Matthias Marianne S, Evans Erica, Porter Brian, McCalley Stephanie, Kroenke Kurt
VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana.
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Pain Med. 2020 Oct 1;21(10):2137-2145. doi: 10.1093/pm/pnz345.
Pain, anxiety, and depression commonly co-occur, can have reciprocal effects, and are associated with substantial disability and health care costs. However, few interventions target treatment of pain and mood disorders as a whole. The Comprehensive vs. Assisted Management of Mood and Pain Symptoms (CAMMPS) trial was a randomized trial comparing two pragmatic telecare interventions, a high- vs low-resource approach to pain and anxiety/depression treatment. The purpose of the current study is to better understand patients' perspectives on both intervention approaches, including intervention components, delivery, patient experiences, and patient outcomes.
Qualitative, semistructured interviews.
A Veterans Affairs Medical Center.
Twenty-five patients were purposefully sampled from both study arms.
Patients were interviewed about their experiences with pain and mood treatment, perceived benefits and changes, and experiences with the intervention model to which they were randomized. The constant comparison method guided analysis.
Pain was more important than mood for most participants. Participants described developing increased awareness of their symptoms, including connecting pain and mood, which enabled better management. Participants in the high-resource intervention described the added value of the study nurse in their symptom management.
Patients in a telecare intervention for chronic pain and mood symptoms learned to connect pain and mood and be more aware of their symptoms, enabling more effective symptom management. Patients in the high-resource intervention described the added benefits of a nurse who provided informational and motivational support. Implications for tradeoffs between resource intensity and patient outcomes are discussed.
疼痛、焦虑和抑郁通常同时出现，会产生相互影响，且与严重的残疾和医疗费用相关。然而，很少有干预措施将疼痛和情绪障碍作为一个整体进行治疗。综合与辅助情绪及疼痛症状管理（CAMMPS）试验是一项随机试验，比较了两种实用的远程护理干预措施，即针对疼痛和焦虑/抑郁治疗的高资源与低资源方法。本研究的目的是更好地了解患者对这两种干预方法的看法，包括干预组成部分、实施方式、患者体验和患者结局。
定性、半结构式访谈。
一家退伍军人事务医疗中心。
从两个研究组中有目的地抽取了25名患者。
就患者在疼痛和情绪治疗方面的经历、感知到的益处和变化，以及他们被随机分配的干预模式的体验进行访谈。采用持续比较法进行分析。
对大多数参与者来说，疼痛比情绪更重要。参与者描述了对自身症状的认识有所提高，包括将疼痛与情绪联系起来，这有助于更好地进行管理。高资源干预组的参与者描述了研究护士在症状管理中的附加价值。
接受慢性疼痛和情绪症状远程护理干预的患者学会了将疼痛与情绪联系起来，并更加了解自己的症状，从而能够更有效地管理症状。高资源干预组的患者描述了提供信息和激励支持的护士带来的额外益处。讨论了资源强度与患者结局之间权衡的意义。
