护理人员癌痛知识及态度的调查

癌痛是癌症患者尤其中晚期癌患者重要症状之一。影响癌痛控制是否满意的一个重要因素是进行有关癌痛知识的教育及普及。本文借助世界卫生组织提供的医护人员癌痛知识及态度调查表，采用多种中心调查方法，于１９９６年７月－８月对６家医院１６６名肿瘤科护士（师）进行了随机调查，结果显示：相当一部分护士缺乏癌痛知识及鸦片类药物临床药理学知识，没有完全掌握世界卫生组织大倡导的三阶梯药物止痛方法及有关原则。提示我们应对护     

中国医护人员癌痛知识及态度调查(医师部分)

癌痛及其它症状的缓解是世界卫生组织癌症控制规划四重点之一。医护人员对癌痛知识的了解程度及普及程度是癌痛能否得到满意缓解的重要原因之一。我们受WqIO西太地区及日本世界卫生组织癌痛缓解和生活质量协作中心主任武田文和先生的委托，于lop年7月一8月对我国部分肿瘤医护人员进行癌痛知识的问卷调查，现报告如下：材料与方法癌症疼痛知识调查问卷分医师和护士两部分。医生部分由世界卫生组织癌症症状评估协作中心主任、教授ChanCS制定。我们将其翻译成中文，力求译文通俗易懂，符合国人文化习惯又贴近原意。在国内采取多中心调查方法…     

癌痛治疗的近况

据世界卫生组织统计，全世界每年新发生肿瘤患者约700万，其中30％-50％有不同程度的疼痛。在我国每年新增肿瘤患者160万，最近调查显示：各期病程中，伴有不同程度的疼痛者占51．1％，早、中、晚期患者分别占30％、50．6％、66．4％，晚期癌痛患者约60％-90％为剧痛。世界卫生组织于1982年在意大利组织专家会议，成立了世界卫生组织癌痛治疗委员会。经讨论一致认为，应用现有的为数有限的镇痛药物，就可解除大多数癌痛病人的疼痛，并提出到2000年达到全世界范围内“使癌症病人不痛”的目标，向全世界推荐三阶梯药物止痛方法和有关原则。现…     

云南省护士癌痛知识状况调查与分析

对参加云南省癌痛知识培训的335名护理人员，分别在讲授癌痛知识前，后、采用问卷调查。通过调查，我们认为应加强癌痛的宣传，教育普及力度，通过各种培训方式，可以提高护理人掌握癌痛知识和处理癌痛水平。     

癌痛的国内外治疗概况

癌痛是中晚期癌症患者的主要临床症状。世界卫生组织（WHO）据有关资料分析指出：70％的癌症晚期患者可出现显著的疼痛。并指出世界上每天约有350万~400万癌症患者忍受疼痛折磨，放在抗癌的同时积极采取有效止痛措施，缓解或减轻患者的疼痛是癌症治疗中的重要内容。近年来，国内外对癌痛的治疗措施有了迅速的发展，使癌痛的控制更方便和有效，从而改善了患者的健康状况，提高了生存质量。本文就作者所掌握的近年来国内外对癌痛治疗方面的情况作一简要介绍。一、癌痛的原因和机理1．癌症本身引起的疼痛包括原发肿瘤及转移瘤。由于肿瘤本身…     

癌症病人疼痛情况调查及对策探讨

近年来，癌痛随着癌症发病率的增高而随之增加。但临床上癌痛的治疗、护理远远达不到世界卫生组织（WHO）提出的“ZttD年让所有癌症患者不痛”的目标。笔者随机调查了在我院住院的450例癌症病人，以了解癌痛的发生及治疗和护理情况，探讨如何实现WHO目标的对策。1材料与方法1．     

以专业护士为主体的癌痛质控体系的效果评价

目的：通过实施以专业护士为主体的癌痛质控体系，提高全院癌痛质量管理水平。方法：依托于我院癌痛姑息专业小组，通过文献回顾及细度相关规章制度，制定了《癌痛护理质量评分标准》，在每个病区选拔一名癌痛专业护士，统一培训，负责运用《癌痛护理质量评分标准》对各病区癌痛护理质量进行检查、反馈、评价。结果：经过两年的实践，癌痛质量管理的病历年总数有所增加（1273 vs 1524），病历缺陷率有所下降（72.74% vs 50.52%），组织结构完整率（98.66% vs 99.87%）、护士评估合格率（87.53% vs 95.93%）、护理记录合格率（41.47% vs 75%）、护理计划合格率（74.63% vs 86.29%）、健康教育合格率（47.21% vs 84.06%）均得到明显提高，差异有统计学意义（P＜0.05）。结论：通过制定《癌痛护理质量评分标准》，以专业护士为主体对各病区进行质量管理取得了很好的效果，是一种值得推广的癌痛护理质量管理方式。     

北京市219位医生对癌痛控制的看法

姑息治疗已纳入WHO癌症工作四大任务之一，而癌痛是姑息治疗的首要内容。癌痛的控制需要国家政策制定者、执行者、医务人员、患者及家属多方面的参与。为推动该项工作的进展，我们进行了医生对癌痛控制的态度及WHO基本方法及策略知识的调查c三材料及方法1998年8月采用美国M．D、Anderson肿瘤中心Cleeland教授设计的调查问卷，组织了北京市24家医院从事肿瘤专业和非肿瘤专业的219名医生对其进行了多中心的协作调查。成员组负责人将调查表送主持单位，统一进行整理、总结。本调查对象分肿瘤专业医生及非肿瘤专业医生两组，分别为129名及90…     

癌痛患者对吗啡止痛治疗的感受及健康教育对策

目的 了解癌症疼痛患者对吗啡止痛治疗的感受,探讨相应的健康教育对策.方法 采用问卷调查法,对80例癌痛患者进行调查,了解癌痛患者对吗啡治疗的感受.结果 癌痛患者对吗啡治疗的主要感受是成瘾恐惧、担心耐药和药物不良反应等.结论 癌痛患者对吗啡止痛治疗存在不同程度的顾虑,积极开展相应的健康教育可减轻顾虑,提高吗啡止痛治疗的依从性.     

广州市基层医院癌痛规范化治疗现状及障碍因素分析

目的 探讨广州市基层医院医务人员癌痛诊疗知识水平及癌痛治疗现状,分析可能的阻碍因素,为提高基层医院癌痛管理水平提供依据。方法 举办基层医院癌痛规范化治疗学习班,参会医务人员填写调查表。共收集有效调查表120份,分析表中数据,并进行统计学处理。结果 在癌痛基本诊疗知识方面,基层医院医务工作者平均得分为12.2±3.5,医师、护士、药剂师及管理人员的得分差异无统计学意义（P＞0.05）;既往参加过癌痛诊疗培训及未参加过培训的医务人员的得分差异亦无统计学意义（P＞0.05）。目前广州基层医院癌痛诊疗中最常见的不良用药习惯为有创给药、阿片类药物应用不合理,而癌痛管理知识不足、担心阿片类药物不良反应、药物供应不充分是导致目前基层医院癌痛诊疗不规范的主要因素。结论 提高基层医院医务人员的癌痛诊疗知识水平,加强对患者及家属的宣教,提供足量、齐全的止痛药物,是提高广州基层医院癌痛规范化诊疗的可行途径。     

Achievement of personalized pain goal in cancer patients referred to a supportive care clinic at a comprehensive cancer center

BACKGROUND:

Cancer pain initiatives recommend using the personalized pain goal to tailor pain management. This study was conducted to examine the feasibility and stability of personalized pain goal, and how it compares to the clinical pain response criteria.

METHODS:

Records of 465 consecutive cancer patients seen in consultation at the Supportive Care Clinic were reviewed. Pain relief was assessed as clinical response (≥30% or ≥2 point pain reduction) and personalized pain goal response (pain ≤ personalized pain goal).

RESULTS:

One hundred fifty‐two (34%), 95 (21%), and 163 (37%) patients presented with mild (1‐4), moderate (5‐6), and severe (7‐10) pain, respectively. Median age (59 years), males (52%), and advanced cancer status (84%) did not differ by pain category. Median personalized pain goal at initial clinic consult was 3 (interquartile range, 2‐3), was similar across pain groups, and remained unchanged (P = .57) at follow‐up (median, 14 days). Clinical response was higher among patients with severe pain (60%) as compared with moderate (40%) and mild pain (33%, P < .001). Personalized pain goal response was higher among patients with mild pain (63%) as compared with moderate (44%) and severe pain (27%, P < .001). By using personalized pain goal response as the gold standard for pain relief, the sensitivity of clinical response was highest (98%) among patients with severe pain, but it had low specificity (54%). In patients with mild pain, clinical response was most specific for pain relief (98%), but had low sensitivity (52%).

CONCLUSIONS:

Personalized pain goal is a simple patient‐reported outcome for pain goals. The majority of patients were capable of stating their desired level for pain relief. The median personalized pain goal was 3, and it was highly stable at follow‐up assessment. Cancer 2012. © 2011 American Cancer Society.     

Assessment and measurement of pain

This paper provides an overview of issues relating to pain assessment and management. Areas to be covered include the problems involved in assessing pain as a subjective phenomenon, the constraints of assessment within the clinical field, factors that affect pain, and pain assessment tools and questionnaires. The aim of the reference list is to provide back-up reading to assist in exploring the options available when considering the possibility of compiling a pain assessment protocol for individual clinical areas.     

Wider issues in pain management

In this paper the accepted holistic approach to pain management in cancer care is scrutinized. A series of oppositions are considered to result from the essential indeterminate nature of pain, and that pain is fundamentally lived and experienced in the body. These oppositions are discussed in terms of mind-body dualism and embodiment, and in particular the body as subject and object. The discussion is illustrated with examples from research examining individual expressions of pain. Patients'powerful attempts to manipulate subject-object distinctions in recounting their experience of pain is offered as a means by which patients make sense of their pain, and connect it to their bodies and to their identity. The implications of acknowledging personal and cultural meanings attributed to pain are highlighted, with recommendations for future research and clinical practice initiatives.     

慢性顽固疼痛患者芬太尼透皮贴剂的门诊治疗

目的:观察门诊慢性疼痛患者用芬太尼透皮贴剂(Transdermalfentanyl,TDF)的镇痛疗效。方法:选择慢性顽固性疼痛患者416例,其中中、晚期癌症性疼痛占314例,非癌性疼痛102例,使用TDF止痛。对治疗前后的疼痛强度、生活质量评价及用药中的不良反应,进行观察和统计分析。结果:癌性疼痛治疗前疼痛视觉模拟评分(VAS)为7.94±1.15,治疗后降低至1.64±1.71;非癌性疼痛治疗前为7.30±1.54,治疗后降低至1.91±1.53。癌性疼痛的明显缓解率为51.5%,完全缓解为19.7%,总缓解率71.2%。非癌性疼痛明显缓解率为45.0%,完全缓解13.7%,总缓解率58.7%。生活质量治疗前后均变化(P<0.01)。用药的不良反应与传统的阿片类药物相似,为便秘、恶心、呕吐、头晕等症,但程度较轻;未出现呼吸抑制者。治疗后需停药的患者无身体及精神戒断症状发生。结论:TDF具有无创性、不间断的给药途径,镇痛效果确实,不良反应发生率低,患者依从性好,适合门诊、家庭应用。     

Patients' and nurses' assessment of cancer pain

The purpose of this study was to examine hospitalised cancer patients' and nurses' assessment of patients' cancer pain and to compare them. The data were collected from 51 patient–nurse pairs in two hospitals from oncological and medical clinics. Each nurse and patient took part in the study no more than once. The data were collected with a structured interview and the questionnaire. The intensity of pain was measured with a visual analogue scale (VAS) and the Finnish version of the McGill Pain Questionnaire (FPQ). The results showed that the differences between patients' and nurses' assessments were statistically significant for most intensive pain and for acceptable pain. In both cases nurses' assessments of the intensity of pain were lower than patients' assessments. The nurses identified 40 words in the verbal FPQ that the patients used in describing their experiences of pain. The words used most often by patients were agonizing, tender, wave-like and radiant. The word that the nurses used most often was that of intense. Nurses' knowledge about pain medication in general and morphine in particular was clearly associated with the differences observed in estimates of the intensity of pain. Nurses with poor knowledge underestimated the patients' most intensive experiences of pain. The difference was statistically significant.     

Cancer pain assessment – Can we predict the need for specialist input?

We can anticipate that failure to assess cancer pain adequately will inevitably lead to inappropriate application of pain management options. However, it is not always standard practice to teach the limitations of the question ‘How bad is the pain?’, as well as the need to consider what may complicate pain management or be a poor prognostic factor for pain control. These issues may complicate cancer pain assessment and require specialist consultation. An internationally accepted classification system for cancer pain could provide the basis for a multidimensional assessment and a common language for clinical and research work. Research dating back to the late 1980s has resulted in the development of the Edmonton Classification System for Cancer Pain. This includes many of the factors that may be prognostic for the complexity of cancer pain management and can assist an inexperienced clinician in anticipating the need for specialist advice.     

The Good Pain Management （GPM） Ward Program in China and its impact on Chinese cancer patients： the SYSUCC experience

To improve cancer pain management, trle MeCllCal uncology uepartmem of sun yat-sen University Cancer Center （SYSUCC） launched the Good Pain Management （GPM） Ward Program, which has been recognized by the Chinese Ministry of Health and promoted throughout the nation. This retrospective casecontrol study was designed to evaluate the effectiveness of the program. Patients diagnosed with malignant solid tumors with bone metastasis were eligible. Patients who were admitted 6 months before the initiation of the GPM program were used as the control group, and patients admitted 6 months after the initiation of the program were used as the GPM group. The painreporting rate and pain management index （PMI） were calculated. The pain levels before and after pain management were compared. A total of 475 patients （244 in the control group and 231 in the GPM group） were analyzed. The painreporting rate of the GPM group was significantly higher than that of the control group （62.8% vs. 37.7%, P 〈 0.001）. The PMI of the GPM group was significantly higher than that of the control group （0.083 vs. -0.261, P 〈 0.001）. Therefore, the GPM Ward Program improved the pain management of cancer patients and provided experience for improving cancer pain management in the future.