Warner Lindsay L, Moeschler Susan S, Pittelkow Thomas P, Strand Jacob J
1 Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
2 Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
Am J Hosp Palliat Care. 2019 Nov;36(11):955-958. doi: 10.1177/1049909119852928. Epub 2019 May 27.
Pain is one of the most commonly experienced and feared symptoms faced by patients with a serious illness. For these patients, intrathecal drug delivery systems (IDDSs) provide greater potency and/or few systemic side effects. However, despite these benefits, the integration and management of IDDS for patients receiving hospice care has not been previous studied. An electronic, 18-question survey was sent to 200 hospice practitioners (physicians, nurse practitioners and nurses) in the state of Minnesota to explore their experience, confidence, and the perceived barriers to caring for patients with IDDS while being cared for on hospice. Providers were identified though mailing lists from the Minnesota Network of Hospice and Palliative Care organization. The survey was administered by the Mayo Clinic Survey Research Center with institutional review board approval. Slightly more than 50% of respondents have ever cared for a patient with an intrathecal pump. If a patient had a pump in place, only 28% of providers expressed confidence in managing their pain. Additionally, only 3 of 10 respondents felt that adjusting an intrathecal pump should be the first option when a patient with an IDDS in place had increased pain. Indeed, the vast majority (over 80%) of respondents preferred the use of systemic therapies for primary pain management. Access to IDDS vendors for changes/refills in the home is identified as another barrier with over 50% of respondents either unaware of an available vendor or reporting no vendor available. There are numerous self-reported barriers to ongoing use of IDDS with patients receiving hospice care.
疼痛是重症患者最常经历且惧怕的症状之一。对于这些患者而言，鞘内药物输送系统（IDDS）能提供更强的药效和/或更少的全身副作用。然而，尽管有这些益处，此前尚未对接受临终关怀的患者使用IDDS的整合与管理进行研究。向明尼苏达州的200名临终关怀从业者（医生、执业护士和护士）发送了一份包含18个问题的电子调查问卷，以探究他们在患者接受临终关怀时护理IDDS患者的经验、信心以及感知到的障碍。通过明尼苏达临终关怀与姑息治疗网络组织的邮件列表确定了提供者。该调查由梅奥诊所调查研究中心在机构审查委员会批准下进行。略多于50%的受访者曾护理过使用鞘内泵的患者。如果患者配备了泵，只有28%的提供者表示有信心管理其疼痛。此外，在10名受访者中只有3人认为，当配备IDDS的患者疼痛加剧时，调整鞘内泵应作为首选方案。实际上，绝大多数（超过80%）的受访者更倾向于使用全身治疗方法来进行主要的疼痛管理。在家中联系IDDS供应商进行更改/补充药物被视为另一个障碍，超过50%的受访者要么不知道有可用的供应商，要么报告没有可用的供应商。对于接受临终关怀的患者持续使用IDDS存在众多自我报告的障碍。
