Ersek M, Kraybill B M, Pen A D
Pain Research Department, Swedish Medical Center, Seattle, Washington 98122-4307, USA.
Cancer Pract. 1999 Sep-Oct;7(5):226-32. doi: 10.1046/j.1523-5394.1999.75007.x.
The purpose of this study was to explore the reasons that cancer patients with pain find it difficult to adhere to analgesic therapy.
Twenty-one patients with advanced cancer with pain were interviewed using a semistructured schedule of questions. Participants were asked to describe their decision making regarding analgesics and the factors that made it difficult for them to take analgesics prescribed for their pain. They also were asked to describe their relationships with their healthcare providers. Themes were identified and refined using qualitative analytic techniques. Two investigators independently coded all data to ensure that findings accurately reflected participants' experiences.
Findings reveal several factors that hindered analgesic use and the specific ways in which patients evaluated these factors in making decisions about taking pain medication. The provider-patient factors that impeded analgesic use also were described. Finally, the common use of nonpharmacologic methods of pain control offers insight into the role of these therapeutic strategies in achieving pain relief and decreasing analgesic use.
The findings underscore the importance of early intervention to address barriers to analgesic use. Some barriers may be overcome through educational efforts. The findings suggest, however, that consistent, repeated patient education often may not be sufficient to subdue patients' negative thoughts about taking the medication. Other approaches, such as changing medications or assisting the patient to use nonpharmacologic pain strategies, may prove more successful.
本研究旨在探究癌症疼痛患者难以坚持镇痛治疗的原因。
采用半结构化问题访谈了21例晚期癌症疼痛患者。参与者被要求描述他们在镇痛药方面的决策，以及那些使他们难以服用为其疼痛所开镇痛药的因素。他们还被要求描述他们与医疗服务提供者的关系。运用定性分析技术确定并完善主题。两名研究人员独立对所有数据进行编码，以确保研究结果准确反映参与者的经历。
研究结果揭示了几个阻碍镇痛药使用的因素，以及患者在决定服用止痛药物时评估这些因素的具体方式。还描述了阻碍镇痛药使用的医患因素。最后，疼痛控制的非药物方法的普遍使用为这些治疗策略在实现疼痛缓解和减少镇痛药使用方面的作用提供了见解。
研究结果强调了早期干预以解决镇痛药使用障碍的重要性。一些障碍可以通过教育努力来克服。然而，研究结果表明，持续、反复的患者教育往往不足以消除患者对服药的消极想法。其他方法，如更换药物或协助患者使用非药物疼痛策略，可能会更成功。
