Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
Washington University in St Louis School of Medicine, St Louis, MO, USA.
Am J Hosp Palliat Care. 2024 Jun;41(6):619-633. doi: 10.1177/10499091231191114. Epub 2023 Jul 25.
Assessing and managing hospice patients' pain is a common source of anxiety among hospice family caregivers (HFCGs), especially caregivers in rural communities who face special challenges including distance, limited access, and concerns about opioid misuse.
To pilot test , a pain management education intervention for rural HFCGs. We sought to determine whether there was a signal of benefit for clinically-relevant outcomes and to identify contextual factors pertinent to conducting a future randomized clinical trial of .
We conducted a multi-method, single-arm study, enabling completion of paired t-tests comparing pre- and post-intervention measures of caregiver anxiety, pain management self-efficacy, barriers to pain management, and reports of patient pain intensity and corresponding patient and caregiver distress. We concurrently conducted an embedded implementation evaluation via calculation of descriptive statistics (recruitment and retention data) and directed content analysis of brief caregiver interviews.
Twenty-seven (n = 27) HFCGs participated; 15 completed the study. Among completers, significant improvement was observed in patient pain intensity (average 1.4 points decrease on 0-10 scale) and in overall pain experience. No statistically significant changes were detected in caregiver anxiety, barriers to pain management, or pain management self-efficacy. Facilitators to successful conduct of a future clinical trial included high acceptability of , driven by its perceived clarity and relevance to caregivers' concerns. Barriers included lower-than-anticipated accrual and an attrition rate of nearly 44%.
A multisite clinical trial of is warranted; however, its success may require more effective recruitment and retention strategies for rural caregiver participants.
评估和管理临终关怀患者的疼痛是临终关怀家庭照顾者（HFCG）普遍感到焦虑的一个常见原因，尤其是在农村社区的照顾者，他们面临着特殊的挑战，包括距离、有限的资源和对阿片类药物滥用的担忧。
试点测试 ，一种针对农村 HFCG 的疼痛管理教育干预措施。我们试图确定是否有临床相关结果的获益信号，并确定与未来 的随机临床试验相关的背景因素。
我们进行了一项多方法、单臂研究，使我们能够完成配对 t 检验，比较干预前后照顾者焦虑、疼痛管理自我效能、疼痛管理障碍以及患者疼痛强度和相应患者和照顾者痛苦报告。我们同时通过计算描述性统计数据（招募和保留数据）和对简短照顾者访谈的定向内容分析，进行了嵌入式实施评估。
27 名（n = 27）HFCG 参与；15 名完成了研究。在完成者中，患者疼痛强度（0-10 量表上平均下降 1.4 分）和整体疼痛体验显著改善。照顾者焦虑、疼痛管理障碍或疼痛管理自我效能感没有统计学上的显著变化。未来临床试验成功进行的促进因素包括对 的高度可接受性，这是由其对照顾者关注的明显相关性和相关性驱动的。障碍包括入组率低于预期和近 44%的失访率。
有必要进行 的多中心临床试验；然而，其成功可能需要针对农村照顾者参与者制定更有效的招募和保留策略。
