Melanie R. Lovell and Meera Agar, HammondCare; Melanie R. Lovell and Frances M. Boyle, University of Sydney; Melanie R. Lovell, Tim Luckett, Jane Phillips, Meera Agar, and Patricia M. Davidson, ImPaCCT (New South Wales Palliative Care Trials Group); Tim Luckett and Patricia M. Davidson, University of Technology Sydney; Jane Phillips, University of Notre Dame; and Meera Agar, University of New South Wales, Sydney, New South Wales, Australia.
J Clin Oncol. 2014 Jun 1;32(16):1712-20. doi: 10.1200/JCO.2013.52.4850. Epub 2014 May 5.
Multiple systematic reviews and meta-analyses have identified the effectiveness of patient education in improving cancer pain management. However, the mechanisms by which patient education improves pain outcomes are uncertain, as are the optimal delivery, content, timing, frequency, and duration. This review provides best-bet recommendations based on available evidence to guide service managers and clinicians in developing a patient education program.
We used patient-centered care, self-management, coaching, and a behavior change wheel as lenses through which to consider the evidence for elements of patient education most likely to be effective within the context of other strategies for overcoming barriers to cancer pain assessment and management.
The evidence suggests that optimal strategies include those that are patient-centered and tailored to individual needs, are embedded within health professional-patient communication and therapeutic relationships, empower patients to self-manage and coordinate their care, and are routinely integrated into standard cancer care. An approach that integrates patient education with processes and systems to ensure implementation of key standards for pain assessment and management and education of health professionals has been shown to be most effective.
Patient education is effective in reducing cancer pain and should be standard practice in all settings. For optimal results, patient education should be integrated with other strategies for implementing evidence-based, person-centered care and overcoming barriers at the levels of patient, provider, and health system.
多项系统评价和荟萃分析已经确定了患者教育在改善癌症疼痛管理方面的有效性。然而，患者教育改善疼痛结局的机制尚不确定，最佳的提供方式、内容、时间、频率和持续时间也不确定。本综述提供了基于现有证据的最佳建议，以指导服务管理者和临床医生制定患者教育计划。
我们使用以患者为中心的护理、自我管理、辅导和行为改变轮作为视角，考虑在克服癌症疼痛评估和管理障碍的其他策略背景下最有可能有效的患者教育要素的证据。
证据表明，最佳策略包括以患者为中心且针对个体需求定制的策略，嵌入在医患沟通和治疗关系中，使患者能够自我管理和协调护理，并常规纳入标准癌症护理中。已证明将患者教育与确保实施疼痛评估和管理关键标准以及对卫生专业人员进行教育的流程和系统相结合的方法最为有效。
患者教育可有效减轻癌症疼痛，应成为所有环境中的标准实践。为了获得最佳效果，患者教育应与其他策略相结合，以实施基于证据的、以患者为中心的护理，并克服患者、提供者和卫生系统各级的障碍。
