Edwards Zoe, Blenkinsopp Alison, Ziegler Lucy, Bennett Michael I
School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK.
Institute of Health Sciences, University of Leeds, Leeds, UK.
Health Soc Care Community. 2018 Jul;26(4):507-518. doi: 10.1111/hsc.12549. Epub 2018 Feb 26.
Pain experienced by many patients with advanced cancer is often not well controlled and community pharmacists are potentially well placed to provide support. The study objective was to explore the views and experiences of patients with advanced cancer about community pharmacies, their services and attitudes towards having a community pharmacist pain medicines consultation. Purposive sampling of GP clinical information systems was used to recruit patients with advanced cancer, living in the community and receiving opioid analgesics in one area of England, UK between January 2015 and July 2016. Thirteen patients had a semi-structured interview which was audio-recorded and transcribed verbatim. Data were analysed deductively and inductively using Framework analysis and incorporating new themes as they emerged. The framework comprised Pain management, Experiences and expectations, Access to care and Communication. All patients reported using one regular community pharmacy citing convenience, service and staff friendliness as influential factors. The idea of a community pharmacy medicines consultation was acceptable to most patients. The idea of telephone consultations was positively received but electronic media such as Skype was not feasible or acceptable for most. Patients perceived a hierarchy of health professionals with specialist palliative care nurses at the top (due to their combined knowledge of their condition and medicines) followed by GPs then pharmacists. Patients receiving specialist palliative care described pain that was better controlled than those who were not. They thought medicines consultations with a pharmacist could be useful for patients before referral for palliative care. There is a need for pain medicines support for patients with advanced cancer, and unmet need appears greater for those not under the care of specialist services. Medicines consultations, in principle, are acceptable to patients both in person and by telephone, and the latter was perceived to be of particular benefit to patients less able to leave the house.
许多晚期癌症患者所经历的疼痛往往得不到很好的控制，而社区药剂师有潜力提供支持。本研究的目的是探讨晚期癌症患者对社区药房、其服务以及对社区药剂师进行疼痛药物咨询的态度的看法和经历。采用目的抽样法，从英国英格兰一个地区的全科医生临床信息系统中招募2015年1月至2016年7月期间居住在社区且正在接受阿片类镇痛药治疗的晚期癌症患者。13名患者接受了半结构化访谈，访谈进行了录音并逐字转录。使用框架分析法对数据进行演绎和归纳分析，并在新主题出现时将其纳入。该框架包括疼痛管理、经历与期望、获得护理和沟通。所有患者都报告使用过一家常规社区药房，称便利性、服务和员工友好度是影响因素。大多数患者都接受社区药房药物咨询的想法。电话咨询的想法得到了积极回应，但大多数人认为Skype等电子媒体不可行或不可接受。患者认为医疗专业人员存在等级制度，专科姑息治疗护士排在首位（因为他们对病情和药物有综合了解），其次是全科医生，然后是药剂师。接受专科姑息治疗的患者描述其疼痛比未接受专科姑息治疗的患者得到了更好的控制。他们认为在患者转诊接受姑息治疗之前，与药剂师进行药物咨询可能会有所帮助。晚期癌症患者需要疼痛药物支持，对于那些未接受专科服务护理的患者，未满足的需求似乎更大。原则上，患者接受亲自或通过电话进行的药物咨询，并且后者被认为对不太能出门的患者特别有益。
