癌症患者疼痛管理:新冠疫情期间实践经验教训:癌症护理提供者观点的定性研究。
Management of pain in cancer patients- lessons from practices during the COVID-19: a qualitative study of cancer care providers' perspectives.
机构信息
Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia.
Sydney Nursing School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia.
出版信息
BMC Health Serv Res. 2024 Feb 22;24(1):232. doi: 10.1186/s12913-024-10710-z.
BACKGROUND
The ongoing COVID-19 pandemic has impacted health systems globally and affected managing many chronic conditions, including cancer. This study aimed to explore the perceptions of multi-disciplinary cancer care providers on how cancer pain management was affected by the COVID-19 pandemic.
METHODS
Participants were eligible if they were cancer care providers of any specialty and discipline from two tertiary hospitals in Australia. Data were collected using semi-structured interviews to explore cancer care providers' perspectives on cancer pain management within COVID-19. Thematic analysis of interview transcripts used an integrated approach that started with inductive coding before coding deductively against a behaviour framework called the COM-B Model, which proposes that 'capability', 'motivation' and 'opportunity' are requisites for any behaviour.
RESULTS
Twenty-three providers participated. Five themes were developed and interpreted from the analysis of data, namely: "Telehealth enables remote access to cancer pain management but also created a digital divide", "Access to cancer pain management in the community is compromised due to the pandemic", "COVID-19 negatively impacts hospital resource allocation", "Patients were required to trade off cancer pain management against other health priorities" and "Hospital restrictions result in decreased social and psychological support for patients with cancer pain".
CONCLUSIONS
The landscape of cancer pain management in the Australian health system underwent substantial shifts during the COVID-19 pandemic, with lasting impacts. Cancer care providers perceived the pandemic to have significant adverse effects on pain management across multiple levels, with repercussions for patients experiencing cancer-related pain. A more adaptive health system model needs to be established in the future to accommodate vulnerable cancer patients.
背景
持续的 COVID-19 大流行对全球卫生系统产生了影响,并影响了许多慢性病的管理,包括癌症。本研究旨在探讨多学科癌症护理提供者对 COVID-19 如何影响癌症疼痛管理的看法。
方法
如果参与者是澳大利亚两家三级医院的任何专业和学科的癌症护理提供者,则有资格参加。使用半结构化访谈收集数据,以探讨癌症护理提供者对 COVID-19 期间癌症疼痛管理的看法。对访谈记录的主题分析采用了一种综合方法,首先是对称为 COM-B 模型的行为框架进行归纳编码,然后进行演绎编码,该模型提出“能力”、“动机”和“机会”是任何行为的必要条件。
结果
共有 23 名提供者参与。从数据分析中得出并解释了五个主题,即:“远程医疗使远程获取癌症疼痛管理成为可能,但也造成了数字鸿沟”、“由于大流行,社区获得癌症疼痛管理的机会受到损害”、“COVID-19 对医院资源配置产生负面影响”、“患者需要在癌症疼痛管理和其他健康优先事项之间做出权衡”和“医院限制导致癌症疼痛患者的社会和心理支持减少”。
结论
在 COVID-19 大流行期间,澳大利亚卫生系统的癌症疼痛管理格局发生了重大变化,并产生了持久的影响。癌症护理提供者认为大流行对多个层面的疼痛管理产生了重大不利影响,对患有癌症相关疼痛的患者产生了影响。未来需要建立一个更具适应性的卫生系统模型,以容纳弱势癌症患者。