Cancer Pain in Elders: Promoting EBPs in Hospices

老年人的癌症疼痛：在临终关怀中心推广 EBP

• 批准号: 7259494
• 负责人: KEELA A HERR
• 金额: $ 22.17万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-09 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7259494
• 关键词: Acute Pain; Address; Adherence; Adoption; Advanced Malignant Neoplasm; Adverse effects; Cancer Pain Management; Cancer Patient; Cessation of life; Clinical Practice Guideline; Condition; Effectiveness; Elderly; Evidence based practice; Family Caregiver; Health Personnel; Healthcare; Hip Fractures; Hospice Care; Impaired cognition; Intervention; Malignant Neoplasms; Morbidity - disease rate; Nurses; Outcome; Pain; Pain Measurement; Pain management; Pain-Free; Palliative Care; Patient Care; Patients; Persons; Pharmaceutical Preparations; Physicians; Population; Process; Quality of life; Randomized Controlled Trials; Recommendation; Research; Savings; Severities; Testing; Translating; Variant; Vulnerable Populations; Work; base; cancer pain; compliance behavior; end of life; evidence based guidelines; follow-up; hospice environment; improved; programs; research to practice; response; symptom management; treatment planning

DESCRIPTION (provided by applicant): This study is an extension of our current research and focuses on promoting adoption of evidence-based practices (EBPs) to improve the quality of pain management for elder persons with cancer. The study addresses barriers to consistent adoption of pain management clinical practice guidelines for assessing and treating cancer pain in elders. These elders suffer needlessly from pain related to their cancer, its treatment, and related co morbid conditions. Despite existence of evidence-based guidelines to improve assessment and management of pain in this vulnerable population, adoption and use of recommendations based on best scientific evidence lags and is sporadic at best. Even in the hospice setting where pain control is a priority, there is considerable variation and patients still die in unresolved pain. A secondary barrier underlying effective pain management in this population is patient and family caregiver non-adherence to the pain treatment plan. Effective implementation of current Clinical Practice Guidelines (CPGs) that include evidence-based strategies for addressing this barrier may further contribute to improved quality of pain management for elders at the end of life. Translating Research into Practice (TRIP) is an active process of promoting use of evidence by healthcare providers that may improve pain management practices for elders with cancer pain. The proposed randomized control trial builds on our successful TRIP-Acute Pain intervention that demonstrated improved quality of acute pain management for hospitalized elders with hip fractures and savings of healthcare dollars. This study will evaluate the effect of an interdisciplinary multifaceted TRIP intervention focused on increasing EBPs for assessing and managing pain in elder hospice patients with cancer pain. The study aims are as follows: 1) Test the effect of a multifaceted TRIP-Cancer Pain intervention on pain severity, pain interference, pain relief and quality of life in elder hospice patients with cancer pain; 2) Test the effect of a multifaceted TRIP-Cancer Pain intervention on promoting adoption, by health care providers, of cancer pain management EBPs for elder hospice patients with cancer pain; 3) Determine the effectiveness of a multifaceted TRIP-Cancer Pain intervention on patient adherence to the pain treatment plan; and 4) Evaluate the persistence of change in process and outcome variables at long-term follow-up (6 months post intervention).

描述（由申请人提供）：本研究是我们当前研究的延伸，重点是促进采用循证实践 (EBP)，以提高老年癌症患者的疼痛管理质量。 该研究解决了一致采用疼痛管理临床实践指南来评估和治疗老年人癌症疼痛的障碍。 这些老年人不必要地遭受与癌症、治疗以及相关并发症相关的疼痛。 尽管存在基于证据的指南来改善这一弱势群体的疼痛评估和管理，但基于最佳科学证据的建议的采纳和使用仍然滞后，而且充其量只是零星的。 即使在以控制疼痛为首要任务的临终关怀机构中，也存在相当大的差异，患者仍然死于未解决的疼痛。 该人群有效疼痛管理的次要障碍是患者和家庭护理人员不遵守疼痛治疗计划。 有效实施当前的临床实践指南（CPG），其中包括解决这一障碍的循证策略，可能会进一步有助于提高老年人临终疼痛管理的质量。 将研究转化为实践 (TRIP) 是一个积极的过程，旨在促进医疗保健提供者使用证据，从而改善患有癌症疼痛的老年人的疼痛管理实践。 拟议的随机对照试验建立在我们成功的 TRIP-急性疼痛干预措施的基础上，该干预措施证明了对患有髋部骨折的住院老年人的急性疼痛管理质量有所提高，并节省了医疗费用。 本研究将评估跨学科、多方面的 TRIP 干预措施的效果，该干预措施的重点是增加 EBP，以评估和管理患有癌症疼痛的老年临终患者的疼痛。 研究目的如下： 1）测试多方位的TRIP-癌痛干预对患有癌痛的老年临终患者的疼痛严重程度、疼痛干扰、疼痛缓解和生活质量的影响； 2) 测试多方面的 TRIP-癌症疼痛干预措施对促进医疗保健提供者采用癌症疼痛管理 EBP 来治疗患有癌症疼痛的老年临终患者的效果； 3) 确定多方面的 TRIP-癌痛干预对患者遵守疼痛治疗计划的有效性； 4) 评估长期随访（干预后 6 个月）过程和结果变量变化的持续性。