Thomas Mary Laudon, Elliott Janette E, Rao Stephen M, Fahey Kathleen F, Paul Steven M, Miaskowski Christine
Veterans Administration Palo Alto Healthcare System, California, USA.
Oncol Nurs Forum. 2012 Jan;39(1):39-49. doi: 10.1188/12.ONF.39-49.
PURPOSE/OBJECTIVES: To test the effectiveness of two interventions compared to usual care in decreasing attitudinal barriers to cancer pain management, decreasing pain intensity, and improving functional status and quality of life (QOL).
Randomized clinical trial.
Six outpatient oncology clinics (three Veterans Affairs [VA] facilities, one county hospital, and one community-based practice in California, and one VA clinic in New Jersey)Sample: 318 adults with various types of cancer-related pain.
Patients were randomly assigned to one of three groups: control, standardized education, or coaching. Patients in the education and coaching groups viewed a video and received a pamphlet on managing cancer pain. In addition, patients in the coaching group participated in four telephone sessions with an advanced practice nurse interventionist using motivational interviewing techniques to decrease attitudinal barriers to cancer pain management. Questionnaires were completed at baseline and six weeks after the final telephone calls. Analysis of covariance was used to evaluate for differences in study outcomes among the three groups.
Pain intensity, pain relief, pain interference, attitudinal barriers, functional status, and QOL.
Attitudinal barrier scores did not change over time among groups. Patients randomized to the coaching group reported significant improvement in their ratings of pain-related interference with function, as well as general health, vitality, and mental health.
Although additional evaluation is needed, coaching may be a useful strategy to help patients decrease attitudinal barriers toward cancer pain management and to better manage their cancer pain.
By using motivational interviewing techniques, advanced practice oncology nurses can help patients develop an appropriate plan of care to decrease pain and other symptoms.
目的/目标：比较两种干预措施与常规护理在降低癌症疼痛管理态度障碍、减轻疼痛强度、改善功能状态和生活质量（QOL）方面的效果。
随机临床试验。
六家门诊肿瘤诊所（三家退伍军人事务部[VA]设施、一家县医院、加利福尼亚州的一家社区诊所，以及新泽西州的一家VA诊所）
318名患有各种类型癌症相关疼痛的成年人。
患者被随机分配到三组之一：对照组、标准化教育组或指导组。教育组和指导组的患者观看了一段视频并收到了一份关于管理癌症疼痛的宣传册。此外，指导组的患者与一名高级实践护士干预人员进行了四次电话会议，使用动机性访谈技术来降低癌症疼痛管理的态度障碍。在基线和最后一次电话会议六周后完成问卷调查。采用协方差分析来评估三组之间研究结果的差异。
疼痛强度、疼痛缓解、疼痛干扰、态度障碍、功能状态和生活质量。
各组态度障碍得分随时间未发生变化。随机分配到指导组的患者报告其在与功能相关的疼痛干扰评分以及总体健康、活力和心理健康方面有显著改善。
尽管需要进一步评估，但指导可能是一种有用的策略，可帮助患者减少对癌症疼痛管理的态度障碍并更好地管理其癌症疼痛。
通过使用动机性访谈技术，高级实践肿瘤护士可以帮助患者制定适当的护理计划以减轻疼痛和其他症状。
