Implementation of observational pain management protocol to improve pain management for long-term institutionalized older care residents with dementia: study protocol for a cluster-randomized controlled trial

Trials

Claudia Lai¹  Justina Yat Wa Liu¹ 

[1] Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong

关键词: Nursing homes;    Dementia care;    Pain measurement;    Pain management;   

Others  :  807304
DOI  :  10.1186/1745-6215-15-78

 received in 2013-08-06, accepted in 2014-02-05,  发布年份 2014

【 摘 要 】

Background

Systematic use of observational pain tools has been advocated as a means to improve pain management for care home residents with dementia. Pain experts suggest that any observational tool should be used as part of a comprehensive pain management protocol, which should include score interpretation and verification with appropriately suggested treatments. The Observational Pain Management Protocol (Protocol) was therefore developed. This study aims to investigate the extent to which the implementation of this Protocol can improve pain management in care home residents with dementia.

Methods/design

In this two-group, single-blinded, cluster-randomized controlled trial, 122 care home residents with dementia and pain-related diagnoses will be recruited from eight care homes (that is 15 to 16 residents from each care home). Invitations will be sent to all local care homes who meet the home selection criteria. The eight care homes will be randomly selected from all care homes that agree to join this trial. They will then be randomized to either the control or experimental conditions. Participants from each care home will be placed into their home’s corresponding group to avoid ‘contamination’ effects across participants. Each intervention cycle will take 16 weeks (that is, baseline assessment and care home staff training for 4 weeks and Protocol implementation for 12 weeks). The Protocol will guide the pain management of the participants in the experimental care homes. Meanwhile, the control care homes will continue their usual pain management strategies. Intervention effects will be measured weekly during the protocol implementation period and compared with the baseline measurements, as well as between the experimental and control conditions.

Discussion

Although similar pain protocols have been suggested previously, the recommendations were based on experts’ opinions rather than evaluation of research studies. The feasibility and effectiveness of this kind of pain management protocol, tailored to older people with dementia, remains unknown. The findings of this trial will offer strong evidence that better strategies for pain management should be used in the care home daily routine.

Trial registration

The Chinese University of Hong Kong, Centre for Clinical Trials: CUHK-CCT00367

【 授权许可】

   
2014 Liu and Lai; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Nygaard HA, Jarland M: Are nursing home patients with dementia diagnosis at increased risk for inadequate pain treatment? Int J Geriatr Psych 2005, 20:730-737.
• [2]Closs SJ, Barr B, Briggs M: Cognitive status and analgesic provision in nursing home residents. Br J Gen Pract 2004, 54:919-921.
• [3]Husebo BS, Strand LI, Moe-Nilssen R, BorgeHusebo S, Aarsland D, Ljunggren AE: Who suffers most? Dementia and pain in nursing home patients: a cross-sectional study. J Am Med Direct Assoc 2008, 9(6):427-433.
• [4]Reynolds KS, Hanson LC, DeVellis RF, Henderson M, Steinhauser KE: Disparities in pain management between cognitively intact and cognitively impaired nursing home residents. J Pain Symptom Manage 2008, 35:388-396.
• [5]McAuliffe L, Nay R, O’Donnell M, Fetherstonhaugh D: Pain assessment in older people with dementia: literature review. J Adv Nurs 2008, 65:2-10.
• [6]Weiner D, Peterson B, Keefe F: Chronic pain-associated behaviors in the nursing home: resident versus caregiver perceptions. Pain 1999, 80:577-588.
• [7]Hadjistavropoulos T, Herr K, Turk DC, Fine PG, Dworkin RH, Helme R, Dworkin R, Jackson K, Parmelee PA, Rudy TE, Lynn BB, Chibnall JT, Craig KD, Ferrell B, Ferrell B, Fillingim RB, Gagliese L, Gallagher R, Gibson SJ, Harrison EL, Katz B, Keefe FJ, Lieber SJ, Lussier D, Schmader KE, Tait RC, Weiner DK, Williams J: An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain 2007, 23:S1-S43.
• [8]Herr K: Pain in the older adult: an imperative across all health care settings. Pain Manage Nursing 2010, 11:S1-S10.
• [9]Herr KA, Bjoro K, Decker S: Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review. J Pain Symptom Manage 2006, 31:170-192.
• [10]Park J, Castellanos-Brown K, Belcher J: A review of observational pain scales in nonverbal elderly with cognitive impairments. Res Social Work Prac 2010, 20:651-664.
• [11]Stolee P, Hillier LM, Esbaugh J, Bol H, McKellar L, Cauthier N: Instruments for the assessment of pain in older persons with cognitive impairment. J Am Geriatr Soc 2005, 53:319-326.
• [12]Zwakhalen SMG, Hamers JPH, Abu-Saad HH, Berger MPF: Pain in elderly people with severe dementia: a systematic review of behavioural pain assessment tools. BMC Geriatr 2006, 6:1-11. BioMed Central Full Text
• [13]Fuchs-Lacelle S, Hadjistavropoulos T, Lix L: Pain assessment as intervention: a study of older adults with severe dementia. Clin J Pain 2008, 24:679-707.
• [14]Liu JYW, Briggs M, Closs SJ: Acceptability of pain behaviour observational methods (PBOMs) for use by nursing home staff. J Clin Nurs 2071–2073, 2011:20.
• [15]Schofield P, O’Mahony S, Collett B, Potter J: Guidance for the assessment of pain in older adults: a literature review. Brit J Nurs 2008, 17:914-918.
• [16]Bjoro K, Herr K: Assessment of pain in the nonverbal or cognitively impaired older adult. Clin Geriatr Med 2008, 24:237-262.
• [17]Horgas AL, Miller L: Pain assessment in people with dementia. Adv J Nurs 2008, 108:62-70.
• [18]Liu JYW, Pang PCP, Lo SKL: Development and implementation of an observational pain assessment protocol in a nursing home. J Clin Nurs 2012, 21:1789-1793.
• [19]Steedman SM, Middaugh SJ, Kee WG, Carson DS, Harden RN, Miller MC: Chronic-pain medications: equivalence levels and methods of quantifying usage. Clin J Pain 1992, 8:204-214.
• [20]Chiu HFK, Lee HC, Chung WS, Kwong PK: Reliability and validity of the Cantonese version of mini-mental state examination: the preliminary study. J HK Col Psych 1994, 4:25-28.
• [21]Chi I, Law B, Lam TP: Translation of Hong Kong Version Mini Data Set-Home Care (DMS-HC) 2.0. Hong Kong: Sau Po Center on Aging, The University of Hong Kong Press; 2000.
• [22]Hemming K, Girling AJ, Sitch AJ, Marsh J, Lilfor RL: Sample size calculations for cluster randomized controlled trials with a fixed number of clusters. BMC Med Res Methodol 2011, 11:102. BioMed Central Full Text
• [23]Chiu HFK, Chan CKY, Lam LCW, Ng K, Li S, Wong M, Chan W: The modified Fuld verbal fluency test: a validation study in Hong Kong. J Gerontol Psychol Sci 1997, 52B:247-250.
• [24]Gibson SJ, Schere S, Goucke CR: Final Report Australian Pain Society and the Australian Pain Relief Association Pain management guidelines for residential care: Stage 1. Preliminary field testing and preparations for implementation. Sydney: Australian Pain Society; 2004.
• [25]Talerico KA, Evans LK: Making sense of aggressive/protective behaviors in persons with dementia. Alzheim Care Q 2000, 1:77-88.
• [26]Talerico KA, Evans LK, Strumpf NE: Mental health correlates of aggression in nursing home residents with dementia. Gerontologist 2002, 42:169-177.
• [27]Blomqvist K: Older people in persistent pain: nursing and paramedical staff perceptions and pain management. J Adv Nurs 2002, 41:575-584.
• [28]Warden V, Hurley AC, Volicer L: Development and psychometric evaluation of the pain assessment in advanced dementia (PAINAD) scale. JAMDA 2003, 4:9-15.
• [29]Leong IYO, Chong MS, Gibson S: The use of a self-reported pain measure, a nurse-reported pain measure and the PAINAD in nursing home residents with moderate and severe dementia: a validation study. Age Ageing 2006, 35:252-256.
• [30]Miller LL, Talerico KA, Rader J, Swafford KB, Hiatt SR, Millar SB, Smith KR, Sloane PD: Development of an intervention to reduce pain in older adults with dementia: challenges and lessons learned. Alzheim Care Q 2005, 6:154-167.
• [31]Talerico KA, Miller LL, Swafford K, Rader J, Sloane PD, Hiatt SO: Psychosocial approaches to prevent and minimize pain in people with dementia during morning care. Alzheim Care Q 2006, 7:163-174.
• [32]Keefe FJ, Block AR: Development of an observation method for assessing pain behavior in chronic low back pain patients. Behav Ther 1982, 13:363-375.
• [33]Weiner D, Pieper C, McConnell EE, Martinez S, Keefe F: Pain measurement in elders with chronic low back pain: traditional and alternative approaches. Pain 1996, 67:461-467.
• [34]Liu JYW, Briggs M, Closs SJ: The psychometric qualities of four observational pain tools (OPTs) for the assessment of pain in elderly people with osteoarthritis pain. J Pain Symptom Manage 2010, 40:582-589.
• [35]Harden RN, Weinland SR, Remble TA, Houle TT, Colio S, Steedman S, Kee WG: Medication quantification scale version III: update in medication classes and revised detriment weights by survey of American Pain Society physicians. J Pain 2005, 6:364-371.
• [36]Gallizzi M, Gagnon C, Harden N, Stanos S, Khan A: Medication quantification scale version III: internal validation of detriment weights using a chronic pain population. Pain Pract 2008, 8:1-4.
• [37]Kayser-Jones JS, Kris AE, Miaskowski CA, Lyons WL, Paul SM: Hospice care in nursing homes: does it contribute to higher quality pain management? Gerontologist 2006, 46:325-333.
• [38]Finch PM, Price LM, Drummond PD: Radiofrequency heating of painful annular disruptions: one-year outcomes. J Spinal Disord Tech 2005, 18:6-13.
• [39]Jacob E, Miaskowski C, Savedra M, Beyer JE, Treadwell M, Styles L: Quantification of analgesic use in children with sickle cell disease. Clin J Pain 2007, 23:8-14.
• [40]Peng MC, Zhong PW, Liang YQ, White P, Xu DY, He LJ, Chen HY, Zhong YM, Lu XX: Initial validation of Chinese Pain Assessment in Advanced Dementia scale (C-PAINAD). Chinese J Nurs 2007, 42:6-9.
• [41]Schug SA: The global year against acute pain. Anaesth Intens Care 2011, 39:11-14.
• [42]International Association for the Study of Pain (IASP): Declaration that Access to Pain Management Is a Fundamental Human Right. https://www.iasp-pain.org/Advocacy/Content.aspx?ItemNumber=1821 webcite
• [43]Algase DL, Beel-Bates C, Beattie ERA: Wandering in long-term care. Ann Long-Term Care 2003, 11:33-39.
• [44]Smith M, Buckwalter K: Behaviors associated with dementia. AM J Nurs 2005, 105:40-53.
• [45]Hadjistavropoulose T, Craig KD: A theoretical framework for understanding self-report and observational measures of pain: a communications model. Behav Res Ther 2002, 40:551-570.
• [46]Kovach C, Griffie J, Muchka S, Noonan P, Weissman D: Nurses’ perceptions of pain assessment and treatment in the cognitively impaired elderly: it’s not a guessing game. J Adv Nurs Pract 2000, 14:215-220.