Sampson E L, van der Steen J T, Pautex S, Svartzman P, Sacchi V, Van den Block L, Van Den Noortgate N
Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK Liaison Psychiatry, North Middlesex University Hospital, Barnet Enfield and Haringey Mental Health Trust, London, UK.
Department of General Practice & Elderly Care Medicine, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
BMJ Support Palliat Care. 2015 Sep;5(3):301-5. doi: 10.1136/bmjspcare-2014-000813. Epub 2015 Apr 13.
Numbers of people dying with cognitive impairment (intellectual disability (ID), dementia or delirium) are increasing. We aimed to examine a range of European national palliative care guidelines to determine if, and how well, pain detection and management for people dying with impaired cognition are covered.
Questionnaires were sent to 14 country representatives of the European Pain and Impaired Cognition (PAIC) network who identified key national palliative care guidelines. Data was collected on guideline content: inclusion of advice on pain management, whether cognitively impaired populations were mentioned, assessment tools and management strategies recommended. Quality of guideline development was assessed with the Appraisal of Guidelines Research and Evaluation (AGREE) instrument.
11 countries identified palliative care guidelines, 10 of which mentioned pain management in general. Of these, seven mentioned cognitive impairment (3 dementia, 2 ID and 4 delirium). Half of guidelines recommended the use of pain tools for people with cognitive impairment; recommended tools were not all validated for the target populations. Guidelines from the UK, the Netherlands and Finland included most information on pain management and detection in impaired cognition. Guidelines from Iceland, Norway and Spain scored most highly on AGREE rating in terms of developmental quality.
European national palliative care guidelines may not meet the needs of the growing population of people dying with cognitive impairment. New guidelines should consider suggesting the use of observational pain tools for people with cognitive impairment. Better recognition of their needs in palliative care guidelines may drive improvements in care.
死于认知障碍（智力残疾、痴呆或谵妄）的人数正在增加。我们旨在研究一系列欧洲国家的姑息治疗指南，以确定对于认知功能受损的临终患者，疼痛检测和管理是否以及在多大程度上得到了涵盖。
向欧洲疼痛与认知障碍（PAIC）网络的14个国家代表发送问卷，他们确定了关键的国家姑息治疗指南。收集了指南内容的数据：关于疼痛管理建议的纳入情况、是否提及认知障碍人群、推荐的评估工具和管理策略。使用指南研究与评价（AGREE）工具评估指南制定的质量。
11个国家确定了姑息治疗指南，其中10个总体上提到了疼痛管理。其中，7个提到了认知障碍（3个痴呆、2个智力残疾和4个谵妄）。一半的指南建议对认知障碍患者使用疼痛评估工具；推荐的工具并非都针对目标人群进行了验证。英国、荷兰和芬兰的指南包含了关于认知障碍患者疼痛管理和检测的最多信息。冰岛、挪威和西班牙的指南在AGREE评级的制定质量方面得分最高。
欧洲国家的姑息治疗指南可能无法满足认知障碍临终患者不断增加的需求。新的指南应考虑建议对认知障碍患者使用观察性疼痛评估工具。在姑息治疗指南中更好地认识他们的需求可能会推动护理质量的提高。
