From the National Center for Policy Analysis, Dallas, Texas.
J Natl Compr Canc Netw. 2014 Sep;12(9):1243-9. doi: 10.6004/jnccn.2014.0122.
Improving the control of cancer-related pain (CRP) is a clinical and ethical imperative. Clinical research has documented improved treatment tolerance and survival rates among patients with cancer who have effective pain control. Barriers to CRP control include inadequate patient and physician education. Meta-analyses of patient education studies correlate improvements in CRP control with improved communications with health care providers and the implementation of strategies that assist with adherence to medication schedules. These strategies build patient confidence, allowing better self-management of pain and reduced psychological consequences. For physicians, ample educational resources exist in CRP management. However, in both the inpatient and outpatient settings, compliance with NCCN Clinical Practice Guidelines in Oncology for Adult Cancer Pain continues to be less than 70%, and more than one-third of patients continue to receive inadequate doses of analgesics. Patient-centered outcomes have become an integral end point in health policy, and the nation's medical training, research, and delivery systems are transforming to a value-based accreditation and reimbursement system. Pain control is a significant patient-centered outcome in cancer care, because pain adversely impacts function and affects all domains of quality of life. Agreement is clear on the value of health care interventions that relieve suffering from cancer pain and restore personal dignity.
改善与癌症相关的疼痛(CRP)的控制是临床和伦理的必然要求。临床研究记录了患有癌症的患者在有效疼痛控制下,治疗耐受性和生存率的提高。CRP 控制的障碍包括患者和医生教育的不足。对患者教育研究的荟萃分析表明,CRP 控制的改善与改善与医疗保健提供者的沟通以及实施有助于遵守药物治疗计划的策略相关。这些策略增强了患者的信心,使他们能够更好地自我管理疼痛并减轻心理后果。对于医生而言,CRP 管理方面有大量的教育资源。但是,在住院和门诊环境中,NCCN 肿瘤成人癌痛临床实践指南的依从性仍低于 70%,超过三分之一的患者继续接受不足剂量的镇痛药。以患者为中心的结果已成为卫生政策的一个重要终点,国家的医疗培训,研究和交付系统正在向基于价值的认证和报销系统转变。疼痛控制是癌症护理中的一个重要的以患者为中心的结果,因为疼痛会对功能产生不利影响,并影响生活质量的所有领域。减轻癌症疼痛和恢复个人尊严的医疗保健干预措施的价值已得到明确认可。