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癌症幸存者慢性疼痛的管理:癌症幸存者所描述的沟通挑战与机遇

Managing Chronic Pain in Cancer Survivorship: Communication Challenges and Opportunities as Described by Cancer Survivors.

作者信息

O'Regan Amy, Fish Laura J, Makarushka Christina, Somers Tamara, Fitzgerald Jones Katie, Merlin Jessica S, Dinan Michaela, Oeffinger Kevin, Check Devon

机构信息

Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.

Duke Cancer Institute, Duke University Health System, Durham, NC, USA.

出版信息

Am J Hosp Palliat Care. 2024 Jan;41(1):78-86. doi: 10.1177/10499091231164634. Epub 2023 Mar 17.

Abstract

OBJECTIVES

Many cancer survivors experience chronic pain after completing curative-intent treatment. Based on available data, chronic pain may be undertreated in this context; however, little is known about cancer survivors' experiences with clinical management of chronic pain. The purpose of this study was to better understand cancer survivors' pain management experiences after curative-intent treatment.

METHODS

We conducted 13 semi-structured interviews with a convenience sample of cancer survivors who had completed treatment for stage I-III breast, head/neck, lung or colorectal cancer. We used a thematic approach to qualitative data analysis.

RESULTS

Participants described that chronic pain often goes unrecognized by their providers, potentially due to limitations in how pain is assessed clinically and the tendency of both cancer survivors and providers to minimize or invalidate the pain experience. To improve communication, participants suggested that providers ask more open-ended questions about their pain, help them to establish functional goals, and provide patients with options for pain management.

SIGNIFICANCE OF RESULTS

This study demonstrates the importance of provider-initiated communication around pain management for cancer survivors to make them feel more supported in their care. Communication and shared decision-making interventions may improve cancer survivor-provider communication around chronic pain management, addressing an important gap in survivorship care.

摘要

目的

许多癌症幸存者在完成根治性治疗后会经历慢性疼痛。根据现有数据,在此背景下慢性疼痛可能未得到充分治疗;然而,对于癌症幸存者在慢性疼痛临床管理方面的经历知之甚少。本研究的目的是更好地了解癌症幸存者在根治性治疗后的疼痛管理经历。

方法

我们对完成I - III期乳腺癌、头颈癌、肺癌或结直肠癌治疗的癌症幸存者便利样本进行了13次半结构化访谈。我们采用主题分析法对定性数据进行分析。

结果

参与者表示,他们的医护人员常常未认识到慢性疼痛,这可能是由于临床疼痛评估存在局限性,以及癌症幸存者和医护人员都倾向于淡化或忽视疼痛体验。为了改善沟通,参与者建议医护人员就他们的疼痛提出更多开放式问题,帮助他们确立功能目标,并为患者提供疼痛管理的选择。

结果的意义

本研究表明,医护人员主动围绕疼痛管理进行沟通对于癌症幸存者至关重要,能让他们在护理中感受到更多支持。沟通和共同决策干预可能会改善癌症幸存者与医护人员围绕慢性疼痛管理的沟通,填补 survivorship care 中的一个重要空白。

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