Duchin Emma R, Moore Megan, Carrougher Gretchen J, Min Emily K, Gordon Debra B, Stewart Barclay T, Sabel Jody, Jo-Nes Anne, Pham Tam N
Harborview Injury Prevention & Research Center; Scripps College.
School of Social Work, University of Washington.
Burns. 2021 Nov;47(7):1627-1634. doi: 10.1016/j.burns.2021.01.010. Epub 2021 Feb 15.
Burns are painful injuries associated with a long recovery. Patients may not be receiving sufficient pain management education to optimize their experience and recovery after burn injury. Therefore, we aimed to obtain patients' perspectives about the effectiveness of current burn pain education to inform future efforts.
We used a mixed-methods research design that included both inpatients and outpatients cared for at a single, American Burn Association-verified burn center. Participants were at least 14 years of age with an acute burn who received a minimum of two wound interventions. The interview was designed by clinician stakeholders using a modified Delphi technique and focused on patient respondent's pain experience, understanding and desire to gain knowledge concerning burn pain and its management. Descriptive quantitative analysis was performed on categorical data. Recorded interview segments were transcribed for content analysis.
Twenty-one adult burn patients were interviewed. Participants reported experiencing variable levels of pain and pain management effectiveness. Inpatients reported more severe pain than outpatients. Only 11% of inpatients reported having received enough pain information, compared to 50% of outpatients. Content analysis yielded 3 themes: patient's pain experience, range of expectations, and clinical information/services desired. Mental and physical effects were key factors in respondents' pain experiences, with many participants reporting mental anguish in addition to pain. Of participants who had pain expectations, most were matched by their experience (56%), although many individuals (44%) described higher pain levels than they anticipated. Positive experiences with the burn care team primarily revolved around receiving pain education from a provider, whereas negative experiences focused on wound care events. Participants desired more information on sleep and pain medications, alternative treatments, weaning and addiction risk, realistic expectations of recovery timelines, and available mental health services. Written (pamphlet) education ranked as the most desirable delivery method, followed by in-person and video education.
Burn patients reported variable pain experiences and a strong desire to receive additional pain education. This project informs key strategies to educate burn patients on pain: leverage the high-level of interest in pain to foster education, describe pharmacologic and alternative therapies, offer weaning plans and explanation of addiction risks.
Burn patients' perspectives help inform strategies and content creation for pain-related education materials that burn centers can provide to improve patients' experiences.
Project was supported in part by the NIH grant for Insight Student Research Program at the Harborview Injury Prevention and Research Center (R25 HD094336).
烧伤是一种伴有漫长康复过程的疼痛性损伤。患者可能未接受足够的疼痛管理教育，以优化其烧伤后的体验和康复。因此，我们旨在了解患者对当前烧伤疼痛教育效果的看法，为未来的工作提供参考。
我们采用了混合方法研究设计，纳入了在一家经美国烧伤协会认证的烧伤中心接受治疗的住院患者和门诊患者。参与者年龄至少14岁，患有急性烧伤，且至少接受过两次伤口干预。访谈由临床利益相关者采用改良的德尔菲技术设计，重点关注患者对疼痛的体验、理解以及获取有关烧伤疼痛及其管理知识的愿望。对分类数据进行描述性定量分析。对录制的访谈片段进行转录以进行内容分析。
对21名成年烧伤患者进行了访谈。参与者报告了不同程度的疼痛和疼痛管理效果。住院患者报告的疼痛比门诊患者更严重。只有11%的住院患者报告收到了足够的疼痛信息，而门诊患者这一比例为50%。内容分析得出3个主题：患者的疼痛体验、期望范围以及期望获得的临床信息/服务。心理和生理影响是受访者疼痛体验的关键因素，许多参与者除了疼痛外还报告了精神痛苦。在有疼痛预期的参与者中，大多数人的体验与预期相符（56%），尽管许多人（44%）描述的疼痛程度高于预期。与烧伤护理团队的积极经历主要围绕从医护人员那里接受疼痛教育，而消极经历则集中在伤口护理事件上。参与者希望获得更多关于睡眠和止痛药物、替代治疗、逐渐减量和成瘾风险、对康复时间线的现实期望以及可用心理健康服务的信息。书面（宣传册）教育被评为最理想的教育方式，其次是面对面教育和视频教育。
烧伤患者报告了不同的疼痛体验，并强烈希望获得更多的疼痛教育。该项目为烧伤患者疼痛教育的关键策略提供了参考：利用对疼痛的高度关注来促进教育，描述药物和替代疗法，提供逐渐减量计划并解释成瘾风险。
烧伤患者的观点有助于为烧伤中心可以提供的与疼痛相关的教育材料的策略制定和内容创作提供参考，以改善患者的体验。
该项目部分由美国国立卫生研究院授予哈博维尤伤害预防与研究中心洞察学生研究项目的资助（R25 HD094336）。
