Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada; Translating Research in Elder Care (TREC), University of Alberta, Edmonton, Alberta, Canada.
Translating Research in Elder Care (TREC), University of Alberta, Edmonton, Alberta, Canada; Faculty of Kinesiology, Western University, London, Ontario, Canada.
J Am Med Dir Assoc. 2019 Jul;20(7):884-892.e3. doi: 10.1016/j.jamda.2019.01.156. Epub 2019 Mar 23.
The burden of pain in nursing home residents is substantial; unfortunately, many times it goes undiagnosed and is inadequately treated. To improve identification of pain in this population, we aimed to review and synthesize findings from qualitative studies that report primary barriers and facilitators to pain assessment in nursing home residents.
This is a Cochrane-style systematic review and narrative synthesis of qualitative evidence adhering to PRISMA guidelines. Databases were searched from inception to June 2018, supplemented by hand searching of references. We assessed the quality of included studies using the Critical Appraisal Skills Program Quality Appraisal Checklist.
We included studies conducted in nursing homes. Studies focused on nursing home residents, nursing home staff, or both.
Extracted data were subject to thematic analyses and were collated and summarized into 3 groups: resident, health care provider, and health care system factors.
Thirty-one studies met our inclusion criteria. Resident factors had 3 subthemes: physical or cognitive impairments, attitudes and beliefs, and social/cultural/demographic characteristics. Health care provider factors had 3 subthemes: knowledge and skills, attitudes and beliefs, and social/cultural/demographic characteristics. Health care system-level factors had 3 subthemes: interpersonal factors, resources, and policy. Key barriers to pain assessment included the presence of resident cognitive impairment, health care providers' lack of knowledge, and the breakdown of communication across organizational hierarchies. Key facilitators to pain assessment included the identification of pain-related behaviors in residents, the experience and skills of health care providers, and establishing facility-level pain assessment protocols and guidelines.
Findings from this review identify primary barriers and facilitators to pain assessment in nursing home residents, highlighting key considerations for stakeholders, including health care providers, and health care policy decision makers. These efforts have the potential to improve the identification of pain in residents, and may ultimately improve pain management and residents' quality of life.
养老院居民的疼痛负担很大；不幸的是，很多时候这种疼痛未被诊断出来，也未得到充分治疗。为了提高对这一人群疼痛的识别能力，我们旨在回顾和综合报告养老院居民疼痛评估的主要障碍和促进因素的定性研究结果。
这是一项遵循 PRISMA 指南的 Cochrane 式系统评价和定性证据综合分析。从成立之初到 2018 年 6 月，我们对数据库进行了搜索，并辅以参考文献的手工搜索。我们使用关键评估技能计划质量评估清单评估纳入研究的质量。
我们纳入了在养老院进行的研究。研究集中于养老院居民、养老院工作人员或两者。
提取的数据进行主题分析，并整理总结为 3 组：居民、医疗保健提供者和医疗保健系统因素。
31 项研究符合我们的纳入标准。居民因素有 3 个子主题：身体或认知障碍、态度和信念以及社会/文化/人口特征。医疗保健提供者因素有 3 个子主题：知识和技能、态度和信念以及社会/文化/人口特征。医疗保健系统层面的因素有 3 个子主题：人际因素、资源和政策。疼痛评估的主要障碍包括居民认知障碍的存在、医疗保健提供者缺乏知识以及组织层次结构之间的沟通中断。疼痛评估的主要促进因素包括识别居民的疼痛相关行为、医疗保健提供者的经验和技能以及建立设施层面的疼痛评估方案和指南。
本综述的结果确定了养老院居民疼痛评估的主要障碍和促进因素，突出了利益相关者（包括医疗保健提供者和医疗保健政策决策者）的关键考虑因素。这些努力有可能提高居民疼痛的识别能力，并最终改善疼痛管理和居民的生活质量。
