Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia; and Gosford Hospital, Central Coast Local Health District, Gosford, NSW, Australia
Rural Remote Health. 2022 May;22(2):7000. doi: 10.22605/RRH7000. Epub 2022 May 6.
Pain is a common and distressing symptom in people living with cancer that requires a patient-centred approach to management. Since 2010, the Australian Government has invested heavily in developing regional cancer centres to improve cancer outcomes. This study explored patient and carer experiences of care from a regional cancer centre with specific reference to cancer pain management.
A qualitative approach was used with semi-structured telephone interviews. Participants were outpatients at a regional cancer centre in New South Wales who had reported worst pain of 2 or more on a 0-10 numerical rating scale, and their carers. Questions explored experiences of pain assessment and management, and perceptions of how these were affected by the regional setting. Researchers analysed data using a deductive approach, using Mead and Bower's (2000) framework of factors influencing patient-centred care.
Eighteen telephone interviews were conducted with 13 patients and 5 carers. Participants perceived that living in a regional setting conferred advantages to the patient-centredness of care via influences at the levels of professional context, the doctor-patient relationship, and consultation. These influences included established and ongoing relationships with a smaller number of care providers who were members of the community, and heightened accessibility in terms of travel/parking, flexible appointments, and ample time spent with each patient. The first of these factors was also perceived to contribute to continuity of care between specialist and primary care providers. However, one negative case reported disagreement between providers and a difficulty accessing specialist pain services. Several participants also reported a preference, and unmet need, for non-pharmacological rather than pharmacological pain management.
While much research has focused on lack of services and poorer outcomes for people with cancer in rural areas, the Australian regional setting may offer benefits to the patient-centredness of cancer pain management and continuity of care. More research is needed to better understand the benefits and trade-offs of cancer care in regional versus urban settings, and how each can learn from the other. An unmet need for non-pharmacological rather than pharmacological pain management is among the most consistent findings of qualitative studies of patient/carer preferences across settings.
疼痛是癌症患者常见且令人痛苦的症状，需要采取以患者为中心的方法进行管理。自 2010 年以来，澳大利亚政府大力投资建设区域癌症中心，以改善癌症治疗效果。本研究探讨了区域性癌症中心的患者和照护者的护理体验，特别参考了癌症疼痛管理。
采用半结构式电话访谈的定性方法。参与者为新南威尔士州一家区域癌症中心的门诊患者，他们报告的疼痛评分最高为 10 分制的 2 分或以上，以及他们的照护者。问题探讨了疼痛评估和管理的体验，以及对这些体验如何受到区域环境影响的看法。研究人员使用演绎法分析数据，使用 Mead 和 Bower（2000 年）的影响以患者为中心的护理的因素框架。
对 13 名患者和 5 名照护者进行了 18 次电话访谈。参与者认为，生活在区域环境中通过专业背景、医患关系和咨询等方面的影响，为以患者为中心的护理带来了优势。这些影响包括与数量较少的、来自社区的护理提供者建立和维持长期关系，以及在旅行/停车、灵活预约和与每位患者充分交流方面提高了可及性。第一个因素也被认为有助于专科医生和初级保健提供者之间的护理连续性。然而，有一个负面案例报告了提供者之间的意见不合，以及难以获得专科疼痛服务。一些参与者还报告说，他们更喜欢非药物治疗而不是药物治疗来缓解疼痛，这也是他们的未满足需求。
虽然许多研究都集中在农村地区癌症患者服务不足和治疗效果较差的问题上，但澳大利亚的区域环境可能有利于癌症疼痛管理和护理连续性的以患者为中心。需要进一步研究以更好地了解区域和城市环境中癌症护理的优势和权衡，以及两者如何相互学习。在不同环境下的患者/照护者偏好的定性研究中，一致发现的一个未满足需求是更喜欢非药物治疗而不是药物治疗来缓解疼痛。
