Mayahara Masako, Wilbur JoEllen, Miller Arlene Michaels, Fogg Louis
Rush University, College of Nursing, Chicago, IL, United States of America.
University of Illinois at Chicago, Department of Occupational Therapy, Chicago, IL, United States of America.
Contemp Clin Trials Commun. 2023 Mar 9;36:101071. doi: 10.1016/j.conctc.2023.101071. eCollection 2023 Dec.
High pain intensity is commonly experienced by patients with serious advanced illness. Impediments to improving pain intensity in home hospice include poor adherence to a pain management regimen due to caregivers' lack of knowledge and self-efficacy (confidence) in administering analgesics. e-PainSupport is a self-administered, digital application directly linked to patients' medical records. It has three elements: Education Module, Patient Pain Record, and the Pain Summary for Nurses. This study will test the effects of e-PainSupport on pain intensity when used by patients, caregivers, and nurses. The study's specific aims are as follows: Aim 1, compare the effects of e-PainSupport to a standard care condition, controlling for covariates (role [patient or caregiver], age, sex, ethnicity, education, and patient's diagnosis), on clinical improvement in pain intensity (primary outcome) and significant improvement on a pain intensity scale (secondary outcome); Aim 2, examine the mediating effects of patient and caregiver knowledge, self-efficacy, and adherence on change in pain intensity during 2 weeks, controlling for covariates and treatment condition; and Aim 3, identify nurses' perceptions of the use of e-PainSupport, including facilitators for and barriers to integration into agency workflow and benefits for patients. Participants (132 triads of patients, caregivers, and hospice nurses) will be recruited from Midwest hospice agencies. Patient and caregiver outcomes will be assessed at baseline and 2 weeks later. Data will be analyzed with multilevel modeling. Post-intervention, semi-structured interviews with nurses in the e-PainSupport condition will be analyzed using qualitative content analysis to identify perceived practice changes. e-PainSupport has the potential to facilitate nurse-patient communication and improve hospice patient pain management.
患有严重晚期疾病的患者通常会经历高强度疼痛。在家居临终关怀中，改善疼痛强度存在诸多障碍，其中包括由于护理人员在使用镇痛药方面缺乏知识和自我效能感（信心），导致对疼痛管理方案的依从性较差。电子疼痛支持（e-PainSupport）是一种直接与患者病历相关联的自我管理数字应用程序。它有三个要素：教育模块、患者疼痛记录和护士疼痛总结。本研究将测试电子疼痛支持在患者、护理人员和护士使用时对疼痛强度的影响。该研究的具体目标如下：目标1，将电子疼痛支持的效果与标准护理条件进行比较，控制协变量（角色[患者或护理人员]、年龄、性别、种族、教育程度和患者诊断），以评估疼痛强度的临床改善情况（主要结果）和疼痛强度量表上的显著改善情况（次要结果）；目标2，在控制协变量和治疗条件的情况下，研究患者和护理人员的知识、自我效能感和依从性对2周内疼痛强度变化的中介作用；目标3，确定护士对使用电子疼痛支持的看法，包括整合到机构工作流程中的促进因素和障碍以及对患者的益处。参与者（132组患者、护理人员和临终关怀护士）将从中西部临终关怀机构招募。将在基线和2周后评估患者和护理人员的结果。数据将采用多层次建模进行分析。干预后，将使用定性内容分析对处于电子疼痛支持条件下的护士进行半结构化访谈，以确定感知到的实践变化。电子疼痛支持有可能促进护患沟通并改善临终关怀患者的疼痛管理。
