Brink-Huis Anita, van Achterberg Theo, Schoonhoven Lisette
Centre for Quality of Care Research, WOK 117, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
J Clin Nurs. 2008 Aug;17(15):1986-2000. doi: 10.1111/j.1365-2702.2007.02228.x.
This paper reports a review of the literature conducted to identify organisation models in cancer pain management that contain integrated care processes and describe their effectiveness.
Pain is experienced by 30-50% of cancer patients receiving treatment and by 70-90% of those with advanced disease. Efforts to improve pain management have been made through the development and dissemination of clinical guidelines. Early improvements in pain management were focussed on just one or two single processes such as pain assessment and patient education. Little is known about organisational models with multiple integrated processes throughout the course of the disease trajectory and concerning all stages of the care process.
Systematic review.
The review involved a systematic search of the literature, published between 1986-2006. Subject-specific keywords used to describe patients, disease, pain management interventions and integrated care processes, relevant for this review were selected using the thesaurus of the databases.
Institutional models, clinical pathways and consultation services are three alternative models for the integration of care processes in cancer pain management. A clinical pathway is a comprehensive institutionalisation model, whereas a pain consultation service is a 'stand-alone' model that can be integrated in a clinical pathway. Positive patient and process outcomes have been described for all three models, although the level of evidence is generally low. Evaluation of the quality of pain management must involve standardised measurements of both patient and process outcomes.
We recommend the development of policies for referrals to a pain consultation service. These policies can be integrated within a clinical pathway. To evaluate the effectiveness of pain management models standardised outcome measures are needed.
本文报告了一项文献综述，旨在识别癌症疼痛管理中包含综合护理流程的组织模式，并描述其有效性。
30%-50%接受治疗的癌症患者以及70%-90%的晚期癌症患者会经历疼痛。人们通过制定和传播临床指南来努力改善疼痛管理。早期疼痛管理的改善仅集中在一两个单一流程上，如疼痛评估和患者教育。对于在疾病轨迹全过程以及护理过程所有阶段具有多个综合流程的组织模式知之甚少。
系统综述。
该综述对1986年至2006年间发表的文献进行了系统检索。使用数据库的词库选择了用于描述患者、疾病、疼痛管理干预措施和综合护理流程的特定主题关键词，这些关键词与本综述相关。
机构模式、临床路径和咨询服务是癌症疼痛管理中护理流程整合的三种替代模式。临床路径是一种全面的制度化模式，而疼痛咨询服务是一种可整合到临床路径中的“独立”模式。尽管证据水平普遍较低，但已描述了所有这三种模式在患者和流程方面的积极结果。疼痛管理质量的评估必须包括对患者和流程结果的标准化测量。
我们建议制定转诊至疼痛咨询服务的政策。这些政策可整合到临床路径中。为了评估疼痛管理模式的有效性，需要标准化的结果测量方法。
