癌性疼痛规范化治疗课件

癌痛规范化和个体化评估广东省中医院李勇Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL癌痛规范化和个体化评估1●●●2019年最新调查研究CancermedicineORIGINALRESEARCHCurrentpracticesincancerpainmanagementinAsia:asurveyofpatientsandphysiciansacross10countries10个亚洲地区医生与患者癌痛管理现状调查yong-chulkim,etal.CancerMedicine.2019.EpubaheadofprintValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL●●●2●●●研究目的调査亚洲目前癌痛管理现状,其中包括癌痛对癌症患者生活质量景响患者描述癌痛情况≯医生对癌症患者癌痛评估情况阿片类药物使用情况yong-chulkim,etal.CancerMedicine.2019.EpubaheadofprintValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL●●●3●●●研究方法参与国家:10个亚洲国家,包括中国,香港,印尼,菲律宾,韩国,马来西亚,新加坡,台湾,泰国,越南研究时间:4个月,2019年09月-12月≥研究方法:无对照,问卷调査,问题设计由16名亚洲资深癌痛专家,严格遵循ESOMAR标准来制定研究对象:医生及患者yong-chulkim,etal.CancerMedicine.2019.EpubaheadofprintValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL●●●4●●●研究方法冫医生纳入标准:由国家机构,医疗机构,社会医疗等机构及其他合法组织随机挑选≯医生排除标准:医药公司聘用或相关医务人员患者入组标准:大于18岁,通过患者自发组织推荐,医生推荐,患者推荐,网络组织,现场招募,电话招募等获得≯患者排除标准:医疗,制药,市场等疼痛相关组织有关患者Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL●●●5●●●研究方法共纳科463名医生mTable1.Demographiccharacteristicsofphysicians(n=463)基本资料如下Madian(QR)313(67,6)Country/regionepublicofKoreaethamPhilippines30(6Yearsinclinicalpractice87(18.8)ainmanagementIORinterquartilerangeyong-chulkim,etal.CancerMedicine2019.EpubaheadofprintValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL●●●6结果●●●共纳1190名患者基本资料如下多8523untry/regionsingapore516個43.30429Mild(0-3)Median(IORNe6monthsto1yea325c7.3)7g50Lessthan3month1058)urationofpain.monthsyong-chuTkim,etal.CancerMedicine2019.EpubaheadofprintValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL结果7结果●●●疼痛对患者生活质量影响Table4.Effectsofcancerpainonpatients'qualityoflife(QoLn=1190)n(%6)ofrespondentsinEffectsofcancerpainonQOLaareementCancerpainaffectspatie影响目常生活67(81ofdailylivingpectsofdailylifeaffePainaffectssleepingp影响睡眠831(859)Painaffectsconcentra影响精神及注意力841(870Paincausestoomuch依赖他人642(66.4)otherpeopleOverallQoLisgood生活质量不受影响328(33.9)yong-chulkim,etal.CancerMedicine.2019.EpubaheadofprintValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL结果8●●●结果Table3.Physicians'perceivedbarrierstooptimizingcancerpainmanagement(n=463)n(%)(NRSscore>Median(IOR)Patient'sreluctancetotakeopioidsduetofear患者害怕成瘾311(67.2)7030)Patientsreluctancetotakeopioidsduetofear301(6507.0(30)Patient'sreluctancetoreportpainnadequateassessmentofpainbyphysiciansal230(4975.050)LackofavailablepainmanagementorpalliativeExcessiveregulationofopioiddrugs疼痛药物监管过222(480)5.0(5.0)ysiciansreluctancetoprescribeopioids医生不愿意使用阿片类药物198(4285.0(40)Patient'sinabilitytopayforinterventionalanalge患者无法支付物费用173(374050)AnNRSconingsystemfrom0to10wasusedtoevaluatephysicansresponses.NRS,numericratingscale:IQR,interquartilerangeadequateassessmentofpainwasrecognizedasabarriertotherapyoptimizationby49.7%ofphysiciansValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL●●●9●●●结论冫证实癌痛严重影响患者生活质量疼痛评估不充分加强宣教≯正确,足量使用阿片类药物yong-chulkim,etal.CancerMedicine.2019.EpubaheadofprintValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL●●●10癌性疼痛规范化治疗课件11癌性疼痛规范化治疗课件12癌性疼痛规范化治疗课件13癌性疼痛规范化治疗课件14癌性疼痛规范化治疗课件15癌性疼痛规范化治疗课件16癌性疼痛规范化治疗课件17癌性疼痛规范化治疗课件18癌性疼痛规范化治疗课件19癌性疼痛规范化治疗课件20癌性疼痛规范化治疗课件21癌性疼痛规范化治疗课件22癌性疼痛规范化治疗课件23癌性疼痛规范化治疗课件24癌性疼痛规范化治疗课件25癌性疼痛规范化治疗课件26癌性疼痛规范化治疗课件27癌性疼痛规范化治疗课件28癌性疼痛规范化治疗课件29癌性疼痛规范化治疗课件30癌性疼痛规范化治疗课件31癌性疼痛规范化治疗课件32癌性疼痛规范化治疗课件33癌性疼痛规范化治疗课件34癌性疼痛规范化治疗课件35癌痛规范化和个体化评估广东省中医院李勇Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL癌痛规范化和个体化评估36●●●2019年最新调查研究CancermedicineORIGINALRESEARCHCurrentpracticesincancerpainmanagementinAsia:asurveyofpatientsandphysiciansacross10countries10个亚洲地区医生与患者癌痛管理现状调查yong-chulkim,etal.CancerMedicine.2019.EpubaheadofprintValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL●●●37●●●研究目的调査亚洲目前癌痛管理现状,其中包括癌痛对癌症患者生活质量景响患者描述癌痛情况≯医生对癌症患者癌痛评估情况阿片类药物使用情况yong-chulkim,etal.CancerMedicine.2019.EpubaheadofprintValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL●●●38●●●研究方法参与国家:10个亚洲国家,包括中国,香港,印尼,菲律宾,韩国,马来西亚,新加坡,台湾,泰国,越南研究时间:4个月,2019年09月-12月≥研究方法:无对照,问卷调査,问题设计由16名亚洲资深癌痛专家,严格遵循ESOMAR标准来制定研究对象:医生及患者yong-chulkim,etal.CancerMedicine.2019.EpubaheadofprintValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL●●●39●●●研究方法冫医生纳入标准:由国家机构,医疗机构,社会医疗等机构及其他合法组织随机挑选≯医生排除标准:医药公司聘用或相关医务人员患者入组标准:大于18岁,通过患者自发组织推荐,医生推荐,患者推荐,网络组织,现场招募,电话招募等获得≯患者排除标准:医疗,制药,市场等疼痛相关组织有关患者Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL●●●40●●●研究方法共纳科463名医生mTable1.Demographiccharacteristicsofphysicians(n=463)基本资料如下Madian(QR)313(67,6)Country/regionepublicofKoreaethamPhilippines30(6Yearsinclinicalpractice87(18.8)ainmanagementIORinterquartilerangeyong-chulkim,etal.CancerMedicine2019.EpubaheadofprintValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL●●●41结果●●●共纳1190名患者基本资料如下多8523untry/regionsingapore516個43.30429Mild(0-3)Median(IORNe6monthsto1yea325c7.3)7g50Lessthan3month1058)urationofpain.monthsyong-chuTkim,etal.CancerMedicine2019.EpubaheadofprintValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL结果42结果●●●疼痛对患者生活质量影响Table4.Effectsofcancerpainonpatients'qualityoflife(QoLn=1190)n(%6)ofrespondentsinEffectsofcancerpainonQOLaareementCancerpainaffectspatie影响目常生活67(81ofdailylivingpectsofdailylifeaffePainaffectssleepingp影响睡眠831(859)Painaffectsconcentra影响精神及注意力841(870Paincausestoomuch依赖他人642(66.4)otherpeopleOverallQoLisgood生活质量不受影响328(33.9)yong-chulkim,etal.CancerMedicine.2019.EpubaheadofprintValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL结果43●●●结果Table3.Physicians'perceivedbarrierstooptimizingcancerpainmanagement(n=463)n(%)(NRSscore>Median(IOR)Patient'sreluctancetotakeopioidsduetofear患者害怕成瘾311(67.2)7030)Patientsreluctancetotakeopioidsduetofear301(6507.0(30)Patient'sreluctancetoreportpainnadequateassessmentofpainbyphysiciansal230(4975.050)LackofavailablepainmanagementorpalliativeExcessiveregulationofopioiddrugs疼痛药物监管过222(480)5.0(5.0)ysiciansreluctancetoprescribeopioids医生不愿意使用阿片类药物198(4285.0(40)Patient'sinabilitytopayforinterventionalanalge患者无法支付物费用173(374050)AnNRSconingsystemfrom0to10wasusedtoevaluatephysicansresponses.NRS,numericratingscale