Nemedicinski dejavniki, povezani z izidom zdravljenja kronične nemaligne bolečine

• Main Author: Kovačević, Irena
• Other Authors: Petek, Davorina
• Format: Doctoral or Postdoctoral Thesis
• Language: Slovenian
• Published: 2020
• Subjects: kronična ne-maligna bolečina; samozdravljenje; stališča; bolniki; zdravstveni delavci; napoved slabega izida zdravljenja; chronic non-malignant pain; self-treatment; attitudes; patients; health care providers; prediction of poor outcome of the treatment; Morali; sami
• Online Access: https://repozitorij.uni-lj.si/IzpisGradiva.php?id=116867; https://repozitorij.uni-lj.si/Dokument.php?id=130556&dn=; https://repozitorij.uni-lj.si/Dokument.php?id=130557&dn=

Izhodišča Kronična bolečina, katere prevalenca je v stalnem porastu, je ena najpomembnejših zdravstvenih težav na svetu. Posledice kronične bolečine so motnje spanja, reaktivna anksioznost, depresija ter slabša kakovost življenja. Predstavlja breme za posameznika in celotno družbo. Samozdravljenje je ena najpogostejših oblik samopomoči posameznika in pomemben del z zdravjem povezanega vedenja. Posameznikova izkušnja z boleznijo in zdravljenjem ni odvisna le od bioloških, temveč tudi od psihološko-vedenjskih in socialnih dejavnikov. Namen Raziskati nemedicinske dejavnike, ki so povezani z uspešnim izidom zdravljenja kronične nemaligne bolečine. Hipoteze Izid zdravljenja bolnikov s kronično nemaligno bolečino je povezan z značilnostmi bolečine (intenzivnost, narava, lokalizacija in trajanje bolečine) ter bolnikovimi psihološkimi (depresija, anksioznost) in socialnimi dejavniki (socialna opora). Izid zdravljenja je pri bolnikih s kronično ne-maligno bolečino povezan z uporabo samozdravljenja, družinskih metod samozdravljenja in bolnikovim verovanjem v metode samozdravljenja. Metode V prvi fazi sem opravila kvalitativno fenomenološko študijo, delno strukturiran intervju s 35 udeleženci raziskave (15 bolnikov s kronično ne-maligno bolečino različne stopnje, ki so bili zdravljeni na kliniki za zdravljenje bolečine in 20 zdravstvenih delavcev). V drugi fazi sem izvedla presečno raziskavo z dvema skupinama bolnikov. Za oceno bioloških, psiholoških in socialnih značilnosti preiskovancev sem uporabila vprašalnik. V prvi skupini uspešno zdravljenih bolnikov je bilo 156 oseb (NRS 0-3), v drugi skupini bolnikov s slabim izidom zdravljenja kronične ne-maligne bolečine je bilo 180 sodelujočih (NRS 4-10). Rezultati V vsaki skupini intervjuvancev sem prepoznala in analizirala tri glavne teme. V skupini bolnikov so izstopale teme: pozitivni učinki samopomoči, potreba po samopomoči in njeni socialni vidiki. V skupini zdravstvenih delavcev so izstopale teme: pozitivni učinki samopomoči, potreba po samopomoči in tveganja samopomoči. Rezultati temelječi na postavljenih ciljih, bivariatna analiza, so pokazali, da so bolniki, pri katerih z zdravljenjem ni prišlo do zmanjšanja bolečine (NRS 4-10), imeli slabšo kakovost življenja (P<0,001), značilno slabšo zadovoljstvo z zdravstveno službo (P<0,001) in slabšo samooceno zdravja v primerjavi z skupino bolniki z uspešno zdravljeno kronično bolečino (NRS 0-3). Slab izid zdravljenja kronične ne-maligne bolečine po multivariatnem binarnem logističnem regresijskem modelu, je statistično pomembno povezan z nižjo vrednostjo WHOQOL-BREF PHYS (OR=0.95 (95% CI: 0.91-0.99 P=0.009). S psihološkega vidika je bila višja stopnja depresivnosti (CES-D lestvica) povezana s slabšim izidom zdravljenja (OR=1.08 (95% CI: 1.02-1.14 P=0,009). Rezultat zdravljenja po multivariatnem binarnem logističnem regresijskem modelu ni bil neposredno povezan z bolnikovo socialno oporo (OR=1.04, 95 % CI: 0.95-1.15, P=0.395). Kljub temu sem dokazala, da je bil pri bolnikih, ki so živeli sami (brez partnerja), rezultat zdravljenja prepričljivo slabši (OR=2.16 (95% CI: 1.03-4.53 P=0,043). Samozdravljenje, uporaba družinskih metod samozdravljenja in bolnikovo prepričanje o koristnosti samozdravljenja pri bolnikih s kronično ne-maligno bolečino, sami po sebi niso direktno povezani s slabšim izidom zdravljenja, razen v primeru samozdravljenja zaradi nedostopnosti zdravnikov in ustreznih načinov zdravljenja, ki tveganje za slabši izid zdravljenja poveča za več kot dvakrat (OR=2,89). Zaključki Samozdravljenje kronične bolečine razumemo kot dejavnost ustrezno opolnomočenega bolnika, ki naj bi ga pri svojem delu uporabljali zdravstveni delavci z namenom nadaljnjega vključevanja bolnika v lastno zdravljenje ter motivacijo za čim večjo samostojnost pri zdravljenju znotraj še varnih okvirov uradne medicine. Zdravstveni delavci podpirajo samozdravljenje kronične ne-maligne bolečine kot dodatek kliničnemu zdravljenju. Zaradi možnih stranskih učinkov (prepozna postavitev diagnoze ter prepozno ugotavljanje resničnega vzroka bolečine), bi morali bolnike natančno obvestiti o varnih metodah in času trajanja samozdravljenja. S številnimi napovednimi dejavniki (prilagojeni vplivom drugih spremenljivk modela) lahko pomembno predvidimo, ali lahko bolnika uvrstimo v skupino s povečanim tveganjem za slabši izid zdravljenja. Tipični bolnik, pri katerem pričakujemo slabši rezultat zdravljenja, je upokojen, depresiven ter z bolečino, ki ga ovira pri vsakodnevnih aktivnostih in spanju. Background Chronic pain is a global public health issue with increasing prevalence. Chronic pain causes sleep disorder, reactive anxiety, and depression, impairs the quality of life it burdens the individual and society as a whole. Self-treatment is one of the most common activities of self-care and an important part of health behavior. The experience that everyone person has in his illness, as well as its outcome, will depend not only on biological factors but on psychological-behavioral and social factors as well. Aim My aim was to examine non-medical factors related to the outcome of the treatment of chronic non-malignant pain. Hypotheses The outcome of the treatment of patients with chronic non-malignant pain is associated with the dimensions of pain (intensity, quality, localization, and duration of pain), psychological factors (depression, anxiety) and social factors (social support). The outcome of the treatment of patients with chronic non-malignant pain is associated with the implementation of self-treatment, the use of family traditions in self-treatment and patients’ belief in the positive effect of self-treatment. Methods The first phase was qualitative phenomenological research, semi-structured interviews with 35 participants (15 patients with chronic non-malignant pain at various levels of treatment at the pain clinic, and 20 healthcare professionals). The qualitative research was carried out by the method of recording interviews. The second phase was a cross-sectional study with two groups of patients using a questionnaire with biological, psychological and social characteristics of patients. The first group of participants, with the successful outcome of the treatment of chronic non-malignant pain (NRS 0-3) comprised 156 subjects. The other group of participants, with the poor outcome of the treatment of chronic non-malignant pain (NRS 4-10) comprised 180 subjects. Results Three themes were recognized from analyzed interviews in each study group. Data were collected from the patient group revealed the following themes: positive aspects of self-care, need for self-care, and social aspects of self-care. Three themes recognized on the basis of data from the health care provider group were: positive aspects of self-care, need for self-care, and risks of self-care. The poor outcome of the treatment of chronic non-malignant pain in a multivariate binary logistic regression model is statistically significantly associated with the lower WHOQOL-BREF PHYS domain (OR=0.95 (95% CI: 0.91-0.99 P=0.009). From the psychological factors’ higher depression level (CES-D score) was significantly associated with a poorer treatment outcome OR=1.08 (95% CI: 1.02-1.14 P=0,009). The outcome of the treatment was not directly related to social support measured by the multivariate binary logistic regression model (OR=1.04, 95 %CI: 0.95-1.15, P=0.395), although Living alone (without a partner) was significantly associated with a poorer treatment outcome (OR=2.16 (95% CI: 1.03-4.53 P=0,043). The implementation of self-treatment, use of family traditions in self-treatment and patients’ belief in the positive effect of self-treatment were not significantly associated with poor outcome of the treatment of patients with chronic non-malignant pain, except self-treatment due to inaccessibility of doctors and adequate therapies that increases the chance of poor outcome more than double (OR=2.89). Conclusion Self-treatment of chronic pain is understood as an activity of the empowered patient and should be used by health care providers to further include patient in his treatment and motivate him for self-care within the safety of official medicine. Health care providers support the self-treatment of chronic non-malignant pain as an adjunct to clinical treatment. Because of possible risk of self-treatment adverse effects (late diagnosis and true cause of pain establishment) patients should be well informed about the methods and time used. Several predictors (adjusted to the effect of other variables in the model) showed the significant prediction of belonging to the poor outcome of the treatment group: The typical patient with the poor pain manages outcome is retired, with depressive behavior, and with pain that disturbs general activity and sleeping.