛，初步证明了其可靠性和有效性。本研究的具体目的是：1)检验MOPAT在三种不同类型的姑息治疗环境中评估非交流患者急性疼痛的信度和效度：1)住院三级急症医院、2)住院社区安宁疗护和3)住院退伍军人管理局安宁疗护；以及2)评估护士在两种不同类型的姑息治疗环境(1)住院三级急性护理医院和2)住院社区安宁疗护)中使用MOPAT评估非交流患者急性疼痛的临床效用。采用方法学设计，研究人员将在130名急症护理住院患者（治疗前和治疗后）和100名临终关怀住院患者（住院时间纵向）中使用成对评分者的观察来测试该工具。还将收集广泛的人口统计、临床和治疗数据。本研究将使用概括性理论评估信度，理论方法和因果测量理论评估效度，以及描述性统计和混合模型评估临床效用。如果这项研究是成功的，如何评估这一弱势群体的疼痛的知识将被推进。它应该有助于在姑息治疗环境中促进非交流患者的疼痛管理，并最终减少痛苦。

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.