Liang Shu-Yuan, Yates Patsy, Edwards Helen, Tsay Shiow-Luan
Department of Nursing, National Taipei College of Nursing, Taipei, Taiwan.
Psychooncology. 2008 Nov;17(11):1100-7. doi: 10.1002/pon.1326.
Although research has suggested that medication adherence rates are lower than what is needed to achieve optimal pain control, the role of patient beliefs and attitudes in influencing opioid adherence has rarely been examined. Perceived self-efficacy is reported to be an important construct in predicting and enhancing adherence behaviour. The purpose of this study was to explore the relationship between opioid-taking self-efficacy, opioid beliefs, adherence behaviours, and pain experience amongst Taiwanese cancer outpatients.
The cross-sectional study included 92 oncology outpatients in two teaching hospitals in the Taipei area of Taiwan. The research instruments included the Opioid-Taking Self-Efficacy Scale-Cancer (OTSES-CA), the Pain Opioid Analgesic Beliefs Scale-Cancer (POABS-CA), opioid adherence, and the Brief Pain Inventory-Chinese (BPI-Chinese).
Opioid-taking self-efficacy demonstrated a significant positive relationship with patients' opioid adherence (r=0.22, p<0.05) and pain relief (r=0.35, p<0.01), while also demonstrating a significant positive correlation with worst pain (r=0.25, p<0.05). In addition, the more negative beliefs regarding opioids the patient had, the worse their adherence to around the clock analgesic regimen (r=-0.30, p<0.01). Multivariate analysis identified opioid-taking self-efficacy continued to have a significant independent influence on opioid adherence and pain relief, after controlling for key demographic variables. Self-efficacy accounted for 4% (R(inc) (2)=0.04, p=0.043) of the variance and opioid beliefs accounted for 8% (R(inc) (2)=0.08, p=0.007) of the variance in opioid adherence. Multivariate analysis also identified that opioid-taking self-efficacy accounted for 11% (R(inc) (2)=0.11, p=0.001) of the variance in pain relief, but opioid beliefs did not continue to have an independent effect for this outcome.
The study highlights the potential importance of a patient's self-efficacy beliefs in adherence to medication and key pain outcomes.
尽管研究表明药物依从率低于实现最佳疼痛控制所需的水平，但患者信念和态度在影响阿片类药物依从性方面的作用很少得到研究。据报道，自我效能感是预测和增强依从行为的一个重要因素。本研究的目的是探讨台湾癌症门诊患者的阿片类药物服用自我效能感、阿片类药物信念、依从行为和疼痛体验之间的关系。
这项横断面研究纳入了台湾台北地区两家教学医院的92名肿瘤门诊患者。研究工具包括癌症患者阿片类药物服用自我效能量表（OTSES-CA）、癌症患者疼痛阿片类镇痛信念量表（POABS-CA）、阿片类药物依从性以及简明疼痛量表中文版（BPI-Chinese）。
阿片类药物服用自我效能感与患者的阿片类药物依从性（r=0.22，p<0.05）和疼痛缓解（r=0.35，p<0.01）呈显著正相关，同时也与最严重疼痛呈显著正相关（r=0.25，p<0.05）。此外，患者对阿片类药物的负面信念越多，其对全天候镇痛方案的依从性就越差（r=-0.30，p<0.01）。多变量分析表明，在控制关键人口统计学变量后，阿片类药物服用自我效能感继续对阿片类药物依从性和疼痛缓解有显著的独立影响。自我效能感解释了阿片类药物依从性变异的4%（R(inc) (2)=0.04，p=0.043），阿片类药物信念解释了8%（R(inc) (2)=0.08，p=0.007）。多变量分析还表明，阿片类药物服用自我效能感解释了疼痛缓解变异的11%（R(inc) (2)=0.11，p=0.001），但阿片类药物信念对这一结果不再有独立影响。
该研究突出了患者自我效能感信念在药物依从性和关键疼痛结局方面的潜在重要性。
