Cancer Pain in Elders: Promoting EBPs in Hospices

描述（由申请人提供）：这项研究是我们目前研究的延伸，重点是促进采用循证实践（EBP），以提高老年癌症患者疼痛管理的质量。 该研究解决了一致采用疼痛管理临床实践指南评估和治疗老年癌症疼痛的障碍。 这些老年人遭受不必要的疼痛与他们的癌症，其治疗，以及相关的共病条件。 尽管存在循证指南，以改善对这一弱势群体疼痛的评估和管理，但基于最佳科学证据的建议的采纳和使用滞后，充其量只是零星的。 即使在临终关怀设置疼痛控制是一个优先事项，有相当大的变化和病人仍然死于未解决的疼痛。 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。 有效实施当前的临床实践指南（CPG），包括解决这一障碍的循证策略，可能会进一步提高老年人临终时疼痛管理的质量。 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，这可能会改善老年癌痛患者的疼痛管理实践。 拟议的随机对照试验建立在我们成功的TRIP-急性疼痛干预的基础上，该干预证明了髋关节骨折住院老年人急性疼痛管理的质量提高，并节省了医疗费用。 本研究将评估跨学科多方面TRIP干预的效果，重点是增加EBP评估和管理老年癌症疼痛临终关怀患者的疼痛。 本研究的目的如下：1）测试多方面TRIP-Cancer Pain干预对老年癌症疼痛临终关怀患者的疼痛严重程度、疼痛干预、疼痛缓解和生活质量的影响; 2）测试多方面TRIP-Cancer Pain干预对促进卫生保健提供者采用癌症疼痛管理EBP对老年癌症疼痛临终关怀患者的影响; 3）确定多方面TRIP-癌痛干预对患者坚持疼痛治疗计划的有效性;和4）评估长期随访（干预后6个月）过程和结果变量变化的持续性。

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).