Steindal Simen A, Bredal Inger Schou, Sørbye Liv Wergeland, Lerdal Anners
Department of Nursing, Diakonhjemmet University College, University of Oslo, Oslo, Norway.
Scand J Caring Sci. 2011 Dec;25(4):771-9. doi: 10.1111/j.1471-6712.2011.00892.x. Epub 2011 May 12.
Pain is a common symptom in dying patients. Previous studies have paid little attention to pain and pain control in terminally ill patients with diseases other than cancer.
This study investigated whether there were differences in healthcare workers' documentation of pain characteristics in cancer and noncancer patients. We investigated what types of analgesics were administrated to dying patients, and if there were differences in the administration routes of opiates in cancer patients compared to noncancer patients in the last 3 days of life.
Data were collected retrospectively in a cross-sectional comparative study at a hospital. The sample included 220 deceased patients (110 died of cancer and 110 died of other causes). Data were extracted from patients' medical records using the Resident Assessment Instrument of Palliative Care.
Healthcare workers consistently documented more pain in cancer patients during their last 3 days of life than in noncancer patients. The odds for having severe to excruciating pain was four times higher in cancer patients compared to noncancer patients. Morphine was the most frequently administrated analgesic for all dying patients; however, the odds ratio of cancer patients compared to noncancer patients receiving morphine plus scopolamine was 0.27. The odds of a cancer patient receiving analgesics classified as fentanyl, ketobemidone and oxycodone was more than 4-5 times higher than for noncancer patients. Opiates were more frequently administered transdermally or by oral administration on an as-need basis in cancer patients; 10% in both groups did not receive adequate pain control.
Pain is a highly prevalent symptom among dying hospitalized patients. Healthcare workers consistently documented more pain in cancer patients and also assessed that the intensity of pain was more severe in these patients than in noncancer patients. The dying patients' intensity of pain was poorly documented.
疼痛是临终患者的常见症状。以往研究很少关注癌症以外疾病的晚期患者的疼痛及疼痛控制情况。
本研究调查医护人员对癌症患者和非癌症患者疼痛特征的记录是否存在差异。我们调查了给予临终患者何种类型的镇痛药，以及在生命的最后3天里，癌症患者与非癌症患者在阿片类药物给药途径上是否存在差异。
在一家医院进行的横断面比较研究中进行回顾性数据收集。样本包括220例死亡患者（110例死于癌症，110例死于其他原因）。使用姑息治疗住院患者评估工具从患者病历中提取数据。
医护人员持续记录到癌症患者在生命的最后3天比非癌症患者有更多疼痛。与非癌症患者相比，癌症患者出现严重至极痛的几率高出四倍。吗啡是所有临终患者最常使用的镇痛药；然而，癌症患者与接受吗啡加东莨菪碱的非癌症患者的比值比为0.27。癌症患者接受芬太尼、凯托米酮和羟考酮等镇痛药的几率比非癌症患者高出4至5倍以上。癌症患者更常采用经皮给药或按需口服阿片类药物；两组中有10%未得到充分的疼痛控制。
疼痛是住院临终患者中非常普遍的症状。医护人员持续记录到癌症患者有更多疼痛，并且评估这些患者的疼痛强度比非癌症患者更严重。临终患者的疼痛强度记录不足。
