Siaton Bernadette C, Hogans Beth B, Frey-Law Laura A, Brown Lana M, Herndon Christopher M, Buenaver Luis F
Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.
Geriatric Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD, United States.
Front Pain Res (Lausanne). 2024 Feb 22;5:1254792. doi: 10.3389/fpain.2024.1254792. eCollection 2024.
Pain is highly prevalent in older adults and often contextualized by multiple clinical conditions (pain comorbidities). Pain comorbidities increase with age and this makes clinical decisions more complex. To address gaps in clinical training and geriatric pain management, we established the Pain in Aging-Educational Assessment of Need (PAEAN) project to appraise the impacts of medical and mental health conditions on clinical decision-making regarding older adults with pain. We here report development and pilot testing of the PAEAN survey instrument to assess clinician perspectives.
Mixed-methods approaches were used. Scoping review methodology was applied to appraise both research literature and selected Medicare-based data. A geographically and professionally diverse interprofessional advisory panel of experts in pain research, medical education, and geriatrics was formed to advise development of the list of pain comorbidities potentially impacting healthcare professional clinical decision-making. A survey instrument was developed, and pilot tested by diverse licensed healthcare practitioners from 2 institutions. Respondents were asked to rate agreement regarding clinical decision-making impact using a 5-point Likert scale. Items were scored for percent agreement.
Scoping reviews indicated that pain conditions and comorbidities are prevalent in older adults but not universally recognized. We found no research literature directly guiding pain educators in designing pain education modules that mirror older adult clinical complexity. The interprofessional advisory panel identified 26 common clinical conditions for inclusion in the pilot PAEAN instrument. Conditions fell into three main categories: "major medical", i.e., cardio-vascular-pulmonary; metabolic; and neuropsychiatric/age-related. The instrument was pilot tested by surveying clinically active healthcare providers, e.g., physicians, nurse practitioners, who all responded completely. Median survey completion time was less than 3 min.
This study, developing and pilot testing our "Pain in Aging-Educational Assessment of Need" (PAEAN) instrument, suggests that 1) many clinical conditions impact pain clinical decision-making, and 2) surveying healthcare practitioners about the impact of pain comorbidities on clinical decision-making for older adults is highly feasible. Given the challenges intrinsic to safe and effective clinical care of older adults with pain, and attendant risks, together with the paucity of existing relevant work, much more education and research are needed.
疼痛在老年人中极为普遍，且常与多种临床病症（疼痛合并症）相关。疼痛合并症会随着年龄增长而增加，这使得临床决策变得更加复杂。为了填补临床培训和老年疼痛管理方面的空白，我们设立了“老年疼痛——教育需求评估”（PAEAN）项目，以评估医疗和心理健康状况对老年疼痛患者临床决策的影响。我们在此报告PAEAN调查问卷的开发及预测试情况，以评估临床医生的观点。
采用混合方法。运用范围综述方法来评估研究文献和选定的基于医疗保险的数据。组建了一个由疼痛研究、医学教育和老年医学领域专家组成的跨专业咨询小组，其成员在地域和专业上具有多样性，旨在为可能影响医疗保健专业人员临床决策的疼痛合并症清单的制定提供建议。开发了一份调查问卷，并由来自2个机构的不同持牌医疗从业者进行预测试。要求受访者使用5点李克特量表对临床决策影响的认同程度进行评分。对各项目的认同百分比进行计分。
范围综述表明，疼痛病症和合并症在老年人中普遍存在，但并未得到普遍认识。我们未发现有研究文献直接指导疼痛教育工作者设计反映老年临床复杂性的疼痛教育模块。跨专业咨询小组确定了26种常见临床病症纳入PAEAN预测试工具。这些病症主要分为三大类：“主要医疗类”，即心血管 - 肺部疾病；代谢性疾病；以及神经精神/与年龄相关的疾病。该工具通过对临床活跃的医疗服务提供者（如医生、执业护士）进行调查来进行预测试，他们均完整回复。调查问卷的中位完成时间不到3分钟。
本研究开发并预测试了我们的“老年疼痛——教育需求评估”（PAEAN）工具，表明1）许多临床病症会影响疼痛临床决策，2）就疼痛合并症对老年患者临床决策的影响对医疗从业者进行调查是高度可行的。鉴于对老年疼痛患者进行安全有效的临床护理存在内在挑战及相关风险，同时现有相关工作匮乏，因此需要更多的教育和研究。
