College of Nursing, 4083University of Iowa, Iowa City, IA, USA.
School of Nursing, 7284University of Washington, Seattle, WA, USA.
Am J Hosp Palliat Care. 2023 Jan;40(1):43-51. doi: 10.1177/10499091221094564. Epub 2022 May 3.
Family caregivers (FCs) of cancer patients play a crucial role in managing their care partner's pain, but little research has examined FCs' specific challenges regarding the provision of pain management (PM) to cancer patients receiving palliative care.
To determine the demographic and clinical characteristics of FCs who encounter challenges in PM and to elucidate the specific challenges that FCs face when managing pain for their care partner with cancer.
We conducted a secondary analysis of 40 interview transcripts of FCs who were caring for persons with cancer. Interviews were audio-recorded, transcribed verbatim, and analyzed using deductive thematic analysis.
The three major identified challenges to PM for FCs of persons with cancer were: (1) communication and teamwork issues, (2) caregiver-related issues, and (3) patient-related issues. Communication and teamwork issues encompassed caregivers' receipt of inadequate information regarding PM, and inappropriate and ineffective communication from the healthcare team. Caregiver issues pertained to caregivers' fear and beliefs, concurrent responsibilities, and lack of pain-related knowledge and skills. Patient issues related to their own fear and beliefs, psychological and physiological well-being, adherence to medications, and reluctance to report pain.
Findings of this study have implications for future research and practice related to cancer PM in palliative care. Results suggest the need for FC training in PM as well as clear clinical practice guidelines and resources to help providers prepare, educate, and communicate with FCs regarding PM.
癌症患者的家庭照顾者（FCs）在管理其照顾者的疼痛方面起着至关重要的作用，但很少有研究探讨 FCs 在为接受姑息治疗的癌症患者提供疼痛管理（PM）方面所面临的具体挑战。
确定在 PM 方面遇到挑战的 FCs 的人口统计学和临床特征，并阐明 FCs 在为其癌症照顾者管理疼痛时所面临的具体挑战。
我们对 40 名照顾癌症患者的 FCs 的访谈记录进行了二次分析。访谈进行了录音、逐字转录，并使用演绎主题分析进行了分析。
癌症患者 FCs 在 PM 方面面临的三个主要挑战是：（1）沟通和团队合作问题，（2）照顾者相关问题，（3）患者相关问题。沟通和团队合作问题包括照顾者对 PM 的信息接收不足，以及医疗团队的沟通不适当和无效。照顾者的问题涉及到他们的恐惧和信念、同时承担的责任，以及缺乏与疼痛相关的知识和技能。患者的问题涉及到他们自己的恐惧和信念、心理和生理健康、对药物的依从性，以及不愿报告疼痛。
本研究的结果对姑息治疗中癌症 PM 的未来研究和实践具有重要意义。结果表明，需要对 FCs 进行 PM 培训，以及制定明确的临床实践指南和资源，以帮助提供者为 FCs 准备、教育和沟通 PM。
