การพัฒนาและประเมินผลโปรแกรมการจัดการความปวดโดยผู้ดูแลสำหรับดูแลผู้ป่วยมะเร็งระยะท้าย

Abstract

Most of terminal cancer patients suffer from pain. It was found that more than 50 percent of cancer patients experienced pain and 1 in 3 have moderate to severe pain. From the survey at Thoen Hospital, terminal cancer patients had problems in pain management such as adverse drug reaction problem and other complexities problems that affect pain management. These patients have primary caregivers taking care of them and administer medication to them. This study is an action research which aims to develop and evaluate a caregiver pain management program for caring terminal cancer patients. This research focuses on collaborative analysis of the problems, finding solutions, planning, implementing and evaluating plans among 15 co - researchers of doctors, nurses and pharmacists working in Palliative Care clinic, including 19 pairs of patients' caregivers. Data was collected by observation, unofficial interview and brainstorming. The process outcomes consisted of two phases: Phase 1: studying the situations and needs of the Palliative Care clinic that is appropriate to the context of the hospital. It was found that the provider's problems were providing services in palliative care clinics, the different experience of service team, availability of medications, availability of location, and service team's understanding of using pain diary. Client's problems (patients and caregivers) were readiness to acquire knowledge, attitudes to take strong opioids and attitudes about service team. Phases 2: creating and developing a caregivers' pain management program for caring of terminal cancer patients. The researchers and the co-researchers determined 5 expected change issues that affect to the development of caregiver pain management programs. These included: 1) Providers have positive attitude towards palliative care. 2) Providers have knowledge and skills in pain management and palliative care. 3) Thoen hospital has Kapanol® for the use of patient with Nasograstic tube feeding. 4) Providers have separating areas for providing pharmaceutical care to terminal cancer patients 5) Operational guidelines and developing pain management program for terminal cancer patients has improve by caregivers. The process of creation and development were performed in 2 cycles, each cycle consisted of 4 sub-steps: planning, implementing plans, observing and reflecting on performance. The process of creation and development were performed in 2 cycles, each cycle consisted of 4 sub-steps: planning, implementing plans, observing and reflecting on performance. The results about provider outcomes found that: the service team has a greater understanding about the concept of palliative care and has a positive attitude towards patient care after developing a caregivers' pain management program. The results about client outcomes compared between 1st and 3rd months of developing showed that: patients had a decrease in their current pain score and maximum pain score in 24 hours (p<0.05) but the minimum pain scores at 24 hours were not different (p>0.05). The number of problems encountered with drug use especially non-compliance problems have decreased. Caregivers have higher knowledge score on the principles of pain management and the use the analgesics for pain management (p<0.001). Caregivers also have higher self-efficacy score in pain management (p<0.001) and their satisfaction was at a very satisfied level.