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，是一个重要的和未充分研究的问题，在农村阿巴拉契亚肯塔基州。尽管人们试图提高对这一问题的认识，但慢性疼痛患者的疼痛仍然没有得到充分治疗，包括那些患有晚期疾病和生命末期的患者。随着人们对处方药滥用和转移的担忧加剧，这种情况只会恶化。该应用程序旨在创建一个功能齐全的社区参与式研究（CBPR）之间的肯塔基州（英国）和蓝草（HOB）临终关怀的大学实体。这种关系的一个主要成果是对一线护理工作者进行正式的基于需求的评估（即，护士、CNA、社会工作者），他们必须管理农村人口的疼痛问题，这些人口因处方药滥用和转移问题而闻名。数据将用于识别有效治疗的障碍，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、主要知情人访谈和对HOB前线护理工作者的评估进行。将特别注意提供者在适当使用阿片类镇痛剂方面知识基础的不足。为了实现这一目标，评估工具将包括工人的人口统计数据，他们的知识基础和对疼痛管理的态度的调查，工作满意度调查，一般自我效能的措施。将制定关于类阿片知识和对使用的恐惧的补充调查，沿着案例简介，以进一步完善评估包。作为最后一步，本研究将通过在HOB进行机构范围的调查来总结基于需求的评估，以确定未来应用研究的领域，以解决与HOB及其患者人群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.