Testing the Pain-CPG-EIT

测试疼痛-CPG-EIT

• 批准号: 10711409
• 负责人: BARBARA RESNICK
• 金额: $ 42.62万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10711409
• 关键词: Acute; Address; Affect; Aggressive behavior; Aging; Agitation; Analgesics; Behavior; Behavioral Symptoms; Belief; Black race; Caring; Clinical; Clinical Practice Guideline; Communities; Dementia; Diagnosis; Education; Effectiveness; Elderly; Ethnic Origin; Ethnic Population; Evaluation; Evidence based practice; Facial Expression; Feedback; Female; Future; Gender; Goals; Individual; Intervention; Knowledge; Long-Term Care; Measurement; Medicine; Mental Depression; Mentors; Modeling; Monitor; Nursing Homes; Nursing Research; Opioid; Pain; Pain Measurement; Pain intensity; Pain management; Pharmaceutical Preparations; Physical activity; Population; Positioning Attribute; Prevention; Process Assessment; Quality of life; Race; Randomized; Recommendation; Reporting; Sex Differences; Sleep disturbances; Societies; Techniques; Testing; Translating; Translations; Use Effectiveness; Withdrawal; Work; associated symptom; clinical translation; common symptom; effectiveness testing; evidence base; experience; health disparity; health equity; home test; improved; innovation; male; meetings; pain outcome; pain relief; pain sensitivity; pharmacologic; psychological symptom; racial population; recruit; response; sex; social; social cognitive theory; treatment response; verbal; vocalization

Pain is experienced by 30% to 80% of residents living with dementia in nursing homes. For those with moderate to severe dementia verbal reporting of pain may not be reliable and observational approaches are recommended as pain in these individuals is more likely to present with facial expressions or behaviors such as aggression, agitation, or restlessness. Lack of accurate pain assessment results in untreated or over- treated pain. Untreated pain can lower quality of life, negatively impact function, impair sleep, increase depression, agitation, aggression, resistiveness to care and use of psychotropic medications. Further, the evaluation, management and treatment of pain are complicated by differences in pain sensitivity, verbal reporting or presentation of pain between genders, races and ethnicities. Although inconsistent, in some studies individuals living with dementia who were Black were more likely to have depression and sleep disturbances associated with pain and less likely to be treated for pain when compared to White residents. There are evidence based processes for assessment and management of pain using pharmacologic and nonpharmacological approaches. These were reviewed and included within the Pain Management Clinical Practice Guideline (Pain Management CPG) recently developed by AMDA: The Society for Post-Acute and Long-Term Care Medicine. There are, however, many challenges to translating the use of Clinical Practice Guidelines into clinical settings. To overcome these challenges we developed and previously tested a theoretically based approach and merged this approach with the Pain Management CPG, which is referred to as the PAIN-CPG-EIT. The PAIN-CPG-EIT involves a research nurse facilitator working with an identified community champion(s) and stakeholder team for 12 months to provide the following four components: Component I: Establishing and meeting monthly with a Stakeholder Team; Component II: Education of the staff; Component III: Mentoring and motivating the staff to address pain; Component IV: Ongoing evaluation of resident pain outcomes. Twelve communities will be included with 25 residents living with dementia and pain recruited from each community. Six communities will be randomized to treatment (PAIN-CPG-EIT) and six randomized to education only (EO) which involves providing the same education to staff as is done in Component II of PAIN-CPG-EIT. The primary aim of this study is to test the effectiveness of use of the PAIN- CPG-EIT to improve the assessment, diagnosis and management of pain and decrease pain intensity among nursing home residents living with dementia between baseline, 4 and 12 months and evaluate treatment fidelity. A secondary aim of the study is to consider differences in measurement, treatment and response to treatment between male and female and Black versus White residents living with dementia. Findings from this study will help build on the currently limited information about pain presentation and management among older adults living with dementia in nursing homes and improve health equity of aging populations experiencing pain.

疗养院中患有痴呆症的居民中，有30％至80％的疼痛经历。对于那些 疼痛的中度至重度痴呆口语报告可能不是可靠的，观察方法是 推荐作为这些人的疼痛，更有可能表现出面部表情或行为 作为侵略，躁动或不安。缺乏准确的疼痛评估会导致未经处理或过度治疗 治疗的疼痛。未经治疗的疼痛会降低生活质量，对功能产生负面影响，损害睡眠，增加 抑郁，躁动，侵略性，对精神药物的护理和使用的抵抗力。此外， 疼痛敏感性的差异，口头上的差异，评估，管理和治疗使疼痛的治疗变得复杂 报告或表现性别，种族和种族之间的痛苦。尽管不一致，但 研究痴呆症患有黑人的人更有可能患有抑郁和睡眠 与白人居民相比，与疼痛相关的障碍和疼痛治疗的可能性较小。 有一些基于证据的过程，用于评估和使用药理学，并 非药理学方法。对这些进行了审查，并将其包括在疼痛管理临床中 AMDA最近开发的实践指南（疼痛管理CPG）：急性后协会和 长期护理医学。但是，翻译临床实践的使用面临许多挑战 指南进入临床环境。为了克服这些挑战，我们开发并以前测试了 理论上基于理论的方法，并将这种方法与疼痛管理CPG合并为 作为止痛-CPG-EIT。疼痛-CPG-EIT涉及研究护士的促进者 社区冠军和利益相关者团队已有12个月的时间提供以下四个组成部分： 组件I：与利益相关者团队每月建立和开会；组件II：教育 职员;组件III：指导和激励员工解决痛苦；组件IV：持续评估 居民疼痛结果。十二个社区将包括25名患有痴呆症和疼痛的居民 从每个社区招募。六个社区将被随机分配给治疗（痛苦-CPG-EIT）和六个 仅随机分配教育（EO），涉及向员工提供相同的教育 疼痛-CPG-EIT的成分II。这项研究的主要目的是测试使用疼痛的有效性 - CPG-EIT改善疼痛的评估，诊断和管理，并减轻疼痛强度 养老院居民在基线，4到12个月之间患有痴呆症并评估治疗 忠诚。该研究的次要目的是考虑测量，治疗和反应的差异 男性和女性与黑人与白人居民之间的治疗。从中的发现 研究将有助于建立有关年龄较大的疼痛表现和管理的当前有限的信息 在疗养院中居住在痴呆症中的成年人，改善疼痛衰老人群的健康平等。