SCAN Foundation, Long Beach, California, USA.
Pain Med. 2010 Sep;11(9):1365-72. doi: 10.1111/j.1526-4637.2010.00931.x. Epub 2010 Aug 30.
Pain is a common, often undertreated problem among patients with palliative needs.
To evaluate clinician factors associated with intention to address diverse aspects of pain.
Clinicians reviewed a clinical vignette describing a frail elderly patient with advanced hormone-refractory metastatic prostate cancer, depression, and pain not on analgesic therapy. Clinicians were surveyed about their intentions for treatment.
All 280 primary care and specialist clinicians working in 19 hospital and community-based primary care, oncology, and cardiology clinics at eight geographically dispersed sites in two large VA hospital systems.
Endpoints were clinician intention to deliver guideline-concordant care: prescribe opioids/antidepressants, assess existential wellbeing, and offer mental health referral. Demographic and behavioral measures were evaluated in association with endpoints.
Of 208 (74%) responding practitioners, 189 were responsible for prescribing decisions. Of those, 86, 77, 75, and 69 were "very"/"somewhat likely" to prescribe opioids, antidepressants, refer to a mental health specialist, or assess existential wellbeing, respectively. Factors associated with greater intent to prescribe an opioid or antidepressant included female gender, being an attending physician, being a primary care clinician, and greater confidence in pain management skills. Greater trust in the validity of pain ratings was associated with intent to prescribe an antidepressant and assess existential wellbeing. Prescribing opioids was less likely if perceived as an administrative burden. Assessing existential wellbeing was less likely if time constraints were perceived a barrier to evaluating pain. Female gender was the only factor associated with intent to refer to a mental health specialist.
Our findings suggest useful targets for improving pain management include bolstering clinician confidence in pain management and their trust in pain ratings.
疼痛是有姑息治疗需求的患者中常见但常常未得到充分治疗的问题。
评估与解决疼痛各方面问题的意愿相关的临床医生因素。
临床医生审查了一个临床病例描述，描述了一位患有晚期激素难治性转移性前列腺癌、抑郁症和未接受镇痛治疗的衰弱老年患者。临床医生接受了关于其治疗意向的调查。
在两个大型退伍军人事务部医院系统的 8 个地理位置分散的地点的 19 个医院和社区初级保健、肿瘤学和心脏病学诊所工作的 280 名初级保健和专科临床医生。
终点是临床医生提供符合指南的护理的意愿：开阿片类药物/抗抑郁药、评估存在的幸福感和提供心理健康转诊。评估人口统计学和行为措施与终点相关。
在 208 名（74%）做出回应的从业者中，有 189 名负责处方决策。在这些人中，分别有 86、77、75 和 69 人“非常”/“有些可能”开阿片类药物、抗抑郁药、转介心理健康专家或评估存在的幸福感。与开阿片类药物或抗抑郁药的意愿更强相关的因素包括女性性别、主治医生身份、初级保健临床医生身份以及对疼痛管理技能的更大信心。对疼痛评分的有效性更信任与开抗抑郁药和评估存在的幸福感的意愿相关。如果认为这是行政负担，则不太可能开阿片类药物。如果认为时间限制是评估疼痛的障碍，则不太可能评估存在的幸福感。女性性别是唯一与转介心理健康专家的意愿相关的因素。
我们的研究结果表明，提高疼痛管理的有用目标包括增强临床医生对疼痛管理的信心和对疼痛评分的信任。
