An Intervention to Reduce Barriers to Effective Pain Management in Hospice

项目摘要/摘要尽管在安宁疗护方面取得了重大成就，但许多病人在生命的最后日子里仍会经历巨大的痛苦和不适。在安宁疗护中有效管理疼痛的一些关键障碍已被确定为本质上的心理社会障碍，包括对成瘾和耐受性的错误信念，因害怕被视为虚弱或寻求药物而不愿报告疼痛，以及患者，家庭照顾者和提供者之间缺乏沟通。为了帮助减少在危及生命的疾病中不适的普遍存在，并改善疼痛治疗的管理和坚持，研究人员呼吁采取系统的策略来了解和解决患者及其家庭护理人员对疼痛管理的担忧。本研究旨在回应AHRQ提出的研究重点，即改善临终关怀，通过测试以证据为基础的教育干预的可行性，以解决临终关怀中有效疼痛管理的障碍。本研究将采用整群随机实验设计，在四间安宁疗护机构中，招募社区住家病人-家庭对，共240对病人-家庭对。实验组的安宁疗护人员将接受训练，以使用简短的筛检工具、提供书面材料，并在入住安宁疗护时，提供个人化的言语干预。干预的内容将解决关于疼痛管理的常见神话和误解，并将为患者和家属量身定制，以涵盖与他们相关的疼痛相关主题。对照组将接受标准的临终关怀服务。通过向安宁疗护消费者提供有关疼痛和疼痛治疗的准确和相关的信息，我们假设提出的干预措施可以改善病人的疼痛管理。因此，本项目的目的是实施所提出的干预措施，并：(1)评估干预措施的保真度；(2)评估数据收集的可行性；(3)提供有关疗效的初步数据，并得出样本量估计；(4)确定员工时间和培训成本。本研究的结果将用于完善方法，并为更大的确定试验（R01）提供样本量估计，以进一步研究干预在不同地理区域和更广泛的安宁疗护提供者样本中的功效和有效性。这项研究的发现也可能对在其他医疗环境中使用社会心理干预措施以减少疼痛管理障碍有影响。

DESCRIPTION (provided by applicant): Project Summary/Abstract Despite significant accomplishments in hospice care, many patients continue to experience substantial pain and discomfort in their final days of life. A number of key barriers to effective pain management in hospice have been identified that are psychosocial in nature, including erroneous beliefs about addiction and tolerance, reluctance to report pain for fear of being perceived as weak or drug-seeking, and lack of communication between patients, family caregivers, and providers. To help minimize the prevalence of discomfort during life threatening illness and improve administration of and adherence to pain treatments, researchers have called for systematic strategies to understand and address the concerns of patients and their family caregivers related to pain management. The proposed study responds to AHRQ's stated research priority to improve care at the end-of-life by testing the feasibility of an evidence-based educational intervention designed to address barriers to effective pain management in hospice. The study will use a cluster-randomized experimental design in four hospice agencies, wherein community dwelling patient-family pairs will be recruited for a total sample size of 240 patient-family pairs. Using a cost-effective train-the-trainer approach, hospice staff members in the experimental group will be trained to use a brief screening instrument, provide written material, and deliver an individualized verbal intervention to patient-family pairs upon admission into hospice care. The content of the intervention will address common myths and misconceptions about pain management and will be tailored to patients and families to cover pain-related topics that are relevant to them. Control subjects will receive standard hospice services. By providing hospice consumers with accurate and relevant information about pain and pain treatments, the proposed intervention is hypothesized to improve the management of patient pain. Hence, the aims of this project are to conduct the proposed intervention and: (1) evaluate intervention fidelity; (2) assess the feasibility of data collection; (3) provide initial data on efficacy and derive sample size estimates; and, (4) determine staff time and training costs. The results of this study will be used to refine the methods and provide sample size estimates for a larger definitive trial (an R01) to further investigate the efficacy and effectiveness of the intervention across diverse geographic regions and a broader sample of hospice providers. Findings from this study may also have implications for the use of psychosocial interventions in other healthcare environments interested in minimizing barriers to pain management. PUBLIC HEALTH RELEVANCE: Project Narrative This study tests the feasibility of an educational intervention designed to address barriers to effective pain management in hospice. The intervention targets hospice staff, patients, and family caregivers to confront common myths and misconceptions associated with pain management. By providing hospice providers and consumers with accurate and relevant information about pain and pain treatments, the proposed intervention is hypothesized to improve the management of patient pain.