Testing the Pain-CPG-EIT

测试疼痛-CPG-EIT

• 批准号: 10711409
• 负责人: BARBARA RESNICK
• 金额: $ 42.62万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10711409
• 关键词: Acute; Address; Affect; Aggressive behavior; Aging; Agitation; Analgesics; Behavior; Behavioral Symptoms; Belief; Black race; Caring; Clinical; Clinical Practice Guideline; Communities; Dementia; Diagnosis; Education; Effectiveness; Elderly; Ethnic Origin; Ethnic Population; Evaluation; Evidence based practice; Facial Expression; Feedback; Female; Future; Gender; Goals; Individual; Intervention; Knowledge; Long-Term Care; Measurement; Medicine; Mental Depression; Mentors; Modeling; Monitor; Nursing Homes; Nursing Research; Opioid; Pain; Pain Measurement; Pain intensity; Pain management; Pharmaceutical Preparations; Physical activity; Population; Positioning Attribute; Prevention; Process Assessment; Quality of life; Race; Randomized; Recommendation; Reporting; Sex Differences; Sleep disturbances; Societies; Techniques; Testing; Translating; Translations; Use Effectiveness; Withdrawal; Work; associated symptom; clinical translation; common symptom; effectiveness testing; evidence base; experience; health disparity; health equity; home test; improved; innovation; male; meetings; pain outcome; pain relief; pain sensitivity; pharmacologic; psychological symptom; racial population; recruit; response; sex; social; social cognitive theory; treatment response; verbal; vocalization

Pain is experienced by 30% to 80% of residents living with dementia in nursing homes. For those with moderate to severe dementia verbal reporting of pain may not be reliable and observational approaches are recommended as pain in these individuals is more likely to present with facial expressions or behaviors such as aggression, agitation, or restlessness. Lack of accurate pain assessment results in untreated or over- treated pain. Untreated pain can lower quality of life, negatively impact function, impair sleep, increase depression, agitation, aggression, resistiveness to care and use of psychotropic medications. Further, the evaluation, management and treatment of pain are complicated by differences in pain sensitivity, verbal reporting or presentation of pain between genders, races and ethnicities. Although inconsistent, in some studies individuals living with dementia who were Black were more likely to have depression and sleep disturbances associated with pain and less likely to be treated for pain when compared to White residents. There are evidence based processes for assessment and management of pain using pharmacologic and nonpharmacological approaches. These were reviewed and included within the Pain Management Clinical Practice Guideline (Pain Management CPG) recently developed by AMDA: The Society for Post-Acute and Long-Term Care Medicine. There are, however, many challenges to translating the use of Clinical Practice Guidelines into clinical settings. To overcome these challenges we developed and previously tested a theoretically based approach and merged this approach with the Pain Management CPG, which is referred to as the PAIN-CPG-EIT. The PAIN-CPG-EIT involves a research nurse facilitator working with an identified community champion(s) and stakeholder team for 12 months to provide the following four components: Component I: Establishing and meeting monthly with a Stakeholder Team; Component II: Education of the staff; Component III: Mentoring and motivating the staff to address pain; Component IV: Ongoing evaluation of resident pain outcomes. Twelve communities will be included with 25 residents living with dementia and pain recruited from each community. Six communities will be randomized to treatment (PAIN-CPG-EIT) and six randomized to education only (EO) which involves providing the same education to staff as is done in Component II of PAIN-CPG-EIT. The primary aim of this study is to test the effectiveness of use of the PAIN- CPG-EIT to improve the assessment, diagnosis and management of pain and decrease pain intensity among nursing home residents living with dementia between baseline, 4 and 12 months and evaluate treatment fidelity. A secondary aim of the study is to consider differences in measurement, treatment and response to treatment between male and female and Black versus White residents living with dementia. Findings from this study will help build on the currently limited information about pain presentation and management among older adults living with dementia in nursing homes and improve health equity of aging populations experiencing pain.

居住在疗养院的痴呆症患者中有 30% 至 80% 都经历过疼痛。对于那些有 中度至重度痴呆 疼痛的口头报告可能不可靠，观察方法是 建议这样做，因为这些人的疼痛更有可能表现为面部表情或行为，例如 如攻击性、激动或不安。缺乏准确的疼痛评估会导致未经治疗或过度治疗 治疗疼痛。未经治疗的疼痛会降低生活质量、对功能产生负面影响、损害睡眠、增加 抑郁、烦躁、攻击性、对护理和使用精神药物的抵抗力。此外， 由于疼痛敏感性、语言能力的差异，疼痛的评估、管理和治疗变得复杂。 报告或呈现不同性别、种族和民族之间的痛苦。尽管不一致，但在某些情况下 研究发现黑人痴呆症患者更有可能患有抑郁症和睡眠障碍 与白人居民相比，他们受到与疼痛相关的干扰，并且不太可能接受疼痛治疗。 有基于证据的过程，可以使用药物和药物来评估和管理疼痛。 非药物方法。这些经过审查并包含在疼痛管理临床中 AMDA：急性后疼痛协会最近制定了实践指南（疼痛管理 CPG） 长期护理医学。然而，转化临床实践的使用存在许多挑战 临床环境指南。为了克服这些挑战，我们开发并之前测试了 基于理论的方法，并将该方法与疼痛管理 CPG 合并，称为 作为 PAIN-CPG-EIT。 PAIN-CPG-EIT 涉及一名研究护士协调员与已确定的人员一起工作 社区冠军和利益相关者团队为期 12 个月，提供以下四个组成部分： 第一部分：建立利益相关者团队并每月召开一次会议；第二部分：教育 职员;第三部分：指导和激励员工解决疼痛问题；第四部分：持续评估 常驻疼痛结果。 12 个社区将包括 25 名患有痴呆症和疼痛的居民 从各个社区招募。六个社区将被随机分配接受治疗 (PAIN-CPG-EIT)，另外六个社区将被随机分配接受治疗 (PAIN-CPG-EIT) 随机分配到仅教育（EO），其中涉及向员工提供与 PAIN-CPG-EIT 的第二部分。本研究的主要目的是测试使用 PAIN-的有效性 CPG-EIT 改善疼痛的评估、诊断和管理并降低疼痛强度 基线、4 至 12 个月期间患有痴呆症的疗养院居民并评估治疗 保真度。该研究的第二个目的是考虑测量、治疗和反应的差异 患有痴呆症的男性和女性以及黑人和白人居民之间的治疗。由此得出的结论 研究将有助于利用目前关于老年人疼痛表现和管理的有限信息 疗养院中患有痴呆症的成年人，并改善经历疼痛的老年人群的健康公平。