Managing Acute Pain in Critically Ill Non-communicative Palliative Care Patients

危重非沟通姑息治疗患者的急性疼痛管理

• 批准号: 8525460
• 负责人: DEBORAH B. MCGUIRE
• 金额: $ 47.03万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-07 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8525460
• 关键词: Acute; Acute Pain; Address; Adverse effects; Algorithms; Analgesics; Behavioral; Build-it; Caring; Clinical; Clinical Data; Control Groups; Coupling; Critical Illness; Data; Diagnosis; Dimensions; Experimental Designs; Frequencies; Gold; Health Professional; Hospitals; Individual; Inpatients; Intensive Care Units; Intervention; Knowledge; Life; Linear Models; Measurement; Measures; Medical; Medication Management; Methods; Modeling; Nurses; Operative Surgical Procedures; Outcome; Pain; Pain Assessment Tool; Pain Measurement; Pain Research; Pain management; Palliative Care; Patient Self-Report; Patients; Pattern; Peer Review; Perception; Pharmaceutical Preparations; Phase; Physiological; Population; Property; Protocols documentation; Psychometrics; Quality Indicator; Quality of Care; Quality of life; Questionnaires; Reporting; Research; Research Personnel; Severities; Specific qualifier value; Structure; Techniques; Testing; Time; Titrations; Training; Trauma; United States National Institutes of Health; Universities; Validity and Reliability; base; clinical practice; cohort; design; dosage; experience; high risk; hospice environment; improved; innovation; instrument; neglect; public health relevance; response; sound; theories; treatment as usual

DESCRIPTION (provided by applicant): This project responds to PA-10-006 Mechanisms, Models, Measurement, & Management in Pain Research (R01). Acutely ill hospitalized palliative care patients who cannot self-report the presence or intensity of their pain are at high risk for under-recognition and under-treatment of pain, experiencing needless suffering and other adverse effects. Across the settings in which palliative care is rendered, there is a dearth of reliable and valid measures for assessing pain in these non-communicative patients, and few standardized protocols or algorithms have been tested for their effects on patients' outcomes. Our recently completed project (5 R01NR009684) tested the psychometric properties and clinical utility of the Multidimensional Objective Pain Assessment Tool (MOPAT) in assessing acute pain in non-communicative palliative care patients, demonstrating strong evidence of validity, reliability, and clinical utility when used regularly over time by trained nurses in critcally ill non-communicative patients. The primary aim of the proposed research is to test whether a pain algorithm that incorporates the MOPAT and an analgesic order set improves pain severity and use of pharmacologic pain management strategies in critically ill non-communicative palliative care patients who are hospitalized on medical, surgical, and trauma intensive care units when compared to patients without the algorithm. We hypothesize: (H1) a decrease in pain severity, (H2) an increase in the number of pharmacologic agents used for pain, and (H3) an increase in the total equi-analgesic dosage of pharmacologic agents used for pain as a result of implementation of the pain algorithm. The secondary descriptive aims are to (S1) Compare pain-related outcomes in patients with and without concurrent pain-related conditions, (S2) Describe the pattern of patients' pain over time, and (S3) Evaluate nurses' perceptions of clinical utility of the pain algorithm. We will use a cohort control group quasi-experimental design conducted in two phases on the medical, surgical, and trauma intensive care units of a major university acute care hospital. In Phase 1 (usual care control cohort n=150 patients), the MOPAT will be incorporated into routine clinical practice and data on pain severity and use of pharmacologic pain management strategies collected. In Phase 2 (intervention cohort n=150 patients), a pain algorithm incorporating MOPAT scores into an analgesic order set will be implemented in routine clinical practice and the same patient outcome data plus nurses' perceptions of clinical utility of the algorithm (including the MOPAT) will be collected. Analysis f the primary aim and its associated hypotheses will be accomplished using the interaction F-test from 2x4 repeated measures analysis or mixed linear modeling and Cochran's Q for 2x2 repeated measures on rank data. Descriptive approaches will be used for the secondary aims, including repeated measures analysis with post-hoc analyses if there are significant interaction effects, graphic techniques (e.g., spaghetti plots) to identify sub-groups, and frequency distributions for responses to questionnaires. This research is significant and innovative because it tests a pain algorithm using an instrument validated in non-communicative patients to guide pain management and improve pain- related outcomes in this vulnerable and understudied population.

描述（由申请人提供）：该项目对PA-10-006疼痛研究中的机制，模型，测量和管理（R01）响应。无法自我报告的疼痛的存在或强度的急性病住院治疗患者对识别不足和治疗疼痛的高风险，疼痛不足，遭受不必要的痛苦和其他不利影响。在提供姑息治疗的整个环境中，缺乏可靠且有效的措施来评估这些非交流性患者的疼痛，并且很少对其对患者结果的影响进行测试。我们最近完成的项目（5 R01NR009684）测试了多维客观疼痛评估工具（MOPAT）的心理测量特性和临床实用性，以评估评估非交流性姑息治疗患者的急性疼痛，证明了有效性，可靠性和临床效用的强烈证据经过训练的护士经常在无数疾病的非交流患者中受过训练的护士。拟议研究的主要目的是测试纳入莫帕特和镇痛序列的疼痛算法是否可以改善疼痛的严重程度，并在严重恶性病的非交流性姑息治疗患者中使用药理学疼痛管理策略，这些患者在医疗，外科医学，外科手术，外科医学，外科医学，，与没有算法的患者相比，与创伤重症监护病房相比。我们假设：（H1）疼痛严重程度的降低，（H2）用于疼痛的药理学剂数量增加，（H3）（H3）由于药物治疗药物的总等化剂量增加而导致用于疼痛的药理剂疼痛算法的实施。次级描述性目的是（S1）比较有或没有并发疼痛相关病情的患者中与疼痛相关的结局，（S2）描述了患者随时间疼痛的模式，（S3）评估护士对临床的看法 疼痛算法的效用。我们将使用一个队列对照组的准实验设计，该设计在大型大学急诊医院的医疗，外科和创伤重症监护病房上进行了两个阶段。在第1阶段（通常的护理控制队列n = 150名患者）中，将MOPAT纳入常规的临床实践和有关疼痛严重程度以及收集的药物疼痛管理策略的数据中。在第2阶段（干预队列n = 150名患者）中，将在常规临床实践中实施，将MOPAT分数纳入镇痛顺序集中，以及同样的患者结果数据以及护士对算法的临床实用性的看法（包括MOPAT（包括MOPAT） ）将被收集。分析f主要目的及其相关的假设将使用2x4重复测量分析或混合线性建模和Cochran Q的相互作用进行f检验来实现，以便在等级数据上进行2x2重复测量。描述性方法将用于次要目的，包括如果存在明显的相互作用效应，图形技术（例如意大利面条图），以进行事后分析的重复措施分析，以识别子组的频率分布，以进行对问卷的回答。这项研究具有重要意义和创新性，因为它使用在非交流性患者中验证的仪器来指导疼痛管理并改善这种脆弱且研究不足的人群的疼痛结局来测试疼痛算法。