Allen Rebecca S, Haley William E, Small Brent J, McMillan Susan C
Department of Psychology, University of Alabama, Tuscaloosa 35487-0348, USA.
Gerontologist. 2002 Aug;42(4):507-14. doi: 10.1093/geront/42.4.507.
Prior research in nursing homes has shown that cognitive impairment may reduce self-reported pain, but this relation has not been systematically explored among hospice patients. The assessment and treatment of pain is a primary goal of hospice care, and both disease processes and the use of opioid analgesics may lead to cognitive impairment among hospice patients. However, little is known about how cognitive functioning may impact the self-report of pain or the report of care recipient pain by family caregivers.
We explored the associations between pain, cognitive functioning, and gender among cancer patients and their family caregivers (N = 176 dyads) during in-home hospice care. This was a cross-sectional, correlational study.
Contrary to expectation, care recipients with cognitive impairment reported more intense pain than care recipients with intact cognitive functioning. However, cognitive impairment among care recipients had no impact on the pain report of family caregivers. Care recipient cognitive impairment was related to greater discrepancy in the pain reports of caregivers and care recipients. No gender differences in pain intensity report were found.
Measurement issues and implications for assessing self-reported pain among hospice cancer patients with impaired cognitive functioning and the report of care recipient pain by family caregivers are discussed. Specifically, hospice staff must educate family caregivers regarding the potential impact of care recipient cognitive impairment on pain reports in order to facilitate accurate pain assessment and management.
先前针对养老院的研究表明，认知障碍可能会降低自我报告的疼痛程度，但这种关系尚未在临终关怀患者中得到系统探讨。疼痛的评估和治疗是临终关怀的主要目标，疾病进程和阿片类镇痛药的使用都可能导致临终关怀患者出现认知障碍。然而，对于认知功能如何影响疼痛的自我报告或家庭照顾者对受照顾者疼痛的报告，我们知之甚少。
我们探讨了居家临终关怀期间癌症患者及其家庭照顾者（N = 176对）的疼痛、认知功能和性别之间的关联。这是一项横断面相关性研究。
与预期相反，认知障碍的受照顾者报告的疼痛比认知功能正常的受照顾者更强烈。然而，受照顾者的认知障碍对家庭照顾者的疼痛报告没有影响。受照顾者的认知障碍与照顾者和受照顾者疼痛报告的更大差异有关。在疼痛强度报告中未发现性别差异。
讨论了测量问题以及对评估认知功能受损的临终关怀癌症患者自我报告的疼痛和家庭照顾者对受照顾者疼痛报告的启示。具体而言，临终关怀工作人员必须就受照顾者认知障碍对疼痛报告的潜在影响对家庭照顾者进行教育，以便于准确的疼痛评估和管理。
