Kibret Anteneh Ayelign, Wolde Haileab Fekadu, Molla Meseret Derbew, Aragie Hailu, Getnet Adugna Dagnew, Tafesse Ephrem, Melese Endalkachew Belayneh, Worku Yilkal Belete, Belay Daniel Gashaneh
Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
Front Pain Res (Lausanne). 2022 Aug 1;3:884253. doi: 10.3389/fpain.2022.884253. eCollection 2022.
Cancer pain is one of the most important deleterious and distressing symptoms suffered by patients with cancer which disturb their quality of life, especially in the last part of their life. Alleviating pain is a primary goal of prognosis of cancer pain management and pain symptoms must be prevented, treated as a priority, and considered an independent part of cancer management. Despite the presence of guidelines for cancer pain management, many patients with cancer are still undertreated. Therefore, this study aimed to assess factors associated with adherence to guidelines in cancer pain management among adult patients evaluated at the oncology unit, in the University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia.
An institution-based cross-sectional study was conducted from January to March 2021. All patients who were in cancer treatment were our population of interest. A systematic random sampling technique was used to select a total of 384 participants. The dependent variable of the study was adherence to guidelines in cancer pain management. It was determined using the pain management index (PMI) which was calculated by subtracting the pain level from the analgesics level. A negative range was considered an indicator of poor adherence to guidelines in cancer pain management. Bivariable and multivariable binary logistic regression analyses were performed. Adjusted odds ratio (AOR) with a 95% CI was used as a measure of association. Variables having < 0.05 from the multivariable analysis were considered to have a significant association with the outcome.
The prevalence of poor adherence to guidelines in cancer pain management among 384 adult patients in this study was 21.35% (95%CI: 17.53, 25.76). Patients who were not married [AOR = 2.2; 95%CI: 1.15, 4.19], who know their diagnosis before 4 months ago [AOR = 0.53; 95%CI: 0.26, 0.96], who have metastasis cancer [AOR = 3.76; 95%CI: 1.83, 7.72], and being stage III patients [AOR = 3.21; 95%CI: 1.64, 7.93] and stage IV patients [AOR = 1.63; 95%CI: 1.09, 5.81], respectively, had a significant association with poor adherence to guidelines in cancer pain management.
The prevalence of poor adherence to guidelines in cancer pain management among adult patients with cancer in UoGCSH Northwest Ethiopia is relatively low as compared with other studies. Factors such as patients who were not married and who have metastasis cancer, and being patients with stage III and stage IV cancer had a significant positive association with poor adherence to guidelines in cancer pain management, on the other hand, patients who know their diagnosis 4 months ago had a positive association with having adherence to guidelines in cancer pain management. Patients with high stage and metastasis need care from pain specialists early on in the diagnosis of pain. The hospital should reassure the diagnosis of cancer for the patient before they started the treatment.
癌症疼痛是癌症患者所遭受的最重要的有害且令人痛苦的症状之一，会干扰他们的生活质量，尤其是在生命的最后阶段。缓解疼痛是癌症疼痛管理预后的首要目标，疼痛症状必须得到预防、优先治疗，并被视为癌症管理的一个独立部分。尽管存在癌症疼痛管理指南，但许多癌症患者仍未得到充分治疗。因此，本研究旨在评估埃塞俄比亚西北部贡德尔大学综合专科医院肿瘤科室评估的成年患者中，与癌症疼痛管理指南依从性相关的因素。
2021年1月至3月进行了一项基于机构的横断面研究。所有正在接受癌症治疗的患者都是我们感兴趣的人群。采用系统随机抽样技术共选取384名参与者。该研究的因变量是癌症疼痛管理指南的依从性。它通过疼痛管理指数（PMI）来确定，PMI通过从镇痛水平中减去疼痛水平来计算。负范围被视为癌症疼痛管理指南依从性差的指标。进行了双变量和多变量二元逻辑回归分析。调整后的比值比（AOR）及其95%置信区间（CI）用作关联度量。多变量分析中P<0.05的变量被认为与结果有显著关联。
本研究中384名成年患者癌症疼痛管理指南依从性差的患病率为21.35%（95%CI：17.53，25.76）。未婚患者[AOR = 2.2；95%CI：1.15，4.19]、在4个月前知晓自己诊断结果的患者[AOR = 0.53；95%CI：0.26，0.96]、患有转移性癌症的患者[AOR = 3.76；95%CI：1.83，7.72]、III期患者[AOR = 3.21；95%CI：1.64，7.93]和IV期患者[AOR = 哪1.63；95%CI：1.09，5.81]，分别与癌症疼痛管理指南依从性差有显著关联。
与其他研究相比，埃塞俄比亚西北部贡德尔大学综合专科医院成年癌症患者癌症疼痛管理指南依从性差的患病率相对较低。未婚、患有转移性癌症以及III期和IV期癌症患者等因素与癌症疼痛管理指南依从性差有显著正相关，另一方面，在4个月前知晓自己诊断结果的患者与癌症疼痛管理指南依从性好有正相关。高分期和转移性患者在疼痛诊断早期就需要疼痛专科医生的护理。医院应在患者开始治疗前向其确认癌症诊断。
