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，是阿巴拉契亚肯塔基州农村地区一个重要而未被研究的问题。尽管试图提高对这一问题的认识，但慢性疼痛患者，包括晚期疾病患者和临终患者，疼痛仍然得不到足够的治疗。随着人们对处方药滥用和转移的担忧与日俱增，这种情况只会恶化。该应用程序旨在创建肯塔基大学(英国)和布鲁格拉斯临终关怀中心(HOB)之间的一个功能齐全的基于社区的参与性研究(CBPR)实体。这种关系的一个主要结果是对一线护理人员(即护士、CNA、社会工作者)进行基于需求的正式评估，这些人员必须管理农村人口中的疼痛问题，农村人口以处方药物滥用和转移问题而闻名。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始数据。需求评估将通过焦点小组、主要线人访谈和对霍布斯前线护理人员的评估来进行。将特别注意提供者在适当使用阿片类镇痛剂方面的知识基础不足的问题。为了达到这一目的，评估工具将包括工人人口统计数据，对他们关于疼痛管理的知识基础和态度的调查，工作满意度调查，以及一般自我效能的测量。将另外开展一项关于阿片类药物知识和对使用的恐惧的调查，以及一个案例小品，以进一步完善评估一揽子计划。作为最后一步，这项研究将通过在HOB进行机构范围的调查来结束基于需求的评估，以针对未来的应用研究领域，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.