Janjan N A, Martin C G, Payne R, Dahl J L, Weissman D E, Hill C S
Department of Radiotherapy, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Cancer. 1996 Mar 1;77(5):996-1001.
Inadequate management of cancer related pain has resulted primarily from attitudinal barriers and a lack of knowledge about clinical assessment, the administration of analgesics, and therapeutic interventions.
Fifty health-care providers (13 physicians, 21 nurses, and 16 pharmacists), working as a team, participated in a Role Model Program that presented principles of cancer pain management. A questionnaire that evaluated the fund of knowledge and attitudes regarding cancer pain management was administered prior to the 1-day workshop, at the end of the workshop, and at 4 and 12 months follow-up. The workshop consisted of lectures and discussion groups; in the discussion groups, concepts were clarified, cases presented, and barriers to optimal cancer pain management identified.
Significant improvements in attitudes (P < 0.01), knowledge (P < 0.01), and total scores (P < 0.002) were observed when the preworkshop responses were compared with those obtained immediately after instruction. Scores on the questionnaire were the same or slightly better at both 4 and 12 months in follow-up, demonstrating no loss in acquired knowledge or attitude. Comparison of the postworkshop scores with those at 12 months follow-up were significantly better in attitude (P < 0.03), and in total score (P < 0.01); improvements in knowledge also approached significance (p < 0.06). These represented continuing improvements because significant differences in the attitude scores (P < 0.05) and the total score (P < 0.05) were observed when the 4-month and 12-month follow-up responses were evaluated. The effectiveness of the program in the transference of knowledge was also measured; in the first year of the program, more than 4500 health-care professionals were subsequently informed about cancer pain management from the Role Model Participants.
Significant improvements were observed immediately in both attitude and knowledge of cancer pain management principles after the 1-day Role Model Workshop. These improvements continued, as determined at 4 and 12 months follow-up. The Role Model Participants were highly motivated to share the learned principles of cancer pain management with other health-care professionals. These results are consistent with other Role Model Programs that both instruct and involve the participants. The Role Model Program is an efficient and effective means of educating health-care professionals in the concepts of cancer pain management.
癌症相关疼痛管理不善主要源于态度障碍以及对临床评估、镇痛药给药和治疗干预措施缺乏了解。
五十名医疗保健提供者（13名医生、21名护士和16名药剂师）作为一个团队参与了一个展示癌症疼痛管理原则的榜样计划。在为期一天的研讨会之前、研讨会结束时以及4个月和12个月随访时，发放了一份评估癌症疼痛管理知识储备和态度的问卷。研讨会包括讲座和讨论小组；在讨论小组中，对概念进行了澄清，展示了案例，并确定了最佳癌症疼痛管理的障碍。
将研讨会前的回答与授课后立即获得的回答进行比较时，观察到态度（P < 0.01）、知识（P < 0.01）和总分（P < 0.002）有显著改善。在4个月和12个月随访时，问卷得分相同或略高，表明所学知识和态度没有丧失。将研讨会后的得分与12个月随访时的得分进行比较，态度（P < 0.03）和总分（P < 0.01）有显著提高；知识方面的改善也接近显著水平（P < 0.06）。这些代表着持续的改善，因为在评估4个月和12个月随访回答时，态度得分（P < 0.05）和总分（P < 0.05）存在显著差异。还衡量了该计划在知识传授方面的有效性；在该计划的第一年，随后有超过4500名医疗保健专业人员从榜样参与者那里了解到癌症疼痛管理知识。
在为期一天的榜样研讨会之后，癌症疼痛管理原则的态度和知识立即有了显著改善。如在4个月和12个月随访时所确定的，这些改善持续存在。榜样参与者有很高的积极性与其他医疗保健专业人员分享所学的癌症疼痛管理原则。这些结果与其他既授课又让参与者参与的榜样计划一致。榜样计划是一种在癌症疼痛管理概念方面教育医疗保健专业人员的高效且有效的手段。
