Rhodes D J, Koshy R C, Waterfield W C, Wu A W, Grossman S A
Johns Hopkins Hospital and St Agnes Hospital, Baltimore, MD, USA.
J Clin Oncol. 2001 Jan 15;19(2):501-8. doi: 10.1200/JCO.2001.19.2.501.
Although physicians view failure to assess pain systematically as the most important barrier to outpatient cancer pain management, little is known about pain assessment in this setting. We sought to determine whether pain is routinely assessed and whether routine quantitative pain assessment is feasible in a busy outpatient oncology practice.
We conducted a pre- and postintervention chart review of 520 randomly selected medical and radiation oncology patient visits at a community hospital-based private outpatient practice. The intervention consisted of training health assistants (HAs) to measure and document patient pain scores by using a visual analog scale. The main outcome measures included HA documentation of patient pain scores, quantitative and qualitative mention of pain in the physician note, and analgesic treatment before and after the intervention.
After the intervention, HA documentation of pain scores increased from 1% to 75.6% (P < .0001). Physician documentation increased from 0% to 4.8% for quantitative documentation (P < .01), and from 60.0% to 68.3% for qualitative documentation (not significant). Of all the patients, 23.1% reported significant pain. Subgroups with greater pain included patients actively receiving radiation treatments and patients with lung cancer. Of patients with significant pain, 28.2% had no mention of pain in the physician note and 47.9% had no documented analgesic treatment.
Quantitative pain assessment was virtually absent before our intervention but easily implemented and sustained in a busy outpatient oncology practice. Pain score collection identified a high prevalence of pain, patient subgroups at risk for pain, and a significant proportion of patients with pain that was neither evaluated nor treated by their oncologists.
尽管医生认为未能系统评估疼痛是门诊癌症疼痛管理的最重要障碍，但对于这种情况下的疼痛评估知之甚少。我们试图确定在繁忙的门诊肿瘤学实践中，疼痛是否得到常规评估，以及常规定量疼痛评估是否可行。
我们对一家社区医院的私立门诊随机抽取的520例医学和放射肿瘤学患者就诊记录进行了干预前后的图表审查。干预措施包括培训健康助理（HA）使用视觉模拟量表测量和记录患者疼痛评分。主要结局指标包括HA对患者疼痛评分的记录、医生记录中对疼痛的定量和定性提及，以及干预前后的镇痛治疗。
干预后，HA对疼痛评分的记录从1%增加到75.6%（P <.0001）。医生记录中定量记录从0%增加到4.8%（P <.01），定性记录从60.0%增加到68.3%（无统计学意义）。所有患者中，23.1%报告有明显疼痛。疼痛较重的亚组包括正在接受放射治疗的患者和肺癌患者。在有明显疼痛的患者中，28.2%在医生记录中未提及疼痛，47.9%没有记录镇痛治疗。
在我们的干预之前，几乎没有进行定量疼痛评估，但在繁忙的门诊肿瘤学实践中很容易实施并持续下去。疼痛评分收集发现疼痛的患病率很高，存在疼痛风险的患者亚组，以及很大一部分有疼痛的患者既未得到肿瘤学家的评估也未得到治疗。
