Ward Sandra E, Wang Ko Kung, Serlin Ronald C, Peterson Shelly L, Murray Mary Ellen
University of Wisconsin-Madison, School of Nursing, CSC, K6/348, 600 Highland Avenue, Madison, WI 53792-2455, USA.
Pain. 2009 Jul;144(1-2):49-56. doi: 10.1016/j.pain.2009.02.021. Epub 2009 Apr 29.
Cancer pain management can be improved by overcoming patients' attitudinal barriers to reporting pain and using analgesics. A simple cost-effective barriers intervention designed to reach a large number of persons with cancer has not yet been tested. Such an intervention should be tested against barriers' assessment-alone, as well as no-treatment control. The purpose of this study was to test the efficacy and the cost effectiveness of a tailored barriers intervention (TBI), an educational intervention tailored to participants' attitudinal barriers toward reporting pain and using analgesics. This was a randomized three-group (TBI, assessment-alone, or control) trial with measures at baseline and 28 days later conducted at the NorthCentral and Heartland offices of the Cancer Information Service (CIS), an NCI program that provides information to persons seeking answers to cancer-related questions. Participants (1256 adult CIS callers diagnosed with cancer with moderate to severe pain in the past week) joined the study and were randomized. Of these participants, 970 (77.23%) provided follow-up data. The TBI consisted of educational messages tailored to each participant's attitudinal barriers, delivered orally over the telephone, followed by a printed mailed copy. The outcome measures were attitudinal barriers to pain management, as well as pain outcomes (duration, severity, and interference with life activities). At follow-up the TBI group had significantly lower attitudinal barriers scores compared to assessment-alone and control, but the groups did not differ on the pain outcome variables. TBI and assessment-alone had similar cost effectiveness. The TBI needs to be strengthened to achieve reductions in pain severity.
通过克服患者在报告疼痛和使用镇痛药方面的态度障碍，可以改善癌症疼痛管理。一种旨在惠及大量癌症患者的简单且具成本效益的障碍干预措施尚未经过测试。这种干预措施应与仅进行障碍评估以及无治疗对照进行比较测试。本研究的目的是测试一种量身定制的障碍干预措施（TBI）的疗效和成本效益，这是一种根据参与者在报告疼痛和使用镇痛药方面的态度障碍量身定制的教育干预措施。这是一项随机三组（TBI、仅评估或对照）试验，在癌症信息服务（CIS）的中北部和中心地带办公室进行，基线和28天后进行测量，CIS是一个为寻求癌症相关问题答案的人提供信息的NCI项目。参与者（1256名在过去一周被诊断患有中度至重度疼痛的成年CIS来电者）加入了研究并被随机分组。在这些参与者中，970人（77.23%）提供了随访数据。TBI包括根据每个参与者的态度障碍量身定制的教育信息，通过电话口头传达，随后邮寄一份印刷副本。结果测量指标是疼痛管理的态度障碍以及疼痛结果（持续时间、严重程度和对生活活动的干扰）。在随访时，与仅评估组和对照组相比，TBI组的态度障碍得分显著更低，但在疼痛结果变量方面，各组之间没有差异。TBI和仅评估组具有相似的成本效益。需要加强TBI以降低疼痛严重程度。
