癌症疼痛治疗不足是农村社区老年人的主要公共卫生问题。需要采取干预措施来改善这些脆弱人群的疼痛管理。
■为了测试可行性,可接受性,以及暴露于适应性干预的疼痛结果的变化,癌症健康赋权无痛生活(CA-HELP),改善患者与临床医生关于疼痛的沟通。
患有癌症的老年人(年龄≥65岁)居住在非机构的农村环境中,并在田纳西州的农村诊所接受门诊治疗。每个人都接受了干预,2022年5月。所有患者在基线和干预后1周进行评估。使用单尾配对样本t检验(α=0.05)分析平均得分差异。数据在2022年6月进行了分析。
■CA-HELP的改编版包括一份18页的面向患者的工作簿和一个30分钟的电话辅导电话,与注册护士就疼痛教育和沟通技巧指导患者与他们的医疗团队讨论疼痛。
■通过应计和完成率检查了可行性。可接受性是通过乐于助人来衡量的,困难,以及对干预的满意度。结果的变化是使用疼痛自我管理前评估的平均得分差异来衡量的,与临床医生沟通疼痛的自我效能感,患者报告的疼痛,和对疼痛的误解。
■在总共30名参与者中,平均(SD)年龄为73.0(5.1)岁;17名参与者(56.7%)为女性,5人(16.7%)是黑人或非裔美国人,30(100%)是非西班牙裔或非拉丁裔,24(80.0%)为白色,16人(53.3%)高中文化程度以下,15人(50.0%)报告年收入低于21000美元。基于100%的应计和完成率,这种干预是非常可行的。提供干预组件的保真度(100%)和沟通能力(27名参与者[90%])也很高。关于可接受性,所有患者都认为干预有帮助,大多数(24名参与者[80%])认为它“非常有帮助”。“大多数患者认为干预措施“一点也不困难”(27名参与者[90%]),享受参与(21名参与者[70%]),并报告“非常满意”(25名参与者[83.3%])。事后结果的变化表明疼痛自我管理和自我效能感显著改善,以便与临床医生就疼痛进行沟通。以及显著减少患者报告的疼痛和疼痛误解。
■在CA-HELP的案例系列研究中,结果表明,CA-HELP的改编版本是可行和可接受的,并且显示了农村地区老年癌症患者疼痛相关结局指标的变化.
UNASSIGNED: Undertreated cancer pain is a major public health concern among older adults in rural communities. Interventions to improve pain management among this vulnerable population are needed.
UNASSIGNED: To test the feasibility, acceptability, and changes in pain outcomes from exposure to an adapted intervention, Cancer Health Empowerment for Living without Pain (CA-HELP), to improve patients\' communication about pain to their clinicians.
UNASSIGNED: Older adults with cancer (aged ≥65 years) who were residing in a noninstitutional rural setting and receiving outpatient care at a rural-based clinic in
Tennessee were enrolled in the study, in which everyone received the intervention, in May 2022. All patients were given assessments at baseline and 1 week after intervention. Mean score differences were analyzed using 1-tailed paired sample t tests (α = .05). Data were analyzed in June 2022.
UNASSIGNED: The adapted version of CA-HELP included an 18-page patient-facing workbook and a 30-minute telephone coaching call with a registered nurse to coach patients on pain education and communication techniques to discuss pain with their medical team.
UNASSIGNED: Feasibility was examined through accrual and completion rates. Acceptability was measured by helpfulness, difficulty, and satisfaction with the intervention. Changes in outcomes were measured using mean score differences from pre-post assessments of pain self-management, self-efficacy for communicating with clinicians about pain, patient-reported pain, and misconceptions about pain.
UNASSIGNED: Among the 30 total participants, the mean (SD) age was 73.0 (5.1) years; 17 participants (56.7%) were female, 5 (16.7%) were Black or African American, 30 (100%) were non-Hispanic or non-Latino, 24 (80.0%) were White, 16 (53.3%) had less than a high school education, and 15 (50.0%) reported income less than $21 000 per year. Based on accrual and completion rates of 100%, this intervention was highly feasible. Fidelity rates for delivering intervention components (100%) and communication competence (27 participants [90%]) were also high. Regarding acceptability, all patients rated the intervention as helpful, with the majority (24 participants [80%]) rating it as \"very helpful.\" Most patients rated the intervention as \"not at all difficult\" (27 participants [90%]), enjoyed participating (21 participants [70%]), and reported being \"very satisfied\" (25 participants [83.3%]). Pre-post changes in outcomes suggested significant improvements in pain self-management and self-efficacy for communicating with clinicians about pain, as well as significant reductions in patient-reported pain and pain misconceptions.
UNASSIGNED: In this case-series study of CA-HELP, results suggested the adapted version of CA-HELP was feasible and acceptable and showed changes in pain-related outcome measures among older adults with cancer in a rural setting.