The Exploration of Adherence to the Clinical Practice Guidelines on the Management of Cancer Pain by Oncology Nurse Practitioners - Current Status and Its Related Factors

• Main Authors: SU-YING YU, 游素英
• Other Authors: YUEH-CHIH CHEN
• Format: Others
• Language: zh-TW
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/74006582070847095709

碩士 === 弘光科技大學 === 護理研究所 === 103 === Cancer has always been the number one killer in Taiwan out of the top ten causes of death. In the largest research study on cancer pain conducted in Taiwan, 62.4% of patients experienced different degrees of pain and problems associated with the inability to control pain (Chen, et al., 2007). Some reasons for this inability to control cancer pain originate from a lack of clinician’s knowledge as well as failure to follow cancer pain control guidelines recommended by the American Society of Clinical Oncology in 2013. Therefore, the ques-tion of adherence to cancer pain control guidelines has always been a challenge that the healthcare community needs to overcome. Domestically, there is limited research on how to better direct and influence clinical professionals toward adherence. Therefore, this research seeks to study the relationship between knowledge of oncology nurse practitioners and the willingness to adhere to guidelines including related factors when treating cancer pain and contribute to literature on how to improve pain control. This study adopted a cross-section descriptive survey and purposive sampling. In Sep-tember 2014, 49 oncology nurse practitioners from an oncology center in the northern district of Taipei were surveyed using a questionnaire. The study focused on the pain control knowledge of specialist nurses and the willingness to adhere to guidelines and the effects of related factors in adhering to guidelines in clinical care. Results from the study found that more than 70% answered correctly on questions about pharmacological management of can-cer pain. It was found that administering pain medication principle subscale outperformed administering pain medication practice subscale. It was found that the disposition and educa-tion level of oncology nurse practitioners along with their research on cancer pain outper-formed others with similar education levels. Additionally, nurses who graduated from voca-tional nursing schools performed worst in their knowledge about cancer pain control and principles of medication, with a statistical significance. The variables such as their major in school, salary, professional status did not have any correlation with cancer pain control knowledge. Moreover, 93.4% of nurse practitioners are willing to follow cancer pain control guide-lines defined by hospitals. The most common reasons for not adhering to the guidelines is epidural analgesia. The most reason for adhering to the guidelines is opioids of side effects. There was no correlation between the department, education level, salary or professional sta-tus nurse practitioners in cancer pain control knowledge. The work experience variable of nurse practitioners from other departments made a difference (p= .00). The three most com-mon factors that influence oncology nurse practitioners with regard to adherence to guidelines are were whether recommendations for cancer pain control guidelines conformed to the in-surance payment system, whether the work environment lacked pain control education mate-rials, and the confidence level of the pain control medical team. The practice of nurse practi-tioners in internal medicine of oncology have a greater effect than surgical oncology, with a statistical significance of p=.01. The biggest effect was seen in the area of practice (p=.00), especially in participants with work experience between 1-5 years and 6-10 years. The work experience variable of nurse practitioners from other departments also made a difference (p=.04). Additionally, there was a positive correlation between the effect of oncology nurse practitioners’ knowledge of cancer pain control and adherence to guidelines, meaning the more knowledge the nurses had about cancer pain control, the lower its effect on the adher-ence to guidelines, and the effect of knowledge on adherence, attitude and practice showed medium correlations. The education levels of nurse practitioners , oncology nurse practitio-ners experience, others nurse practitioners experience and Department can explained about guidelines adherence 46.3%.Research findings conclude that nurse practitioners need to increase their knowledge about pharmacological management of cancer pain – practical subscale. In the area of over-coming and improving nurse practitioners’ propensity to follow guidelines, practice en-hancements should first be made and hospitals need to keep the contents of the guidelines updated so they can be applied to and are suitable for clinics. This will increase the willing-ness by medical staff to use them, thereby elevating the quality of pain control overall. Keyword：Nurse practitioners、Cancer pain control guidelines、Adherence