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Henshall C, Jones L, Armitage C, Tomlinson L. Empowering nurses through inclusive leadership to promote research capacity building: A James Lind Alliance priority setting Partnership in Community Nursing. J Adv Nurs 2022; 78:2765-2774. [PMID: 35765768 PMCID: PMC9546327 DOI: 10.1111/jan.15342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/23/2022] [Accepted: 06/13/2022] [Indexed: 12/01/2022]
Abstract
Aims This paper focuses on the benefits of inclusive leadership when undertaking a priority setting partnership in community nursing, through providing a collaborative and committed nurse‐led forum for initiating impactful changes, identifying evidence uncertainties and driving research capacity‐building initiatives. Design This is a Discussion paper. The project was undertaken between 2020 and 2021. Data sources This paper is based on shared reflections as 70@70 Senior Nurse Research Leaders and is supported by literature and theory. It draws on issues relating to collective leadership, stakeholder engagement, diversity, inclusivity and COVID‐19. Implications for nursing The James Lind Alliance Priority Setting Partnership catalysed the development of a rigorous evidence‐base in community nursing. The collaborative opportunities, networks and connections developed with patients, carers, nursing leaders, policy makers and healthcare colleagues raised the profile of community nursing research. This will benefit nursing research, practice, education and patients in receipt of community nursing care. Collective buy in from national leaders in policy, education, funding and commissioning has secured a commitment that the evidence uncertainties will be funded. Conclusion Four key learnings emerged: collective leadership can ensure learning is embedded and sustained; developing an engaged stakeholder community to promote community nursing research is essential; a diverse membership ensures inclusivity and representation; and insights into the impact of COVID‐19 aid progress. The process increased research engagement and created capacity and capability‐building initiatives. This will help community nurses feel empowered to lead changes to practice. Sustained engagement and commitment are required to integrate research priorities into community nursing research, education and practice and to drive forward changes to commissioning and service delivery. Impact The study promoted research capacity building through inclusive leadership. This can increase community nurses' research engagement and career development and patient care quality and safety; this can incentivize funders and policy makers to prioritize community nursing research.
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Affiliation(s)
- Catherine Henshall
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Louise Jones
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Claire Armitage
- Directorate of Mental Health, Partnership NHS Trust, Leicestershire, UK
| | - Lee Tomlinson
- Kent Community Health NHS Foundation Trust, London, UK
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Hackett J, Allsop MJ, Taylor S, Bennett MI, Bewick BM. Using information and communication technologies to improve the management of pain from advanced cancer in the community: Qualitative study of the experience of implementation for patients and health professionals in a trial. Health Informatics J 2020; 26:2435-2445. [PMID: 32133902 DOI: 10.1177/1460458220906289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In cancer care, there are emerging information and communication technology systems being developed, enabling real-time information sharing between patients and health professionals. This study explored health professionals' and patients' perceptions of their engagement with an information and communication technology system for pain management to understand the mechanisms that could support implementation into routine palliative care practice. This was a qualitative study, embedded within a randomised control trial, using semi-structured face-to-face interviews. Data were analysed using thematic analysis. The role of health professionals was a key component to patient engagement with the information and communication technology system. Where patients engaged with the information and communication technology system, both patients and health professionals reported benefits to system use in addition to usual care. Implementation issues were identified that can be used to guide future system development to support pain management in the context of routine clinical care in palliative care services. Where interventions are dependent on multiple providers, collaborative working and consideration of the context within which they are set are needed.
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Development of a cancer pain self-management resource to address patient, provider, and health system barriers to care. Palliat Support Care 2019; 17:472-478. [PMID: 31010454 DOI: 10.1017/s1478951518000792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The majority of self-management interventions are designed with a narrow focus on patient skills and fail to consider their potential as "catalysts" for improving care delivery. A project was undertaken to develop a patient self-management resource to support evidence-based, person-centered care for cancer pain and overcome barriers at the levels of the patient, provider, and health system. METHOD The project used a mixed-method design with concurrent triangulation, including the following: a national online survey of current practice; two systematic reviews of cancer pain needs and education; a desktop review of online patient pain diaries and other related resources; consultation with stakeholders; and interviews with patients regarding acceptability and usefulness of a draft resource. RESULT Findings suggested that an optimal self-management resource should encourage pain reporting, build patients' sense of control, and support communication with providers and coordination between services. Each of these characteristics was identified as important in overcoming established barriers to cancer pain care. A pain self-management resource was developed to include: (1) a template for setting specific, measureable, achievable, relevant and time-bound goals of care, as well as identifying potential obstacles and ways to overcome these; and (2) a pain management plan detailing exacerbating and alleviating factors, current strategies for management, and contacts for support. SIGNIFICANCE OF RESULTS Self-management resources have the potential for addressing barriers not only at the patient level, but also at provider and health system levels. A cluster randomized controlled trial is under way to test effectiveness of the resource designed in this project in combination with pain screening, audit and feedback, and provider education. More research of this kind is needed to understand how interventions at different levels can be optimally combined to overcome barriers and improve care.
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Screening and Audit as Service-Level Strategies to Support Implementation of Australian Guidelines for Cancer Pain Management in Adults: A Feasibility Study. Pain Manag Nurs 2018; 20:113-117. [PMID: 30448191 DOI: 10.1016/j.pmn.2018.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 04/10/2018] [Accepted: 05/13/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pain in people with cancer is common but often under-recognized and under-treated. Guidelines can improve the quality of pain care, but need targeted strategies to support implementation. AIM To test the feasibility of two service-level strategies for supporting guideline implementation: a screening system and medical record audit. DESIGN Multimethods. SETTING One oncology outpatient service, and one palliative care outpatient and inpatient service. PARTICIPANTS Patients with advanced cancer. METHODS Patients were screened in the waiting room with a modified version of the Edmonton Symptom Assessment System-revised either electronically or in paper-based format. Feasibility indicated the percentage of patients successfully screened from the total number attending the services. An audit assessed adherence to key indicators of pain assessment and management. Feasibility thresholds were set at 75% incidence for screening and a median of 30 minutes per patient for audit. RESULTS Of 452 patient visits, 95% (n = 429) were successfully screened, 34% (n = 155) electronically and 61% (n = 274) paper-based. Electronic pain screening was technically challenging and time-intensive for nurses. Thirty-one patients consented to have their records audited. The median audit time was 37.5 minutes (range 10-120 minutes). Variability arose from the number and type of record (outpatient or inpatient). Adherence to indicators varied from 63% (pain assessment at first presentation) to 94% (regular pain assessment and medication prescribed at regular intervals). CONCLUSIONS This study confirmed the need to implement evidence-based guidelines for cancer pain and generated useful insights into the feasibility of pain screening and audit.
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Luckett T, Phillips J, Agar M, Lam L, Davidson PM, McCaffrey N, Boyle F, Shaw T, Currow DC, Read A, Hosie A, Lovell M. Protocol for a phase III pragmatic stepped wedge cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of screening and guidelines with, versus without, implementation strategies for improving pain in adults with cancer attending outpatient oncology and palliative care services: the Stop Cancer PAIN trial. BMC Health Serv Res 2018; 18:558. [PMID: 30012122 PMCID: PMC6048744 DOI: 10.1186/s12913-018-3318-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/21/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Pain is a common and distressing symptom in people with cancer, but is under-recognised and under-treated. Australian guidelines for 'Cancer Pain Management in Adults' are available on the Cancer Council Australia Cancer Guideline Wiki. This study aims to evaluate the effectiveness and cost-effectiveness of a suite of guideline implementation strategies for improving pain outcomes in adults with cancer in oncology and palliative care outpatient settings. METHODS The study will use a stepped-wedge cluster randomised controlled design, with oncology and palliative care outpatient services as the clusters. Patients will be eligible if they are adults with cancer and pain presenting to participating services during the study period. During an initial control arm, services will routinely screen patients for average and worst pain over the past 24 h using a 0-10 numerical rating scale (NRS) and have unfettered access to online guidelines. During the intervention arm, staff at each service will be encouraged to use: 1) a patient education booklet and self-management resource; 2) an online spaced learning cancer pain education module for clinicians from different disciplines; and 3) audit and feedback of service performance on key indices of cancer pain screening, assessment and management. Service-based clinical change champions will lead implementation of these strategies. The trial's primary outcome will be the probability that patients initially screened as having moderate-severe (≥5/10 NRS) worst pain experience a clinically important improvement one week later, defined as ≥ 30% reduction. Secondary outcomes will include patient empowerment and quality of life, carer experience, and cost-effectiveness. For the main analysis, linear mixed models will be used, accounting for clustering and the longitudinal design. Eighty-two patients per service at six services (N = 492) will provide > 90% power. A qualitative sub-study and analyses of structural and process factors will explore opportunities for further refinement and tailoring of the intervention. DISCUSSION This pragmatic trial will inform implementation of guidelines across a range of oncology and palliative care outpatient service contexts. If found effective, the implementation strategies will be made freely available on the Wiki alongside the guidelines. TRIAL REGISTRATION Registered 23/01/2015 on the Australian New Zealand Clinical Trials Registry ( ACTRN12615000064505 ).
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Affiliation(s)
- Tim Luckett
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Level 7, 235 Jones St, Ultimo, (PO Box 123), Sydney, NSW 2007 Australia
| | - Jane Phillips
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Level 7, 235 Jones St, Ultimo, (PO Box 123), Sydney, NSW 2007 Australia
| | - Meera Agar
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Level 7, 235 Jones St, Ultimo, (PO Box 123), Sydney, NSW 2007 Australia
| | | | | | - Nicola McCaffrey
- Deakin Health Economics, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC Australia
| | - Frances Boyle
- The Mater Hospital, Cancer Care, Sydney, NSW Australia
| | - Tim Shaw
- Faculty of Health Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW Australia
| | - David C. Currow
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Level 7, 235 Jones St, Ultimo, (PO Box 123), Sydney, NSW 2007 Australia
| | - Alison Read
- Department of Renal/Oncology, Gosford Hospital, Gosford, NSW Australia
| | - Annmarie Hosie
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Level 7, 235 Jones St, Ultimo, (PO Box 123), Sydney, NSW 2007 Australia
| | - Melanie Lovell
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, NSW Australia
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Zhang P, Meng X, Tang X, Ren L, Liang J. The effect of a coix seed oil injection on cancer pain relief. Support Care Cancer 2018; 27:461-465. [PMID: 29971522 DOI: 10.1007/s00520-018-4313-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/06/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Pain is one of the most commonly reported symptoms in patients with advanced cancer, but is still less than optimally treated. The effect of traditional Chinese medicine in cancer pain treatment is nowadays getting more and more attention. OBJECTIVE To investigate the effect of a coix seed oil injection on cancer pain relief in a cancer center in a tertiary hospital in China. METHODS Patients in the treatment group received a coix seed oil injection for 2 weeks, while patients in the control group received equivalent 0.9% saline. The numeric rating scale was used to assess the pain level. The Quality of Life Questionnaire-Core 30 was used to assess life quality. The adverse drug reactions during the treatment process were observed. RESULTS Patients in the coix seed treatment group had significantly superior efficacy on pain control over those in the control group. Coix seed therapy significantly improved patients' scores reflecting by the Quality of Life Questionnaire-Core 30 (QLQ-C30) scale. In addition, the occurrence of adverse reactions such as constipation and nausea in the treatment group was significantly lower than that in the control group. CONCLUSION The coix seed oil injection effectively reduced the pain level of cancer patients, significantly improved their life quality, and had no obvious adverse effects.
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Affiliation(s)
- Peirong Zhang
- Department of Oncology, Peking University International Hospital, No. 1, Life Science Park Road, Beijing, 102206, China
| | - Xiaoyan Meng
- Department of Oncology, Peking University International Hospital, No. 1, Life Science Park Road, Beijing, 102206, China
| | - Xiaohua Tang
- Department of Oncology, Peking University International Hospital, No. 1, Life Science Park Road, Beijing, 102206, China
| | - Li Ren
- Department of Oncology, Peking University International Hospital, No. 1, Life Science Park Road, Beijing, 102206, China
| | - Jun Liang
- Department of Oncology, Peking University International Hospital, No. 1, Life Science Park Road, Beijing, 102206, China.
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Al-Atiyyat NMH, Vallerand AH. Patient-related attitudinal barriers to cancer pain management among adult Jordanian patients. Eur J Oncol Nurs 2018; 33:56-61. [DOI: 10.1016/j.ejon.2018.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 01/20/2018] [Accepted: 01/22/2018] [Indexed: 11/29/2022]
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Taylor S, Allsop MJ, Bekker HL, Bennett MI, Bewick BM. Identifying professionals' needs in integrating electronic pain monitoring in community palliative care services: An interview study. Palliat Med 2017; 31:661-670. [PMID: 27836943 DOI: 10.1177/0269216316677470] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Poor pain assessment is a barrier to effective pain control. There is growing interest internationally in the development and implementation of remote monitoring technologies to enhance assessment in cancer and chronic disease contexts. Findings describe the development and testing of pain monitoring systems, but research identifying the needs of health professionals to implement routine monitoring systems within clinical practice is limited. AIM To inform the development and implementation strategy of an electronic pain monitoring system, PainCheck, by understanding palliative care professionals' needs when integrating PainCheck into routine clinical practice. DESIGN Qualitative study using face-to-face interviews. Data were analysed using framework analysis Setting/participants: Purposive sample of health professionals managing the palliative care of patients living in the community Results: A total of 15 interviews with health professionals took place. Three meta-themes emerged from the data: (1) uncertainties about integration of PainCheck and changes to current practice, (2) appraisal of current practice and (3) pain management is everybody's responsibility Conclusion: Even the most sceptical of health professionals could see the potential benefits of implementing an electronic patient-reported pain monitoring system. Health professionals have reservations about how PainCheck would work in practice. For optimal use, PainCheck needs embedding within existing electronic health records. Electronic pain monitoring systems have the potential to enable professionals to support patients' pain management more effectively but only when barriers to implementation are appropriately identified and addressed.
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Affiliation(s)
- Sally Taylor
- 1 Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew J Allsop
- 1 Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Hilary L Bekker
- 2 Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Michael I Bennett
- 1 Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Bridgette M Bewick
- 2 Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Lovell M, Luckett T, Boyle F, Stubbs J, Phillips J, Davidson PM, Olver I, von Dincklage J, Agar M. Adaptation of international guidelines on assessment and management of cancer pain for the Australian context. Asia Pac J Clin Oncol 2015; 11:170-7. [DOI: 10.1111/ajco.12352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Melanie Lovell
- Greenwich Hospital; HammondCare; Sydney New South Wales Australia
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
- Improving Palliative Care through Clinical Trials (ImPaCCT); Sydney New South Wales Australia
| | - Tim Luckett
- Improving Palliative Care through Clinical Trials (ImPaCCT); Sydney New South Wales Australia
- Centre for Cardiovascular and Chronic Care; Faculty of Health; University of Technology Sydney (UTS); Sydney New South Wales Australia
- South Western Sydney Clinical School; University of New South Wales (UNSW); Sydney New South Wales Australia
| | - Frances Boyle
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
- Improving Palliative Care through Clinical Trials (ImPaCCT); Sydney New South Wales Australia
- Patricia Ritchie Centre for Cancer Care and Research; Mater Hospital; Sydney New South Wales Australia
| | | | - Jane Phillips
- Improving Palliative Care through Clinical Trials (ImPaCCT); Sydney New South Wales Australia
- Centre for Cardiovascular and Chronic Care; Faculty of Health; University of Technology Sydney (UTS); Sydney New South Wales Australia
| | - Patricia Mary Davidson
- Improving Palliative Care through Clinical Trials (ImPaCCT); Sydney New South Wales Australia
- Centre for Cardiovascular and Chronic Care; Faculty of Health; University of Technology Sydney (UTS); Sydney New South Wales Australia
- School of Nursing; Johns Hopkins University; Baltimore Maryland USA
| | - Ian Olver
- Cancer Council Australia; Sydney New South Wales Australia
| | | | - Meera Agar
- Greenwich Hospital; HammondCare; Sydney New South Wales Australia
- Improving Palliative Care through Clinical Trials (ImPaCCT); Sydney New South Wales Australia
- South Western Sydney Clinical School; University of New South Wales (UNSW); Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research; Sydney New South Wales Australia
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