一项评估针对门诊患者的癌症疼痛自我管理干预措施的随机临床试验。
Randomized clinical trial to evaluate a cancer pain self-management intervention for outpatients.
作者信息
Valenta Sabine, Miaskowski Christine, Spirig Rebecca, Zaugg Kathrin, Denhaerynck Kris, Rettke Horst, Spichiger Elisabeth
机构信息
Nursing Science, Department Public Health, University of Basel, Basel, Switzerland.
Department Theragnostik, Hematology, University Hospital Basel, Basel, Switzerland.
出版信息
Asia Pac J Oncol Nurs. 2022 Jan 21;9(1):39-47. doi: 10.1016/j.apjon.2021.12.003. eCollection 2022 Jan.
OBJECTIVE
Unrelieved pain is common in patients with advanced cancer. Although psychoeducational interventions were found to decrease pain, effects were moderate. The purpose of this study was to evaluate the efficacy of a pain self-management intervention compared with usual care and to explore participants' experiences with pain management and study participation.
METHODS
A multicenter randomized controlled trial design with post-trial interviews was used. Outpatients with cancer pain and their family caregivers were recruited from three Swiss university hospitals. The intervention group (IG) received the six-week intervention consisting of education, skills building, and nurse coaching. The control group (CG) received usual care. Outcome variables were analyzed using multilevel models. Interpretive description guided the qualitative study part.
RESULTS
Twenty-one patients with advanced cancer and seven family caregivers completed the study. The group x time effect showed a statistically significant decrease in average pain ( = 0.04), but no significant group x time effect for worst pain ( = 0.06). Pain scores, pain-related knowledge, Pain Management Index, self-efficacy, and performance status improved in the IG ( < 0.05). Almost all of the interviewed participants perceived the pain management diary, tailored intervention sessions, and weekly support as useful. None experienced study participation as burdensome.
CONCLUSIONS
This study was the first to test the efficacy of a psychoeducational cancer pain self-management intervention in a German-speaking context, with most patients receiving palliative care. Clinicians can recommend the use of pain management diaries. Tailoring interventions to an individual's situation and dynamic pain trajectory may improve patients' pain self-management.
REGISTRATION NUMBER
This study has been registered via ClinicalTrials.gov: NCT02713919.https://clinicaltrials.gov/ct2/show/NCT02713919?term=NCT02713919&draw=2&rank=1.
目的
晚期癌症患者中，疼痛未得到缓解的情况很常见。尽管心理教育干预被发现可减轻疼痛，但其效果中等。本研究的目的是评估疼痛自我管理干预与常规护理相比的疗效，并探讨参与者在疼痛管理和研究参与方面的经历。
方法
采用多中心随机对照试验设计，并进行试验后访谈。从瑞士的三家大学医院招募了患有癌症疼痛的门诊患者及其家庭护理人员。干预组（IG）接受为期六周的干预，包括教育、技能培养和护士指导。对照组（CG）接受常规护理。使用多层次模型分析结果变量。解释性描述指导定性研究部分。
结果
21名晚期癌症患者和7名家庭护理人员完成了研究。组×时间效应显示平均疼痛有统计学显著下降（P = 0.04），但最严重疼痛无显著组×时间效应（P = 0.06）。干预组的疼痛评分、疼痛相关知识、疼痛管理指数、自我效能和功能状态均有所改善（P < 0.05）。几乎所有接受访谈的参与者都认为疼痛管理日记、量身定制的干预课程和每周的支持很有用。没有人觉得参与研究是负担。
结论
本研究首次在德语环境中测试了心理教育癌症疼痛自我管理干预的疗效，大多数患者接受姑息治疗。临床医生可以推荐使用疼痛管理日记。根据个体情况和动态疼痛轨迹量身定制干预措施可能会改善患者的疼痛自我管理。
注册号
本研究已在ClinicalTrials.gov注册：NCT02713919。https://clinicaltrials.gov/ct2/show/NCT02713919?term=NCT02713919&draw=2&rank=1
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