Shahid Anmol, Owen Victoria S, Sept Bonnie G, Longmore Shelly, Soo Andrea, Brundin-Mather Rebecca, Krewulak Karla D, Moss Stephana J, Plotnikoff Kara M, Gélinas Céline, Fiest Kirsten M, Stelfox Henry T
Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada.
Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Canada.
Pilot Feasibility Stud. 2022 Jul 16;8(1):147. doi: 10.1186/s40814-022-01102-3.
Patients in the intensive care unit (ICU) often have limited ability to communicate making it more difficult to identify and effectively treat their pain. Family caregivers or close friends of critically ill patients may be able to identify signs of pain before the clinical care team and could potentially assist in routine pain assessments. This study will adapt the Critical Care Pain Observation Tool (CPOT) for use by family members to create the CPOT-Fam and compare family CPOT-Fam assessments with nurse-provided CPOT assessments for a given patient.
This study will be executed in two phases: 1) Development of the CPOT-Fam - A working group of patient partners, ICU clinicians, and researchers will adapt the CPOT for use by family caregivers (creating the CPOT-Fam) and produce an accompanying educational module to deliver information on pain and how to use the tool. The CPOT-Fam will undergo preclinical testing with participants (i.e., members of the public and family caregivers of critically ill adults), who will complete the educational module and provide CPOT-Fam scores on sample cases. Feedback on the CPOT-Fam will be collected. 2) Pilot testing the CPOT - Fam family caregivers of critically ill adults will complete the educational module and provide information on the following: (1) demographics, (2) anxiety, (3) caregiving self-efficacy, and (4) satisfaction with care in the ICU. Family caregivers will then provide a proxy assessment of their critically ill loved one's pain through the CPOT-Fam and also provide a subjective (i.e., questionnaire-based including open-ended responses) account of their loved one's pain status. A comparison (i.e., agreement) will be made between family caregiver provided CPOT-Fam scores and ICU nurse-provided CPOT scores (collected from the provincial health information system), calculated independently and blinded to one another. Feasibility and acceptability of the CPOT-Fam will be determined.
The results of this work will produce a family caregiver CPOT (i.e., CPOT-Fam), determine feasibility and acceptability of the CPOT-Fam, and compare pain assessments conducted by family caregivers and ICU nurses. The results will inform whether a larger study to determine a role for family caregivers in ICU pain assessment using the CPOT-Fam is warranted.
重症监护病房（ICU）的患者沟通能力往往有限，这使得识别和有效治疗他们的疼痛变得更加困难。重症患者的家庭护理人员或亲密朋友可能能够在临床护理团队之前识别出疼痛迹象，并有可能协助进行常规疼痛评估。本研究将对重症监护疼痛观察工具（CPOT）进行调整，以供家庭成员使用，创建CPOT-Fam，并将家庭成员使用CPOT-Fam的评估结果与护士为特定患者提供的CPOT评估结果进行比较。
本研究将分两个阶段进行：1）CPOT-Fam的开发——患者合作伙伴、ICU临床医生和研究人员组成的工作组将对CPOT进行调整，以供家庭护理人员使用（创建CPOT-Fam），并制作一个配套的教育模块，提供有关疼痛以及如何使用该工具的信息。CPOT-Fam将在参与者（即公众和重症成年患者的家庭护理人员）中进行临床前测试，他们将完成教育模块，并对样本病例给出CPOT-Fam评分。将收集对CPOT-Fam的反馈。2）CPOT-Fam的试点测试——重症成年患者的家庭护理人员将完成教育模块，并提供以下信息：（1）人口统计学信息，（2）焦虑情况，（3）护理自我效能感，以及（4）对ICU护理的满意度。然后，家庭护理人员将通过CPOT-Fam对其重症亲人的疼痛进行代理评估，并提供关于其亲人疼痛状况的主观（即基于问卷，包括开放式回答）描述。将对家庭护理人员提供的CPOT-Fam评分与ICU护士提供的CPOT评分（从省级卫生信息系统收集）进行比较（即一致性比较），两者独立计算且相互不知情。将确定CPOT-Fam的可行性和可接受性。
这项工作的结果将产生一个家庭护理人员CPOT（即CPOT-Fam），确定CPOT-Fam的可行性和可接受性，并比较家庭护理人员和ICU护士进行的疼痛评估。这些结果将为是否有必要开展一项更大规模的研究以确定家庭护理人员在使用CPOT-Fam进行ICU疼痛评估中的作用提供依据。
