Wiese C H R, Lassen C L, Vormelker J, Meyer N, Popov A F, Graf B M, Hanekop G G, Wirz S
Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
Schmerz. 2011 Dec;25(6):654-62. doi: 10.1007/s00482-011-1110-8.
Palliative care needs a high level of expertise. In particular, there are some potential difficulties in the treatment of patients with the symptom cancer pain (for example lack of education). In Germany, various physicians are involved in cancer pain treatment but in general palliative care patients are treated by a physician who is educated in palliative medicine. In special circumstances prehospital emergency physicians and other physicians are involved in therapy decisions in palliative care patients as well. The authors surveyed different groups of physicians in Germany about their specific knowledge of cancer pain management.
A self-designed, standardized questionnaire (50 items) was given to palliative physicians in training (PP). The survey asked prospectively for knowledge on the World Health Organization (WHO) step ladder of cancer pain therapy. The results were retrolectively compared with an earlier investigation with the same background (emergency physicians in training EP).
There was a 99.5% response rate with a total of 654 respondents (PP 185, EP 469) and 461 (70.5%) of the respondents had knowledge of the WHO step ladder for the treatment of cancer pain [PP 164/185 (88.6%), EP 297/469 (63.3%), PP versus EP p < 0.001)]. The correct numbers of therapeutic levels were known by 361/461 participants [PP 151/164 (92.1%), EP 210/297 (70.7%), p < 0.001].The EPs with a professional experience less than 5 years answered statistically significantly more questions correctly (p = 0.004). Concerning the defined parameters knowledge and professional experience, there was no statistically significant difference in the group of PP.
The results of this study verified that the highest knowledge scores were achieved by PPs and overall, the knowledge scores showed an improvement in comparison to previous investigations. In recent years there seems to have been an improvement in education on pain treatment,for example during medical school. Whether this also leads to an improvement of patient care and the relevance of these data for the clinical practice needs to be investigated in further studies.
姑息治疗需要高水平的专业知识。特别是，在治疗癌症疼痛患者时存在一些潜在困难（例如缺乏相关教育）。在德国，各类医生都参与癌症疼痛治疗，但一般而言，姑息治疗患者由接受过姑息医学教育的医生治疗。在特殊情况下，院前急救医生和其他医生也会参与姑息治疗患者的治疗决策。作者就德国不同医生群体对癌症疼痛管理的具体知识进行了调查。
向接受培训的姑息治疗医生（PP）发放了一份自行设计的标准化问卷（50项）。该调查前瞻性地询问了关于世界卫生组织（WHO）癌症疼痛治疗阶梯的知识。结果与之前相同背景的一项调查（接受培训的急救医生，EP）进行回顾性比较。
总共有654名受访者回复，回复率为99.5%（PP 185名，EP 469名），461名（70.5%）受访者了解WHO癌症疼痛治疗阶梯[PP 164/185（88.6%），EP 297/469（63.3%），PP与EP相比，p < 0.001]。361/461名参与者知道正确的治疗级别数量[PP 151/164（92.1%），EP 210/297（70.7%），p < 0.001]。专业经验少于5年的EP回答正确的问题在统计学上显著更多（p = 0.004）。关于既定参数知识和专业经验，PP组没有统计学上的显著差异。
本研究结果证实，PP的知识得分最高，总体而言，与之前的调查相比，知识得分有所提高。近年来，疼痛治疗教育似乎有所改善，例如在医学院期间。这是否也会导致患者护理的改善以及这些数据对临床实践的相关性，需要在进一步研究中进行调查。
