Pain Assessment in Non-Communicative Palliative Care Patients

无法沟通的姑息治疗患者的疼痛评估

• 批准号: 7145726
• 负责人: DEBORAH B. MCGUIRE
• 金额: $ 52.95万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-05 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7145726
• 关键词: clinical research; hospices; pain

DESCRIPTION (provided by applicant): Pain, the universal human experience, has been the focus of intense efforts to improve its management in ill clinical populations for years, but sadly, many people continue to suffer with inadequately managed pain. Good assessment is fundamental to managing pain, and is based on individual self-report because pain is subjective. People who cannot communicate their pain because of underlying medical conditions and treatments are at higher risk for unrecognized pain, unnecessary suffering, additional co-morbidities, poorer quality of life, and prolonged healing and recovery. Many of these individuals are receiving palliative care, which is now delivered in tertiary acute, hospice, long term, and home care settings. A major emphasis is pain management, yet no satisfactory pain assessment tools are available for non-communicative palliative care patients with pain. The research team's preliminary studies of the Multidimensional Objective Pain Assessment Tool (MOPAT), which uses behavioral and physiological indicators to assess pain, demonstrate initial evidence of reliability and validity. The specific aims of this study are to: 1) test the reliability and validity of the MOPAT for assessing acute pain in non-communicative patients in three different types of palliative care settings: 1) inpatient tertiary acute care hospital, 2) inpatient community hospice, and 3) inpatient Veterans Administration hospice; and 2) appraise the clinical utility of the MOPAT when used by nurses to assess acute pain in non-communicative patients in two different types of palliative care settings: 1) inpatient tertiary acute care hospital, and 2) inpatient community hospice. Using a methodologic design, the researchers will test the tool in 130 acute care inpatients (pre- and post-pain medication intervention) and 100 hospice inpatients (longitudinally for duration of admission) using observations by pairs of raters. Extensive demographic, clinical, and treatment data will also be collected. The analyses will use Generalizability Theory to evaluate reliability, a theoretical approach and causal measurement theory to evaluate validity, and descriptive statistics and mixed modeling to evaluate clinical utility. If this study is successful, knowledge of how to assess pain in this vulnerable population will be advanced. It should help facilitate the management of pain in non-communicative patients across palliative care settings and ultimately result in less suffering.

描述（由申请人提供）：多年来，人类普遍的经验，是人类的普遍经验，一直是改善临床人群管理管理的强烈努力，但可悲的是，许多人继续遭受管理不足的疼痛。良好的评估是管理疼痛的基础，并且基于个人自我报告，因为疼痛是主观的。由于基本的医疗状况和治疗而无法传达疼痛的人面临未识别的疼痛，不必要的痛苦，额外的合并症，较差的生活质量以及长期康复和康复的风险。这些人中的许多人正在接受姑息治疗，该护理现已以高等急性，临终关怀，长期和家庭护理环境提供。主要重点是疼痛管理，但没有令人满意的疼痛评估工具可用于疼痛的非交流性姑息治疗患者。研究小组对使用行为和生理指标评估疼痛的多维客观疼痛评估工具（MOPAT）的初步研究证明了可靠性和有效性的初步证据。这项研究的具体目的是：1）测试MOPAT评估三种不同类型的姑息治疗环境中非交流患者急性疼痛的可靠性和有效性：1）住院高级急性护理医院，2）住院社区临终关怀医院，3）住院老兵管理临终关怀；和2）评估护士使用两种不同类型的姑息治疗环境中非交流性患者的急性疼痛时，MOPAT的临床实用性：1）住院高级急性护理医院和2）住院社区临终关怀。使用方法论设计，研究人员将使用成对的评估者观察到130个急性护理住院患者（前后药物干预措施）和100个临终关怀的住院患者（纵向入院时间）中测试该工具。还将收集广泛的人口统计学，临床和治疗数据。分析将使用概括性理论评估可靠性，一种理论方法和因果测量理论，以评估有效性，描述性统计和混合模型来评估临床实用性。如果这项研究成功，那么如何评估该脆弱人群中的疼痛的知识将得到改进。它应该有助于促进姑息治疗环境中非交流性患者的疼痛管理，并最终导致苦难减少。