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: 8665822
• 负责人: DEBORAH B. MCGUIRE
• 金额: $ 49.36万
• 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/8665822
• 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）：该项目响应 PA-10-006 疼痛研究的机制、模型、测量和管理 (R01)。无法自我报告疼痛的存在或强度的急症住院姑息治疗患者很容易对疼痛认识不足和治疗不足，从而遭受不必要的痛苦和其他不良反应。在提供姑息治疗的环境中，缺乏可靠且有效的措施来评估这些无法沟通的患者的疼痛，并且很少有标准化的方案或算法经过测试其对患者结果的影响。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) 在评估非沟通性姑息治疗患者的急性疼痛方面的心理测量特性和临床实用性，证明了使用时的有效性、可靠性和临床实用性的有力证据随着时间的推移，由训练有素的护士定期对无法沟通的危重患者进行治疗。拟议研究的主要目的是测试结合 MOPAT 和镇痛指令集的疼痛算法是否可以改善因内科、外科手术、住院治疗的危重非沟通性姑息治疗患者的疼痛严重程度以及药物疼痛管理策略的使用。与没有算法的患者相比，在创伤重症监护室中。我们假设：（H1）疼痛严重程度降低，（H2）用于疼痛的药物数量增加，以及（H3）由于以下原因，用于疼痛的药物的等镇痛总剂量增加疼痛算法的实现。次要描述性目标是 (S1) 比较患有和不患有疼痛相关病症的患者的疼痛相关结果，(S2) 描述患者随时间的疼痛模式，以及 (S3) 评估护士对临床的看法 疼痛算法的实用性。我们将使用队列对照组准实验设计，在一所主要大学急症护理医院的内科、外科和创伤重症监护病房分两个阶段进行。在第一阶段（常规护理对照队列 n=150 名患者）中，MOPAT 将纳入常规临床实践，并收集有关疼痛严重程度和药物疼痛管理策略使用的数据。在第 2 阶段（干预队列 n=150 名患者），将在常规临床实践中实施将 MOPAT 评分纳入镇痛医嘱集的疼痛算法，并且相同的患者结果数据加上护士对该算法临床效用的看法（包括 MOPAT ）将被收集。对主要目标及其相关假设的分析将使用 2x4 重复测量分析或混合线性模型的交互 F 检验以及排名数据上 2x2 重复测量的 Cochran Q 来完成。描述性方法将用于次要目标，包括重复测量分析和事后分析（如果存在显着的交互效应）、图形技术（例如意大利面图）来识别子组，以及对问卷答复的频率分布。这项研究具有重要意义和创新性，因为它使用在非沟通患者中验证的仪器来测试疼痛算法，以指导疼痛管理并改善这一弱势且研究不足的人群的疼痛相关结果。