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行政院國家科學委員會補助專題研究計畫成果報告
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運用癌症病人及家屬之疼痛教育諮商措施改善癌症疼痛處置之品質
The Implementation of a Pain Education and Counseling Program for Cancer Patients and
Families to Improve the Quality of Management of Cancer Pain
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計畫類別：個別型計畫
計畫編號：NSC 89－2314－B－038－069
執行期間： 88 年 08 月 01 日至 90 年 07 月 31 日
計畫主持人：林佳靜 共同主持人：賴允量 周玉坤
執行單位：台北醫學大學護理學研究所
中 華 民 國 90 年 10 月 26 日
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行政院國家科學委員會專題研究計畫成果報告
運用癌症病人及家屬之疼痛教育諮商措施改善 癌症疼痛處置之品質
The Implementation of a Pain Education and Counseling Pr ogr am for Cancer Patients and Families to Impr ove the Quality of
Management of Cancer Pain
計畫編號：NSC 89-2314-B-038-069執行期限：88 年 08 月 01 日至 90 年 07 月 31 日 主持人：林佳靜 台北醫學大學 護理學研究所
共同主持人：賴允量 馬偕醫院 安寧寮護教育示範中心 張玉坤 淡江大學 統計學系
一、中文摘要
近來,世界先進國家之疼痛專家正努力 以各種措施以改善癌症疼痛之處置成效。
病人及家屬相關之障礙因子，即病人之知 識及態度，被認為是癌症疼痛處置之主要 障礙因子。尤其，根據國內民情，家屬往 往為病人醫療處置之決定者及代言人。因 此，於國內為更有效改善癌症疼痛處置成 效，疼痛教育措施可能需要病人與家屬之 共同參與。本研究之主要目的為 (1) 針對 台灣癌症病人及家屬常見之止痛藥障礙因 子，發展一套病人及家屬之疼痛教育措 施，(2) 並加以兩星期後及四星期後追蹤評 值此措施於改善癌症疼痛處置品質之成 效。研究工具包括障礙因子問卷，簡明疼 痛量表，及基本資料。於疼痛教育前，予 以病人及家屬分別填寫障礙因子問卷，簡 明疼痛量表，及基本資料，之後，共同予 以病人及家屬疼痛教育措施。於措施後兩 週及四週分別予以病人及家屬填寫障礙因 子問卷及簡明疼痛量表。本研究共有 44 對 癌症病人及其主要照顧家屬參予。研究之 主要結果包括，病人之障礙因子分數於疼 痛教育措施後兩週及四週，皆較措施前之 障礙因子分數顯著為低。於疼痛教育後之 兩週及四週之病人猶豫不願意服用止痛藥 之人數，亦較疼痛教育前為少。病人之疼
痛強度及疼痛對生活之影響程度於教育措 施後兩週並未有顯著降低，但於教育措施 後四週皆有顯著降低。家屬之障礙因子分 數於疼痛教育措施後兩週及四週，皆較措 施前之障礙因子分數顯著為低。於疼痛教 育後之兩週及四週之家屬猶豫不願意讓病 人服用止痛藥之人數，亦較疼痛教育前為 少。家屬感受病人之疼痛強度及疼痛對生 活之影響程度於教育措施後兩週並未有顯 著降低，但於教育措施後四週皆有顯著降 低。本研究支持病人及家屬之疼痛教育措 施於改善研究疼痛處置之成效。
關鍵字: 癌症疼痛，疼痛教育措施，家屬，
障礙因子
Abstract
Internationally, priority given to cancer pain management in recent years has emphasized the need for changes. Numerous
researchers have documented that the management of cancer pain is not effective and has identified patient and family related barriers are major barriers to management of cancer pain. In Taiwan, family members usually are the gatekeepers are caregivers for cancer patients at home. Therefore,
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involvement of family members in pain education has important implications for the management of cancer pain. The purposes of this study were: (1) based on the
common patient and family related barriers in Taiwan to develop a pain education program, and (2) to evaluate the effectiveness of the pain education program 2 weeks and 4 weeks after the program implemented. The
instruments included Barriers
Questionnaire-Taiwan Form, Brief Pain Inventory, and Demographic information.
Before the pain education program, patients and family members were individually given the Barriers Questionnaire-Taiwan form, Brief Pain Inventory, and Demographic Information. Then the patient and the primary family caregiver were both involved in the pain education program. Two weeks and four weeks after the program, both the patient and the family caregiver completed the Barriers Questionnaire and Brief Pain Inventory. A total of 44 pairs of patients and family caregivers participated in this study. The major results of this study were as follows. The patient’s BQ score at two weeks and four weeks after the pain
education were significantly lower than the BQ score before the pain education. The number of patients who hesitated to take analgesics was lower at two weeks and four weeks after the pain education than before.
Patients reported significantly lower levels of pain intensity and pain interference four weeks after the pain education but not two weeks after than before the pain education.
The family caregiver’s BQ score at two weeks and four weeks after the pain
education were significantly lower than the BQ score before the pain education. The
number of family caregivers who hesitated to administer analgesics was lower at two weeks and four weeks after the pain education than before. Family caregivers reported significantly lower levels of
perceived pain intensity and pain interference four weeks after the pain education but not two weeks after than before the pain education. This study has supported the effectiveness of the pain education program, which involved both cancer patients and their family members on improving the
management of cancer pain.
Key Wor ds: cancer pain, pain education, family, barriers
二、緣由與目的
Internationally, priority given to cancer pain management in recent years has
emphasized the need for changes.
Numerous researchers have documented that the management of cancer pain is not
effective and has identified patient and family related barriers are major barriers to management of cancer pain. The Agency for Health Care Policy and Research
(AHCPR) guideline supports the importance of patient education, especially on concerns about reporting pain and using analgesics, to overcome the patient-related barriers to cancer pain management. In Taiwan, family members usually are the gatekeepers are caregivers for cancer patients at home.
Therefore, involvement of family members in pain education has important implications for the management of cancer pain. The
purposes of this study were: (1) based on the common patient and family related barriers in Taiwan to develop a pain education program, and (2) to evaluate the effectiveness of the pain education program 2 weeks and 4 weeks after the program
implemented.
三、結果與討論
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The instruments included Barriers Questionnaire-Taiwan Form, Brief Pain Inventory, and Demographic information.
Before the pain education program, patients and family members were individually given the Barriers Questionnaire-Taiwan form, Brief Pain Inventory, and Demographic Information. Then the patient and the primary family caregiver were both involved in the pain education program. Two weeks and four weeks after the program, both the patient and the family caregiver completed the Barriers Questionnaire and Brief Pain Inventory. A total of 44 pairs of patients and family caregivers participated in this study. The major results of this study were as follows. The patient’s BQ score at two weeks and four weeks after the pain
education were significantly lower than the BQ score before the pain education. The number of patients who hesitated to take analgesics was lower at two weeks and four weeks after the pain education than before.
Patients reported significantly lower levels of pain intensity and pain interference four weeks after the pain education but not two weeks after than before the pain education.
The family caregiver’s BQ score at two weeks and four weeks after the pain
education were significantly lower than the BQ score before the pain education. The number of family caregivers who hesitated to administer analgesics was lower at two weeks and four weeks after the pain education than before. Family caregivers reported significantly lower levels of
perceived pain intensity and pain interference four weeks after the pain education but not two weeks after than before the pain
education. The findings of this study are consistent with prior studies on the impact of a pain education program in western
countries (Ferrell, Grant, Chan, & Ferrell, 1995; Lindroth, Bauman, Brooks, Priestley, 1995). This study has supported the effectiveness of the pain education program, which involved both cancer patients and their family members on improving the
management of cancer pain.
四、參考文獻
Cleeland, C. (1987). Barriers to the
management of cancer pain. Oncology, 1 (Suppl. 2), 277-288.
Ferrell, B.R., Grant, M., Chan, J., Ahn, C., &
Ferrell, B.A. (1995). The impact of cancer pain education on family caregivers of
elderly patient. Oncology Nursing Forum, 22, 1211-1218.
Ferrell, B.R., & Rivera, L.M. (1997). Cancer pain education for patients. Seminars in Oncology Nursing, 13, 2028.
Lewandowsk, W. & Jones, S.L. The family with cancer: nursing interventions throughout the course of living with cancer. Cancer Nursing, 11, 313-321.
Lindroth, Y., Bauman, A., Brooks, P.M., &
Priestley, D. (1995). A 5-year follow-up of a controlled trial o an arthritis education program. British Journal of Rheumatoloty, 34, 647-652.
Shug, S.A., Zech, D., & Dorr, C.L. (1990).
Cancer pain management according to WHO analgesic guidelines. Journal of Pain and Symptom Management, 5, 27-32.
