Hospice Pain Control: Developing an Opioid Order Sheet

描述（由申请人提供）：尽管有有效的药物，但疼痛是一种常见的，通常是毁灭性的临终症状控制问题。我们制定了一个模型，描述了门诊肿瘤设置“适当的疼痛控制标准”。基于这一理论模型，我们开发了一种方案，该方案正在测试阿片类药物滴定订单表，该订单表的结构为三个关键的提供者行为提供明确的方向：(1)疼痛评估，(2)生成治疗计划，(3)与患者沟通治疗计划。在安宁疗护环境中，使用类似的指令单可以加强疼痛控制；然而，需要和潜在的障碍，以适当的疼痛控制在临终关怀设置是独特的，很大程度上未经调查。此外，目前的临床协议对安宁疗护病患和照护者的负担过重，主要终点也不适合末期病患。可能影响疼痛结果和/或需要改变临床方案的安宁疗护特定因素包括：(1)照护者角色的增加，(2)转为居家疗护，(3)引入安宁疗护人员作为健康疗护团队的一部分，(4)初级疗护团队角色的减少，以及(5)疾病过程的医疗并发症。因此，修改理论模型、阿片类药物滴定单和协议，将是必要的，以便在临终关怀人群中测试这种干预措施。采用混合方法，我们建议确定关键利益相关者（患者、照护者、安宁疗护人员和转诊医师）在安宁疗护环境中疼痛控制的独特需求和障碍。根据这些数据，我们将修改理论模型、订单单和协议。一旦修改完成，我们将进行一项试点研究，以评估订单单在门诊安宁疗护环境中的可行性、效用和功效。

DESCRIPTION (provided by applicant): Despite the availability of effective pharmaceutical agents, pain is a common and often devastating symptom control problem at end-of-life. We have formulated a model that describes "criteria for adequate pain control" in the outpatient oncology setting. Based on this theoretical model, we have developed a protocol which is testing an opioid titration order sheet structured to provide clear direction for three critical provider behaviors: (1) pain assessment, (2) generation of a treatment plan, and (3) communication of the treatment plan to the patient. The use of a similar order sheet may enhance pain control in the hospice setting; however, the needs and potential barriers to adequate pain control within the hospice setting are unique and largely uninvestigated. Furthermore, the burden imposed by the current clinical protocol on patients and caregivers is excessive for the hospice setting and the primary endpoints are not appropriate to the terminal patient population. Hospice specific factors which may affect pain outcome and/or require alterations in the clinical protocol include: (1) the increasing role of caregivers, (2) the shift to home based care, (3) introduction of hospice staff as part of the health care team, (4) the decreasing role of the primary care team and (5) medical complications of the disease process. Thus, modification of the theoretical model, the opioid titration order sheet, and the protocol, will be necessary in order to test this intervention in the hospice population. Using a mixed methods approach, we propose to identify the unique needs and barriers for pain control in the hospice setting as identified by key stakeholders (patients, caregivers, hospice staff and referring physicians). Based on these data we will modify the theoretical model, the order sheet and the protocol. Once the modifications lave been made, we will conduct a pilot study to assess feasibility, utility and efficacy of the order sheet in the outpatient hospice setting.