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癌症患者在接受住院专科姑息治疗服务时的疼痛管理。

Cancer Pain Management in Patients Receiving Inpatient Specialized Palliative Care Services.

机构信息

Department of Palliative Medicine (K.T., Y.H., T.I., A.I.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.

Division of Biostatistics (S-W.C., M.S., T.Y.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.

出版信息

J Pain Symptom Manage. 2024 Jan;67(1):27-38.e1. doi: 10.1016/j.jpainsymman.2023.09.015. Epub 2023 Sep 18.

Abstract

CONTEXT

Cancer pain is a common complication that is frequently undertreated in patients with cancer.

OBJECTIVES

This study is aimed at assessing the time needed to achieve cancer pain management goals through specialized palliative care (SPC).

METHODS

This was a multicenter, prospective, longitudinal study of inpatients with cancer pain who received SPC. Patients were continuously followed up until they considered cancer pain management successful, and we estimated this duration using the Kaplan-Meier method. We investigated the effectiveness of pain management using multiple patient-reported outcomes (PROs) and quantitative measures, including pain intensity change in the Brief Pain Inventory. A paired-sample t-test was used to compare the pain intensity at the beginning and end of the observation period.

RESULTS

Cancer pain management based on the PROs was achieved in 87.9% (385/438) of all cases. In 94.5% (364/385) of these cases, cancer pain management was achieved within 1 week, and the median time to pain management was 3 days (95% confidence interval [CI], 2-3). The mean worst pain intensity in the last 24 h at the start and end of observation were 6.9 ± 2.2 and 4.0 ± 2.3, respectively, with a difference of -2.9 (95% CI, -3.2 to -2.6; p < 0.01). Overall, 81.6% of the patients reported satisfaction with cancer pain management, and 62 adverse events occurred.

CONCLUSION

SPC achieved cancer pain management over a short period with a high level of patient satisfaction resulting in significant pain reduction and few documented adverse events.

摘要

背景

癌症疼痛是一种常见的并发症,在癌症患者中经常得不到充分治疗。

目的

本研究旨在评估通过专门的姑息治疗(SPC)实现癌症疼痛管理目标所需的时间。

方法

这是一项多中心、前瞻性、纵向研究,纳入了接受 SPC 的癌症疼痛住院患者。对患者进行持续随访,直到他们认为癌症疼痛管理成功,我们使用 Kaplan-Meier 方法估计这一持续时间。我们使用多种患者报告结局(PROs)和定量测量来评估疼痛管理的效果,包括简明疼痛量表中的疼痛强度变化。采用配对样本 t 检验比较观察期开始和结束时的疼痛强度。

结果

根据 PROs,所有病例中有 87.9%(385/438)实现了癌症疼痛管理。在这些病例中有 94.5%(364/385)在 1 周内实现了癌症疼痛管理,疼痛管理的中位时间为 3 天(95%置信区间 [CI],2-3)。观察开始和结束时最后 24 小时内的平均最差疼痛强度分别为 6.9±2.2 和 4.0±2.3,差异为-2.9(95% CI,-3.2 至-2.6;p<0.01)。总体而言,81.6%的患者对癌症疼痛管理表示满意,发生了 62 例不良事件。

结论

SPC 在短时间内实现了癌症疼痛管理,患者满意度高,疼痛显著减轻,记录的不良事件很少。

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