家长对重病濒死儿童和青少年进行疼痛管理的自我效能感。

Parent self-efficacy for managing pain in seriously ill children and adolescents nearing end of life.

机构信息

Columbia University School of Nursing, New York, New York.

Department of Pediatrics, Pediatric Pain Program, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California.

出版信息

Palliat Support Care. 2011 Jun;9(2):137-47. doi: 10.1017/S1478951511000010.

DOI:10.1017/S1478951511000010

PMID:24468481

Abstract

OBJECTIVE

Using data from a multi-site study of parent-child symptom reporting concordance, this secondary analysis explored the role of parent self-efficacy related to pain management for seriously ill school-age children and adolescents.

METHOD

In the initial study, 50 children and adolescents who were expected to survive 3 years or less were recruited along with their parent/primary caregiver. Parent self-report data were used in this secondary analysis to describe parent self-efficacy for managing their child's pain, caregiver strain, mood states, and perception of the child's pain; to explore relationships among these variables; and to determine predictors of greater self-efficacy.

RESULTS

Parents expressed a wide range of self-efficacy levels (Chronic Pain Self-Efficacy Scale; possible range 10-100, mean 76.2, SD 14.7) and higher levels on average than reported previously by family caregivers of adult patients. Caregiver Strain Index scores were markedly high (possible range 0-13, mean 8.1, SD 3.8) and inversely correlated with self-efficacy (r = -0.44, p = 0.001). On the Profile of Mood States parents reported more negative moods (t = 4.0, p < 0.001) and less vigor (t = -5.0, p < 0.001) than adults in a normative sample, yet vigor rather than mood disturbance predicted self-efficacy. With the exception of child age, self-efficacy was not associated with demographics (child gender, ethnicity, household income, parent age, education, family size) or with the diagnostic groups (primarily cardiac and oncologic) comprising the sample. Younger child age, less caregiver strain, more parent vigor, and parent perception that child is without pain predicted more than half of the variance in parent self-efficacy (R2 = 0.51).

SIGNIFICANCE OF RESULTS

Findings advance knowledge of parent self-efficacy in managing the pain of a child with life-threatening illness. Results can be used to design supportive interventions enhancing parents' caregiving roles during their child's last stages of life.

摘要

目的

利用来自一项多地点亲子症状报告一致性研究的数据，本二次分析探讨了与重病学龄儿童和青少年疼痛管理相关的父母自我效能感在其中的作用。

方法

在初始研究中，招募了 50 名预计存活 3 年或更短时间的儿童和青少年及其父母/主要照顾者。本二次分析使用了父母的自我报告数据，以描述父母对管理孩子疼痛、照顾者压力、情绪状态和对孩子疼痛感知的自我效能感；探讨这些变量之间的关系；并确定更高自我效能感的预测因素。

结果

父母表现出广泛的自我效能感水平（慢性疼痛自我效能感量表；可能范围为 10-100，平均 76.2，标准差 14.7），平均水平高于之前报告的成年患者家庭照顾者。照顾者压力指数得分明显较高（可能范围为 0-13，平均 8.1，标准差 3.8），与自我效能感呈负相关（r = -0.44，p = 0.001）。在心境状态剖面图上，父母报告的负面情绪（t = 4.0，p < 0.001）和活力（t = -5.0，p < 0.001）比正常样本中的成年人更多，但活力而不是情绪困扰预测自我效能感。除了孩子的年龄，自我效能感与人口统计学因素（孩子的性别、种族、家庭收入、父母的年龄、教育程度、家庭规模）或样本中的诊断组（主要是心脏和肿瘤）无关。孩子年龄较小、照顾者压力较小、父母活力较高以及父母认为孩子没有疼痛，这四个因素共同预测了父母自我效能感的一半以上的变异（R2 = 0.51）。