Rafii Forough, Taleghani Fariba, Khatooni Marzieh
Nursing Care Research Centre, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
Nursing and Midwifery Care Research Centre, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
Indian J Palliat Care. 2020 Oct-Dec;26(4):457-467. doi: 10.4103/IJPC.IJPC_8_20. Epub 2020 Nov 19.
Cancer pain management at home is a complicated and multidimensional experience that affects the foundational aspects of patients and their families' lives. Understanding the pain relief process and the outcomes of palliative care at home is essential for designing programs to improve the quality of life of patients and their families.
To explore family caregivers and patients' experiences of pain management at home and develop a substantive theory.
The study was carried out using a grounded theory methodology.
SETTING/PARTICIPANTS: Twenty patients and 32 family caregivers were recruited from Oncology wards and palliative medicine clinics in the hospitals affiliated to Iran University of Medical Sciences using Purposeful and theoretical sampling.
The core category in this study was "pain relief with the least harm." Other categories were formed around the core category including "pain assessment, determining the severity of pain, using hierarchical approaches to pain relief, assessing the results of applied approaches, determining the range of effectiveness, and barriers and facilitators of pain relief." The substantive theory emerged from these categories was "Pain management process in cancer patients at home: Causing the least harm" that explains the stages of applying hierarchical approaches to pain relief, family care givers try to make decisions in a way that maximize pain relief and minimize damage to the patient. Along with using a hierarchical pattern, the process is featured with a circular pattern at broader perspective, which reflects dynamism of the process.
The inferred categories and theory can expand knowledge and awareness about the stages of pain relief process, the pattern of using pain relief approaches, and the barriers and facilitators of pain relief process at home. Health-care professionals may use these findings to assess the knowledge, skill, capability, problems, and needs of family caregivers and patients and develop supportive and educational programs to improve the efficiency of pain relief process at home and improve the patients' quality of life.
癌症患者居家疼痛管理是一个复杂且多维度的体验，会影响患者及其家人生活的方方面面。了解居家姑息治疗的疼痛缓解过程及结果对于设计旨在改善患者及其家人生活质量的项目至关重要。
探讨家庭照护者和患者居家疼痛管理的体验并构建一个实质性理论。
本研究采用扎根理论方法开展。
设置/参与者：采用立意抽样和理论抽样的方法，从伊朗医科大学附属各医院的肿瘤科病房和姑息医学诊所招募了20名患者和32名家庭照护者。
本研究的核心类别是“以最小伤害实现疼痛缓解”。围绕该核心类别形成了其他类别，包括“疼痛评估、确定疼痛严重程度、采用分层方法缓解疼痛、评估应用方法的结果、确定有效范围以及疼痛缓解的障碍和促进因素”。从这些类别中得出的实质性理论是“癌症患者居家疼痛管理过程：造成最小伤害”，该理论解释了应用分层方法缓解疼痛的阶段，家庭照护者试图以最大化疼痛缓解和最小化对患者损害的方式做出决策。除了采用分层模式外，该过程从更广泛的角度还具有循环模式，这反映了该过程的动态性。
推断出的类别和理论可以扩展关于疼痛缓解过程阶段、疼痛缓解方法使用模式以及居家疼痛缓解过程的障碍和促进因素的知识和认识。医疗保健专业人员可利用这些研究结果评估家庭照护者和患者的知识、技能、能力、问题及需求，并制定支持性和教育性项目，以提高居家疼痛缓解过程的效率并改善患者生活质量。
