Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA; Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.
J Pain Symptom Manage. 2019 Jan;57(1):28-36. doi: 10.1016/j.jpainsymman.2018.10.491. Epub 2018 Oct 12.
Cancer pain relief is often inadequate because of poor adherence to pain medication, especially for black patients.
The purpose of this study is to describe factors related to adherence to around-the-clock opioids among 110 black patients being treated for cancer pain.
Sociodemographic, clinical, symptoms, and social support data were collected at baseline; pain and adherence data were collected at 30 days. Associations between these variables and opioid adherence measured by Medication Event Monitoring System were estimated using multiple regression.
Mean age was 56 (±10.1), the majority were women (63%) and college educated (56%). Mean pain severity at baseline equaled 4.6 (±2.3). Mean dose adherence was 60% (±28.5), while mean schedule adherence was 33.0% (±31.0). In adjusted analysis, 26% of the variance in dose adherence was explained by recent chemotherapy, changes in pain, concerns about nausea, and doctors' focus on cure versus pain control (P<0.001); 27% of the variance in schedule adherence was explained by recent chemotherapy, changes in pain, symptom burden, and concerns about doctors focus on cure versus pain control (P<0.001).
Findings confirm pain medication adherence is poor and pain was not well relieved. Multiple factors influence adherence to around-the-clock opioids. Clinicians need to partner with patients by providing a personalized pain treatment plan including an in-depth assessment of treatment choices and adherence.
由于对疼痛药物的依从性差，癌症疼痛缓解往往不充分，尤其是黑人患者。
本研究旨在描述 110 名接受癌症疼痛治疗的黑人患者中与按时使用阿片类药物依从性相关的因素。
在基线时收集社会人口统计学、临床、症状和社会支持数据；在 30 天时收集疼痛和依从性数据。使用多元回归估计这些变量与通过药物事件监测系统测量的阿片类药物依从性之间的关联。
平均年龄为 56（±10.1）岁，大多数为女性（63%）和大学学历（56%）。基线时平均疼痛严重程度为 4.6（±2.3）。平均剂量依从率为 60%（±28.5），而平均方案依从率为 33.0%（±31.0）。在调整分析中，剂量依从性的 26%差异由近期化疗、疼痛变化、对恶心的担忧以及医生对治愈与疼痛控制的关注解释（P<0.001）；方案依从性的 27%差异由近期化疗、疼痛变化、症状负担以及对医生关注治愈与疼痛控制的担忧解释（P<0.001）。
研究结果证实疼痛药物的依从性较差，疼痛缓解不佳。多种因素影响按时使用阿片类药物的依从性。临床医生需要与患者合作，提供个性化的疼痛治疗计划，包括对治疗选择和依从性的深入评估。
