Cancer Pain in Elders: Promoting EBPs in Hospices

描述(申请人提供)：这项研究是我们目前研究的扩展，重点是促进采用循证实践(EBP)来提高癌症老年患者的疼痛管理质量。这项研究解决了持续采用疼痛管理临床实践指南评估和治疗老年人癌症疼痛的障碍。这些老年人不必要地遭受与他们的癌症、治疗和相关的合并症相关的疼痛。尽管存在改善这一弱势群体疼痛评估和管理的循证指南，但基于最佳科学证据的建议的采纳和使用滞后，充其量也是零星的。即使在临终关怀环境中，疼痛控制是优先事项，也有相当大的差异，患者仍然死于未解决的疼痛。在这一人群中，有效的疼痛管理的第二个障碍是患者和家庭照顾者不遵守疼痛治疗计划。有效实施目前的临床实践指南(CPGs)，其中包括解决这一障碍的循证战略，可能进一步有助于提高老年人在生命末期的疼痛管理质量。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，可能会改善患有癌症疼痛的老年人的疼痛管理实践。 拟议的随机对照试验建立在我们成功的Trip-急性疼痛干预措施的基础上，该干预措施证明了髋部骨折住院老年人的急性疼痛管理质量得到了改善，并节省了医疗保健费用。这项研究将评估一项跨学科、多方面的旅行干预的效果，该干预的重点是增加EBPS，以评估和管理患有癌症疼痛的老年临终关怀患者的疼痛。本研究的目的如下：1)测试多层面旅行癌症疼痛干预对癌症疼痛老年临终关怀患者疼痛严重程度、疼痛干预、疼痛缓解和生活质量的影响；2)测试多层面旅行癌症疼痛干预对促进医疗服务提供者对癌症疼痛老年临终关怀患者采用EBPS进行癌症疼痛管理的效果；3)确定多层面旅行癌症疼痛干预措施对患者遵守疼痛治疗计划的有效性；以及4)评估长期随访(干预后6个月)过程中变化的持续性和结果变量。

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).