Wilkie Diana J, Ezenwa M O, Yao Y, Gill A, Hipp T, Shea R, Miller J, Carrasco J, Shuey D, Zhao Z, Angulo V, Suarez M L, McCurry T, Martin J, Molokie R E, Wang Z W
1 Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA.
2 Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.
Am J Hosp Palliat Care. 2017 May;34(4):318-324. doi: 10.1177/1049909116639612. Epub 2016 Mar 22.
There is little evidence about barriers to pain management or their relationships with pain outcomes of hospice patients with cancer. The purpose of the study was to determine the barriers reported by hospice patients with cancer and their caregivers and the relationships with demographic characteristics and the patients' pain. In this cross-sectional study, we used selected baseline data from an ongoing randomized clinical trial of patient and lay caregiver dyads receiving home-level hospice care. Participants used an Internet-enabled tablet to complete the valid, reliable measures of pain intensity, pain management barriers (Barriers Questionnaire 13 items [BQ-13]), and demographic characteristics. The responses indicate that the 2 areas of highest concern (mean scores >3) to both patients and caregivers were "pain means disease progression" and "constipation." Additionally, 3 other areas of highest concern (mean scores >3) to caregivers were "addiction" pain medicine causing "one to do embarrassing things" and "confusion." The mean BQ-13 scores ranged from 0.2 to 4.9 and averaged 2.6 ± 0.9 for the patients and ranged from 0.5 to 4.7 and averaged 2.7 ± 0.9 for the caregivers. Mean barrier scores remain high and were not different between patients and their caregivers or significantly related to the patients' pain intensity. However, there were differences in race, ethnic, and hospice setting in the barrier scores. Patients with Hispanic heritage reported higher barrier scores than non-Hispanic patients. Together, these findings not only support prior research findings but also contribute new insights about pain intensity and pain barriers that are relevant to hospices serving minorities with cancer.
关于癌症临终关怀患者疼痛管理的障碍及其与疼痛结局的关系，几乎没有相关证据。本研究的目的是确定癌症临终关怀患者及其照护者报告的障碍，以及这些障碍与人口统计学特征和患者疼痛的关系。在这项横断面研究中，我们使用了一项正在进行的针对接受家庭层面临终关怀护理的患者和非专业照护者二元组的随机临床试验的部分基线数据。参与者使用联网平板电脑完成疼痛强度、疼痛管理障碍管理障碍（障碍问卷13项[BQ - 13]）以及人口统计学特征的有效、可靠测量。结果表明，患者和照护者最关注的两个领域（平均得分>3）是“疼痛意味着疾病进展”和“便秘”。此外，照护者最关注的其他三个领域（平均得分>3）是“成瘾”、止痛药导致“做出尴尬的事”和“意识模糊”。患者的BQ - 13平均得分在0.2至4.9之间，平均为2.6±0.9；照护者的得分在0.5至4.7之间，平均为2.7±0.9。平均障碍得分仍然较高，患者与其照护者之间没有差异，也与患者的疼痛强度没有显著关联。然而，在障碍得分方面，种族、族裔和临终关怀环境存在差异。有西班牙裔血统的患者报告的障碍得分高于非西班牙裔患者。这些发现不仅支持了先前的研究结果，还为与为患癌少数群体提供服务的临终关怀机构相关的疼痛强度和疼痛障碍提供了新的见解。
