Cancer Pain in Elders: Promoting EBPs in Hospices

描述（由申请人提供）：本研究是我们现有研究的延伸，重点是促进采用循证实践（EBPs）来提高老年癌症患者疼痛管理的质量。该研究解决了在评估和治疗老年人癌症疼痛时，一致采用疼痛管理临床实践指南的障碍。这些老年人遭受着与他们的癌症、治疗和相关的合并症有关的不必要的痛苦。尽管存在以证据为基础的指南，以改善这一弱势群体的疼痛评估和管理，但基于最佳科学证据的建议的采用和使用滞后，充其量是零星的。即使在以控制疼痛为首要任务的临终关怀环境中，也存在相当大的差异，病人仍然死于无法解决的疼痛。在这一人群中，有效疼痛管理的第二个障碍是患者和家庭护理人员不遵守疼痛治疗计划。有效实施现行的临床实践指南（cpg），包括解决这一障碍的循证策略，可能进一步有助于提高老年人临终疼痛管理的质量。将研究转化为实践（TRIP）是一个积极的过程，促进医疗保健提供者使用证据，可以改善老年人癌症疼痛的疼痛管理实践。

DESCRIPTION (provided by applicant): This study is an extension of our current research and focuses on promoting adoption of evidence-based practices (EBPs) to improve the quality of pain management for elder persons with cancer. The study addresses barriers to consistent adoption of pain management clinical practice guidelines for assessing and treating cancer pain in elders. These elders suffer needlessly from pain related to their cancer, its treatment, and related co morbid conditions. Despite existence of evidence-based guidelines to improve assessment and management of pain in this vulnerable population, adoption and use of recommendations based on best scientific evidence lags and is sporadic at best. Even in the hospice setting where pain control is a priority, there is considerable variation and patients still die in unresolved pain. A secondary barrier underlying effective pain management in this population is patient and family caregiver non-adherence to the pain treatment plan. Effective implementation of current Clinical Practice Guidelines (CPGs) that include evidence-based strategies for addressing this barrier may further contribute to improved quality of pain management for elders at the end of life. Translating Research into Practice (TRIP) is an active process of promoting use of evidence by healthcare providers that may improve pain management practices for elders with cancer pain. The proposed randomized control trial builds on our successful TRIP-Acute Pain intervention that demonstrated improved quality of acute pain management for hospitalized elders with hip fractures and savings of healthcare dollars. This study will evaluate the effect of an interdisciplinary multifaceted TRIP intervention focused on increasing EBPs for assessing and managing pain in elder hospice patients with cancer pain. The study aims are as follows: 1) Test the effect of a multifaceted TRIP-Cancer Pain intervention on pain severity, pain interference, pain relief and quality of life in elder hospice patients with cancer pain; 2) Test the effect of a multifaceted TRIP-Cancer Pain intervention on promoting adoption, by health care providers, of cancer pain management EBPs for elder hospice patients with cancer pain; 3) Determine the effectiveness of a multifaceted TRIP-Cancer Pain intervention on patient adherence to the pain treatment plan; and 4) Evaluate the persistence of change in process and outcome variables at long-term follow-up (6 months post intervention).