Background 

Adherence to prescribed analgesics for patients seriously ill with cancer pain is essential for comfort.

Objective 

The objective of this study was to determine the analgesic adherence in seriously ill patients with cancer and its association with clinical and demographic characteristics.

Methods 

This is a cross-sectional study. At home, 202 patients with cancer (mean age, 59.9 ± 14.2 years; 58% female, 48% Black, and 42% White) admitted to hospice/palliative care completed measures on a pen tablet: PAINReportIt, Symptom Distress Scale, mood state item, Pittsburgh Sleep Quality Index item, and Pain Management Index.

Results 

The mean current pain intensity was 4.4 ± 2.9, and the mean worst pain in the past 24 hours was 7.2 ± 2.7. More than one-half of participants were not satisfied with their pain level (54%) and reported their pain was more intense than they wanted to tolerate for 18 hours or longer in the last 24 hours (51%). Only 12% were not prescribed analgesics appropriate for the intensity of their pain. Adherence rates were variable: nonsteroidal anti-inflammatory drugs (0.63 ± 0.50), adjuvants (0.93 ± 0.50), World Health Organization step 2 opioids (0.63 ± 0.49), and step 3 opioids (0.80 ± 0.40). With setting/clinical/demographic variables in the model, dose intervals of less than 8 hours were associated with less adherence (P < .001).

Conclusion 

Little progress has been made toward improving analgesic adherence even in settings providing analgesics without cost. Research focused on targeting analgesic dose intervals and barriers not related to cost is needed.

Implication for Practice 

Dose intervals of 8 hours or longer were significantly associated with higher adherence rates; therefore, use of longer-acting analgesics is one strategy to improve pain control at the end of life.

中文翻译：

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门诊重症癌症患者对镇痛药的依从性

背景 

对于患有癌症疼痛的重病患者，坚持使用处方止痛药对于舒适度至关重要。

客观的 

本研究的目的是确定重症癌症患者的镇痛依从性及其与临床和人口统计学特征的关联。

方法 

这是一项横断面研究。在家中，202 名癌症患者（平均年龄 59.9 ± 14.2 岁；58% 女性，48% 黑人和 42% 白人）在临终关怀/姑息治疗中完成了数位板测量：PAIN Report It、Symptom Distress Scale、情绪状态项目、匹兹堡睡眠质量指数项目和疼痛管理指数。

结果 

平均当前疼痛强度为 4.4 ± 2.9，过去 24 小时平均最严重疼痛为 7.2 ± 2.7。超过一半的参与者 (54%) 对他们的疼痛程度不满意，并报告说在过去 24 小时内有 18 小时或更长时间 (51%) 的疼痛比他们想要忍受的更剧烈。只有 12% 的人没有获得适合其疼痛强度的止痛药。依从率是可变的：非甾体抗炎药 (0.63 ± 0.50)、佐剂 (0.93 ± 0.50)、世界卫生组织第 2 步阿片类药物 (0.63 ± 0.49) 和第 3 步阿片类药物 (0.80 ± 0.40)。对于模型中的设置/临床/人口统计学变量，小于 8 小时的给药间隔与较低的依从性相关 ( P < .001)。

结论 

即使在免费提供镇痛药的环境中，在提高镇痛药依从性方面也几乎没有取得进展。需要针对镇痛剂量间隔和与成本无关的障碍进行研究。

实践意义 

8 小时或更长时间的剂量间隔与较高的依从率显着相关；因此，使用长效镇痛药是改善临终疼痛控制的一种策略。