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[医疗保健危机对癌症疼痛治疗的影响:从提供者角度以2019年冠状病毒病大流行为例的阐述]

[Influence of health care crises on the treatment of cancer pain: a presentation using the example of the COVID-19 pandemic from the provider's perspective].

作者信息

Dombrowski Frederik, Wirz Stefan, Hofbauer Hannes, Kowark Pascal, Erlenwein Joachim, Stamer Ulrike, Kieselbach Kristin

机构信息

Zentrum für Orthopädie, Unfallchirurgie und Sportmedizin, Gemeinschaftskrankenhaus Bonn, Bonner Talweg 4-6, 53113, Bonn, Deutschland.

Cura Krankenhaus - eine Betriebsstätte der GFO Kliniken Bonn, Abteilung für Anästhesie, Intensivmedizin, Schmerzmedizin/Palliativmedizin - Zentrum für Schmerzmedizin, Weaningzentrum, Schülgenstr. 15, 53604, Bad Honnef, Deutschland.

出版信息

Schmerz. 2024 Sep 5. doi: 10.1007/s00482-024-00826-w.

Abstract

BACKGROUND

The COVID-19 pandemic led to significantly restricted access to pain medicine services. Patients with cancer-related pain are considered a vulnerable group in terms of care deficits. A questionnaire among providers providing treatment to this group was used to assess limitations and solutions in this critical situation.

MATERIALS AND METHODS

The online survey, developed by the 'Tumour Pain Working Group' of the German Pain Society using the Delphi method, included questions on site structure, pandemic-related care problems, and burdens experienced by those treating patients. It was distributed several times via the mailing lists of the German Pain Society and the 'Palliative Medicine Working Group' of the German Society of Anaesthesiology and Intensive Care Medicine.

RESULTS

In all, 175 fully completed questionnaires were analysed. Over 75% of participants reported pandemic-related staff shortages and closures of pain medicine facilities, with 32% of facilities temporarily not treating elective pain patients and 13% not treating any emergencies. Care was hampered by numerous logistical problems such as very frequent pandemic-related cancellations by patients or in the transmission of prescriptions. Alternative forms of consultation by telephone or telemedicine, rarely used before the pandemic, were reported by 79 and 31% of respondents respectively, but deficiencies were noted. In addition, 52.1% of respondents complained of severe and 26.8% of moderate psychological stress due to the pandemic, and 74.1% evaluated working conditions as moderately to severely difficult. Medical training was still possible for 86% through format changes.

CONCLUSION

The COVID-19 pandemic revealed numerous deficits in the care of patients with cancer-related pain, as well as burdens on healthcare providers. The development of new concepts could help to ensure better care in future crisis situations.

摘要

背景

新冠疫情导致疼痛医学服务的获取受到显著限制。癌症相关疼痛患者在护理不足方面被视为弱势群体。通过对为该群体提供治疗的医护人员进行问卷调查,以评估这一危急情况下的限制因素和解决方案。

材料与方法

德国疼痛协会的“肿瘤疼痛工作组”采用德尔菲法开发的在线调查问卷,涵盖了关于机构结构、疫情相关护理问题以及治疗患者的人员所经历的负担等问题。该问卷通过德国疼痛协会和德国麻醉与重症医学学会的“姑息医学工作组”的邮件列表多次分发。

结果

共分析了175份完整填写的问卷。超过75%的参与者报告了与疫情相关的人员短缺和疼痛医学设施关闭的情况,32%的机构暂时不治疗择期疼痛患者,13%的机构不治疗任何急诊患者。护理工作受到诸多后勤问题的阻碍,如患者因疫情频繁取消预约或处方传递方面的问题。分别有79%和31%的受访者报告了在疫情之前很少使用的电话或远程医疗等替代咨询形式,但也指出了其中存在的不足。此外,52.1%的受访者抱怨因疫情导致严重的心理压力,26.8%的受访者抱怨有中度心理压力,74.1%的受访者认为工作条件为中度至重度困难。通过改变形式,86%的人仍可接受医学培训。

结论

新冠疫情揭示了癌症相关疼痛患者护理方面的诸多不足以及医护人员所承受的负担。开发新的理念有助于在未来危机情况下确保更好的护理。

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