针对晚期癌症患者的照护者指导下的疼痛应对技能培训：一项随机临床试验的结果
Caregiver-guided pain coping skills training for patients with advanced cancer: Results from a randomized clinical trial.
作者信息
Porter Laura S, Steel Jennifer L, Fairclough Diane L, LeBlanc Thomas W, Bull Janet, Hanson Laura C, Fischer Stacy, Keefe Francis J
机构信息
Duke University School of Medicine, Durham, NC, USA.
University of Pittsburgh, Pittsburgh, PA, USA.
出版信息
Palliat Med. 2021 May;35(5):952-961. doi: 10.1177/02692163211004216. Epub 2021 Mar 29.
BACKGROUND
Pain is a major concern among patients with advanced cancer and their family caregivers. Evidence suggests that pain coping skills training interventions can improve outcomes, however they have rarely been tested in this population.
AIM
To test the efficacy of a caregiver-guided pain coping skills training intervention. The primary outcome was caregiver self-efficacy for helping the patient manage pain.
DESIGN
A randomized controlled trial compared the intervention to an enhanced treatment-as-usual control. Dyads in both conditions received pain education, and those in the intervention received three sessions of pain coping skills training. Caregiver outcomes (self-efficacy; caregiver strain, caregiving satisfaction, psychological distress) and patient outcomes (self-efficacy, pain intensity and interference, psychological distress) were collected at baseline and post-intervention.
SETTING/PARTICIPANTS: Two hundred two patients with stage III-IV cancer and pain and their family caregivers were enrolled from four outpatient oncology clinics and a free-standing hospice/palliative care organization.
RESULTS
Compared to those in the control arm, caregivers in the intervention reported significant increases in caregiving satisfaction ( < 0.01) and decreased anxiety ( = 0.04). In both conditions, caregivers reported improvements in self-efficacy, and patients reported improvements in self-efficacy, pain severity and interference, and psychological distress.
CONCLUSIONS
This is the first study to test a pain coping skills intervention targeted to patients and caregivers facing advanced cancer. Findings suggest that pain education provides benefits for patients and caregivers, and coping skills training may be beneficial for caregivers. Further research is needed to optimize the benefits of education and pain coping skills training for improving cancer pain outcomes. ClinicalTrials.gov NCT02430467, Caregiver-Guided Pain Management Training in Palliative Care.
背景
疼痛是晚期癌症患者及其家庭护理人员主要关心的问题。有证据表明，疼痛应对技能培训干预可以改善结果，然而在这一人群中很少进行测试。
目的
测试由护理人员指导的疼痛应对技能培训干预的效果。主要结果是护理人员帮助患者管理疼痛的自我效能感。
设计
一项随机对照试验将该干预与强化常规治疗对照进行比较。两组患者均接受疼痛教育，干预组患者接受三节疼痛应对技能培训课程。在基线和干预后收集护理人员的结果（自我效能感、护理负担、护理满意度、心理困扰）和患者的结果（自我效能感、疼痛强度和干扰、心理困扰）。
地点/参与者：从四个门诊肿瘤诊所和一个独立的临终关怀/姑息治疗机构招募了202名患有III-IV期癌症且伴有疼痛的患者及其家庭护理人员。
结果
与对照组相比，干预组的护理人员报告护理满意度显著提高（<0.01），焦虑感降低（=0.04）。在两组中，护理人员报告自我效能感有所改善，患者报告自我效能感、疼痛严重程度和干扰以及心理困扰有所改善。
结论
这是第一项针对晚期癌症患者及其护理人员测试疼痛应对技能干预的研究。研究结果表明，疼痛教育对患者和护理人员有益，应对技能培训可能对护理人员有益。需要进一步研究以优化教育和疼痛应对技能培训对改善癌症疼痛结果的益处。ClinicalTrials.gov NCT02430467，姑息治疗中护理人员指导的疼痛管理培训。
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