Goldberg Gabrielle R, Morrison R Sean
Division of Hematology and Medical Oncology, Samuel Bronfman Department of Medicine, Mount Sinai School of Medicine, New York 10029, USA.
J Clin Oncol. 2007 May 1;25(13):1792-801. doi: 10.1200/JCO.2006.07.9038.
To assist cancer centers in improving pain management, we conducted a systematic review of institutional interventions designed to improve the assessment and treatment of pain in hospitalized cancer patients.
We performed a MEDLINE search for all English-language articles published from January 1966 through February 2006 using the medical subject headings terms of pain or pain measurement and outcome assessment (health care) or quality assurance (health care). Selected bibliographies were also searched. Studies were reviewed if they included clinical interventions directed at improving the treatment of cancer pain across an institution or nursing unit. Meta-analyses and randomized controlled trials or other controlled studies were included where possible. If no such trials were identified, then the best evidence available from studies with other designs was included.
Five interventions were identified. These interventions included professional and patient education, instituting regular pain assessment (pain as a vital sign), audit of pain results and feedback to clinical staff, computerized decisional support systems, and specialist-level pain consultation services. Most studies were small in size and used quasiexperimental pre-post test designs. Successes were reported in increasing patient satisfaction, increasing documentation of pain intensity, and improving nurses' knowledge and attitudes. No study reported successful interventions that consistently improved patients' pain severity.
Although professional knowledge and attitudes about pain and nursing pain assessment rates have been shown to be improvable, no systematic, hospital-wide intervention has yet to be associated with improvement in pain severity. Future research on the development of new interventions, perhaps targeted specifically at physicians, is urgently needed.
为协助癌症中心改善疼痛管理，我们对旨在改善住院癌症患者疼痛评估与治疗的机构干预措施进行了系统评价。
我们使用疼痛或疼痛测量以及结果评估（医疗保健）或质量保证（医疗保健）的医学主题词，对1966年1月至2006年2月发表的所有英文文章进行了MEDLINE检索。还检索了选定的参考文献。如果研究包括针对整个机构或护理单元改善癌症疼痛治疗的临床干预措施，则对其进行综述。尽可能纳入荟萃分析、随机对照试验或其他对照研究。如果未找到此类试验，则纳入其他设计研究中可得的最佳证据。
确定了五项干预措施。这些干预措施包括专业人员和患者教育、开展定期疼痛评估（将疼痛作为生命体征）、对疼痛结果进行审核并向临床工作人员反馈、计算机化决策支持系统以及专科水平的疼痛咨询服务。大多数研究规模较小，采用类实验前后测试设计。报告显示在提高患者满意度、增加疼痛强度记录以及改善护士知识和态度方面取得了成功。没有研究报告成功的干预措施能持续改善患者的疼痛严重程度。
尽管已表明关于疼痛的专业知识和态度以及护理疼痛评估率是可以改善的，但尚无系统的全院范围干预措施与疼痛严重程度的改善相关联。迫切需要针对新干预措施的开发开展未来研究，或许可专门针对医生。
