University of Massachusetts Amherst, College of Nursing, Amherst, Massachusetts; Phyllis F. Cantor Center for Research in Nursing and Patient Care, Dana-Farber Cancer Institute, Boston, Massachusetts.
Schwartz Center Rounds, Dana-Farber Cancer Institute, Boston, Massachusetts.
Pain Manag Nurs. 2021 Dec;22(6):716-723. doi: 10.1016/j.pmn.2021.03.003. Epub 2021 May 4.
Persons with advanced cancers experience high rates of pain. Nursing interventions for pain, which are tailored to the individual patient, may support motivation to engage in self-management and should include setting of realistic functional goals. For patients with advanced cancer, functional pain goals include personally important activities, measurable across clinical encounters. However, limited evidence exists regarding nursing assessment of functional pain goals. To address this gap, we piloted use of a motivational interviewing intervention. Motivational interviewing is a clinical technique for clarifying goals and related impediments, such as cognitive and emotional factors underlying pain management behaviors.
Pilot feasibility testing.
Palliative care patients with cancer-related pain completed up to four intervention sessions, the Pain Self-Efficacy Questionnaire, and an author-developed acceptability questionnaire. Feasibility success was determined by 60% of participants completing at least two interventions. Fidelity to the intervention was assessed using the Motivational Interviewing Skills for Healthcare Encounters tool.
Sixty-seven percent completed two interventions. Participants reported that interventions were helpful, worthwhile, and recommended. Mean pain self-efficacy scores (0-60 possible) rose from 31.5 (SD = 11.2) at intervention 1 to 35.5 (SD = 13) after intervention 4. Intervention fidelity was maintained.
Participants were willing to engage in multiple motivational interviewing conversations focused on pain management behaviors related to functional goals. Based on these findings about motivational interviewing for functional goals and patient willingness to set them, these conversations may have a place in clinical care as an element of pain assessment and intervention tailoring.
晚期癌症患者疼痛发生率较高。针对个体患者量身定制的护理干预措施可以支持他们积极参与自我管理，并且应该包括设定现实的功能目标。对于晚期癌症患者，功能疼痛目标包括个人重要的活动，这些活动可以在临床就诊中进行衡量。然而，关于护理人员评估功能疼痛目标的证据有限。为了解决这一差距，我们试点使用了动机性访谈干预措施。动机性访谈是一种用于明确目标和相关障碍的临床技术，例如疼痛管理行为背后的认知和情感因素。
试点可行性测试。
患有癌症相关疼痛的姑息治疗患者完成了最多四个干预疗程、疼痛自我效能问卷和作者开发的可接受性问卷。通过至少完成两次干预的 60%参与者来确定可行性成功。使用医疗保健互动中的动机性访谈技能工具评估干预措施的保真度。
67%的参与者完成了两次干预。参与者报告说，干预措施很有帮助、值得和推荐。疼痛自我效能评分（0-60 分）从第 1 次干预时的 31.5（SD=11.2）升高到第 4 次干预后的 35.5（SD=13）。干预的保真度得到了维持。
参与者愿意参与多次针对与功能目标相关的疼痛管理行为的动机性访谈对话。基于这些关于功能目标和患者设定这些目标意愿的动机性访谈发现，这些对话可能在临床护理中作为疼痛评估和干预调整的一部分具有一席之地。
