Hospice Pain Control: Developing an Opioid Order Sheet

临终关怀疼痛控制：制定阿片类药物订单表

• 批准号: 7121936
• 负责人: Barbara A. Murphy
• 金额: $ 14.46万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-13 至 2009-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7121936
• 关键词: behavioral /social science research tag; cancer pain; clinical research; dosage; drug administration rate /duration; health care model; health services research tag; hospices; human subject; model design /development; opiate alkaloid; patient oriented research; terminal patient care

DESCRIPTION (provided by applicant): Despite the availability of effective pharmaceutical agents, pain is a common and often devastating symptom control problem at end-of-life. We have formulated a model that describes "criteria for adequate pain control" in the outpatient oncology setting. Based on this theoretical model, we have developed a protocol which is testing an opioid titration order sheet structured to provide clear direction for three critical provider behaviors: (1) pain assessment, (2) generation of a treatment plan, and (3) communication of the treatment plan to the patient. The use of a similar order sheet may enhance pain control in the hospice setting; however, the needs and potential barriers to adequate pain control within the hospice setting are unique and largely uninvestigated. Furthermore, the burden imposed by the current clinical protocol on patients and caregivers is excessive for the hospice setting and the primary endpoints are not appropriate to the terminal patient population. Hospice specific factors which may affect pain outcome and/or require alterations in the clinical protocol include: (1) the increasing role of caregivers, (2) the shift to home based care, (3) introduction of hospice staff as part of the health care team, (4) the decreasing role of the primary care team and (5) medical complications of the disease process. Thus, modification of the theoretical model, the opioid titration order sheet, and the protocol, will be necessary in order to test this intervention in the hospice population. Using a mixed methods approach, we propose to identify the unique needs and barriers for pain control in the hospice setting as identified by key stakeholders (patients, caregivers, hospice staff and referring physicians). Based on these data we will modify the theoretical model, the order sheet and the protocol. Once the modifications lave been made, we will conduct a pilot study to assess feasibility, utility and efficacy of the order sheet in the outpatient hospice setting.

描述（由申请人提供）：尽管有效的药物可用，但疼痛是一种常见且经常毁灭性的症状控制问题。我们制定了一个模型，该模型描述了门诊肿瘤设置中的“足够疼痛控制标准”。基于这个理论模型，我们开发了一项方案，该方案正在测试阿片类药物滴定订单，该订单构成了为三种关键提供者行为提供明确方向的方向：（1）疼痛评估，（2）生成治疗计划，以及（3）治疗计划与患者进行交流。使用类似的订单表可以增强临终关怀环境中的疼痛控制；但是，在临终关怀环境中进行适当疼痛控制的需求和潜在障碍是独特的，并且在很大程度上没有被评估。此外，当前临床方案对患者和护理人员施加的负担对于临终关怀的设置过大，主要终点不适合终末患者人群。临床方案中可能影响疼痛结果和/或需要改变的临终关怀因素包括：（1）护理人员的作用增加，（2）转移到家庭护理的转变，（3）将临终关怀人员引入医疗团队的一部分，（4）初级保健团队的作用下降和（5）疾病过程的医疗复杂性。因此，为了在临终关怀人群中测试这种干预措施，需要修改理论模型，阿片类药物滴定顺序和方案。我们建议使用混合方法，以确定主要利益相关者（患者，护理人员，临终关怀人员和参考医师）确定的临终关怀环境中疼痛控制的独特需求和障碍。基于这些数据，我们将修改理论模型，顺序表和协议。一旦进行了修改，我们将进行一项试点研究，以评估门诊临终关怀环境中订单表的可行性，实用性和功效。