增强力量：一项解决临终关怀中疼痛管理障碍的干预措施。
EMPOWER: an intervention to address barriers to pain management in hospice.
作者信息
Cagle John G, Zimmerman Sheryl, Cohen Lauren W, Porter Laura S, Hanson Laura C, Reed David
机构信息
School of Social Work, University of Maryland, Baltimore, Maryland, USA.
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
出版信息
J Pain Symptom Manage. 2015 Jan;49(1):1-12. doi: 10.1016/j.jpainsymman.2014.05.007. Epub 2014 May 28.
CONTEXT
Concerns about pain medications are major barriers to pain management in hospice, but few studies have focused on systematic methods to address these concerns.
OBJECTIVES
The objective of this study was to test the preliminary efficacy of the Effective Management of Pain: Overcoming Worries to Enable Relief (EMPOWER) intervention, which included hospice staff education, staff screening of barriers to pain management at admission, and discussion about misunderstandings regarding pain management with family caregivers and patients.
METHODS
We conducted a pilot, cluster randomized, controlled trial with four hospices. One hundred twenty-six family caregivers (55 interventions and 71 controls) were interviewed at two weeks after admission. If patients survived three months after admission, caregivers were reinterviewed.
RESULTS
At two weeks, caregivers in the intervention group reported better knowledge about pain management (P = 0.001), fewer concerns about pain and pain medications (P = 0.008), and lower patient pain over the past week (P = 0.014) and trended toward improvement in most other areas under study. Exploratory analyses suggest that EMPOWER had a greater effect for black subjects (vs. whites) on reducing concern about stigma. At three months, the intervention group trended better on most study outcomes.
CONCLUSION
EMPOWER is a promising model to reduce barriers to pain management in hospice.
背景
对止痛药物的担忧是临终关怀中疼痛管理的主要障碍，但很少有研究聚焦于解决这些担忧的系统方法。
目的
本研究的目的是测试“有效疼痛管理：克服担忧以实现缓解”（EMPOWER）干预措施的初步疗效，该干预措施包括临终关怀工作人员教育、工作人员在患者入院时筛查疼痛管理障碍，以及与家庭护理人员和患者讨论有关疼痛管理的误解。
方法
我们在四家临终关怀机构进行了一项试点、整群随机对照试验。126名家庭护理人员（55名干预组和71名对照组）在入院两周后接受了访谈。如果患者入院后存活三个月，护理人员将再次接受访谈。
结果
在两周时，干预组的护理人员报告称对疼痛管理的了解更好（P = 0.001），对疼痛和止痛药物的担忧更少（P = 0.008），患者在过去一周的疼痛程度更低（P = 0.014），并且在大多数其他研究领域有改善趋势。探索性分析表明，EMPOWER对黑人受试者（与白人相比）在减少对耻辱感的担忧方面有更大的效果。在三个月时，干预组在大多数研究结果上有更好的趋势。
结论
EMPOWER是一种有前景的模式，可减少临终关怀中疼痛管理的障碍。
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