University of Virginia School of Nursing, 225 Jeannette Lancaster Way, Charlottesville, VA, 22908, USA.
Kathmandu Cancer Center, Tathali, Bhaktapur, Nepal.
BMC Palliat Care. 2021 Nov 5;20(1):171. doi: 10.1186/s12904-021-00824-0.
One way to improve the delivery of oncology palliative care in low and middle-income countries (LMICs) is to leverage mobile technology to support healthcare providers in implementing pain management guidelines (PMG). However, PMG are often developed in higher-resourced settings and may not be appropriate for the resource and cultural context of LMICs.
This research represents a collaboration between the University of Virginia and the Nepalese Association of Palliative Care (NAPCare) to design a mobile health application ('app') to scale-up implementation of existing locally developed PMG.
We conducted a cross-sectional survey of clinicians within Nepal to inform design of the app. Questions focused on knowledge, beliefs, and confidence in managing cancer pain; barriers to cancer pain management; awareness and use of the NAPCare PMG; barriers to smart phone use and desired features of a mobile app.
Surveys were completed by 97 palliative care and/or oncology healthcare providers from four diverse cancer care institutions in Nepal. 49.5% (n = 48) had training in palliative care/cancer pain management and the majority (63.9%, n = 62) reported high confidence levels (scores of 8 or higher/10) in managing cancer pain. Highest ranked barriers to cancer pain management included those at the country/cultural level, such as nursing and medical school curricula lacking adequate content about palliative care and pain management, and patients who live in rural areas experiencing difficulty accessing healthcare services (overall mean = 6.36/10). Most nurses and physicians use an Android Smart Phone (82%, n = 74), had heard of the NAPCare PMG (96%, n = 88), and reported frequent use of apps to provide clinical care (mean = 6.38/10, n = 92). Key barriers to smart phone use differed by discipline, with nurses reporting greater concerns related to cost of data access (70%, n = 45) and being prohibited from using a mobile phone at work (61%; n = 39).
Smart phone apps can help implement PMG and support healthcare providers in managing cancer pain in Nepal and similar settings. However, such tools must be designed to be culturally and contextually congruent and address perceived barriers to pain management and app use.
在中低收入国家（LMICs）提高肿瘤姑息治疗服务的一种方法是利用移动技术来支持医疗保健提供者实施疼痛管理指南（PMG）。然而，PMG 通常是在资源更丰富的环境中开发的，可能并不适合 LMICs 的资源和文化背景。
这项研究是弗吉尼亚大学与尼泊尔姑息治疗协会（NAPCare）之间的合作，旨在设计一个移动健康应用程序（'app'），以扩大现有本地开发的 PMG 的实施。
我们对尼泊尔的临床医生进行了横断面调查，以了解应用程序的设计。问题集中在管理癌症疼痛的知识、信念和信心；癌症疼痛管理的障碍；对 NAPCare PMG 的认识和使用；智能手机使用的障碍和移动应用程序的期望功能。
来自尼泊尔四家不同癌症护理机构的 97 名姑息治疗和/或肿瘤学医疗保健提供者完成了调查。49.5%（n=48）接受过姑息治疗/癌症疼痛管理培训，大多数（63.9%，n=62）报告在管理癌症疼痛方面具有较高的信心水平（评分 8 或更高/10）。癌症疼痛管理的最高障碍包括国家/文化层面的障碍，例如护理和医学院课程缺乏关于姑息治疗和疼痛管理的足够内容，以及居住在农村地区的患者难以获得医疗服务（总体平均值=6.36/10）。大多数护士和医生使用 Android 智能手机（82%，n=74），听说过 NAPCare PMG（96%，n=88），并报告经常使用应用程序提供临床护理（平均值=6.38/10，n=92）。智能手机使用的主要障碍因学科而异，护士报告更关注数据访问费用（70%，n=45）和工作时被禁止使用手机（61%，n=39）。
智能手机应用程序可以帮助在尼泊尔和类似环境中实施 PMG 并支持医疗保健提供者管理癌症疼痛。然而，这些工具必须在文化和背景上保持一致，并解决对疼痛管理和应用程序使用的感知障碍。
