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Samara H, O’Hara L, Singh K. Nurses' Knowledge and Attitudes about Adult Post-Operative Pain Assessment and Management: Cross Sectional Study in Qatar. NURSING REPORTS 2024; 14:2061-2071. [PMID: 39189283 PMCID: PMC11348211 DOI: 10.3390/nursrep14030153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/06/2023] [Accepted: 12/22/2023] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Pain is a complex and challenging phenomenon. People have different pain experiences, but everyone has the right to effective pain management. Pain assessment and management are integral components of a nurse's role. AIM To assess the knowledge and attitudes of nurses in Qatar about adult post-operative patients' pain assessment and management, and the factors that may be associated with such knowledge and attitudes. METHODS Post-operative registered nurses from all peri-operative areas at Hamad Medical Corporation participated in a cross-sectional online survey using a self-administered questionnaire. A knowledge and attitudes (K&A) score was calculated. Associations between K&A and potential explanatory variables were assessed using t-tests and one-way ANOVA. RESULTS A total of 151 post-operative nurses participated in the study. The mean knowledge and attitudes (K&A) score was 19.6 ± 4.5 out of 41 (48%), indicating a large deficit in nurses' knowledge and attitudes about adult post-operative pain. There were no statistically significant differences in the mean K&A scores of participants based on gender, nationality, education level, marital status, workplace facility, current job designation, or hours of pain education. CONCLUSIONS There is a significant deficit in post-operative nurses' knowledge and attitudes about pain across the nursing workforce in post-operative care. Implications for nursing education and policy: Evidence-based, innovative nursing education courses are needed to improve nurses' knowledge and attitudes about pain assessment and management. Health service policy is required to ensure that evidence-based in-service education on pain management is compulsory for all nurses. This study was not registered.
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Affiliation(s)
- Haya Samara
- Nursing Education Department, Hamad Medical Corporation, Doha 122014, Qatar
| | - Lily O’Hara
- Department of Public Health, QU Health, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Kalpana Singh
- Department of Nursing Research, Hamad Medical Corporation, Doha 122014, Qatar;
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Sedney CL, Dekeseredy P, Singh SA, Holbein M. Stigmatizing Language Expressed Towards Individuals With Current or Previous OUD Who Have Pain and Cancer: A Qualitative Study. J Pain Symptom Manage 2023; 65:553-561. [PMID: 36804424 DOI: 10.1016/j.jpainsymman.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
CONTEXT Stigma is known to impact the care of patients with opioid use disorder (OUD). OBJECTIVES This qualitative study seeks to understand how stigma is expressed in the medical chart by healthcare workers towards patients with cancer pain and OUD treated at an academic medical center. METHODS This descriptive qualitative study utilized a thematic analysis approach to analyze the medical charts of 25 hospitalized patients with current or previous opioid use disorder and cancer with respect to their pain care in forty pain-related hospital admissions to a tertiary academic center from 2015 to 2020. The codebook utilized a well-characterized stigma framework and emerging themes were identified through an iterative, comparative method. COREQ guidelines were followed. RESULTS Evidence of stigma marking was present in the medical chart aligning with several intersecting stigmas. Drivers such as blame and stereotypes impeded pain care, while facilitators such as legal or policy influences and non-care advocates could be either positive or negative determinants to pain care. Care by known providers within the healthcare environment was largely a facilitator of improved pain care. CONCLUSIONS Healthcare provider stigma must be addressed as its effects are both quantitatively and qualitatively affecting patient care; in particular access to pain treatment. Continuity of care by known care providers may improve pain care for patients with cancer and OUD who are acutely hospitalized.
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Affiliation(s)
- Cara L Sedney
- Department of Neurosurgery (C.L.S., P.D.), Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA.
| | - Patricia Dekeseredy
- Department of Neurosurgery (C.L.S., P.D.), Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Sarah A Singh
- Department of Radiation Oncology (S.A.S.), West Virginia University, Morgantown, West Virginia, USA
| | - Monika Holbein
- Department of Medicine (M.H.), Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA
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Moral-Cuesta D, Gutiérrez-Misis A, Veloz BAC, Matovelle-Ochoa P, Epelde IM, Alarcón TA, Díez-Sebastián J, Galbete A, Maestre IM, Velilla NM, González-Montalvo JI. Profile and 3-month evolution of geriatric patients after a hip fracture followed-up at a Fracture Liaison Service (FLS). Rev Esp Geriatr Gerontol 2022; 57:205-211. [PMID: 35872030 DOI: 10.1016/j.regg.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 05/29/2022] [Accepted: 06/23/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION There are few studies on Fracture Liaison Service (FLS) that evaluate older patients after a hip fracture (HF) through comprehensive geriatric assessment. We aim to determine these patients' characteristics, outcomes, and prescribed treatments. METHODS A retrospective observational study of a cohort of patients older than 65 years admitted with HFs to an orthogeriatric unit between February 25th (2013) and December 16th (2016). After hospitalization, those patients with a good baseline social, functional, and cognitive situation were referred to the FLS. A comprehensive geriatric assessment and treatment adjustment were conducted. A comparison between FLS patients and HF patients non-referred was made. RESULTS From 1887 patients admitted to the orthogeriatric unit, 469 (23%) were referred to the FLS. Of those, 335 were women (77.2%) and 337 (77.6%) lived in the community. The FLS patients had a better functional status (97.1% of the patients with independent gait versus 79.2%) than non-FLS patients (p<0.001). After 3 months in the FLS, 356 (82%) patients had independent gait and had improved their analytical values. Antiosteoporotic treatment was prescribed to 322 patients (74%), vitamin D supplements to 397 (91.5%), calcium to 321 (74%), and physical exercise to 421 (97%). CONCLUSIONS Patients referred to an FLS were younger, with a better functional and cognitive situation. At hospital discharge, they frequently presented gait impairment and laboratory abnormalities (anemia, hypoproteinemia, vitamin D deficiency) that presented good recovery due to the patient's previous baseline. These patients benefit from comprehensive treatment (pharmacological and non-pharmacological).
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Affiliation(s)
- Debora Moral-Cuesta
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (Idisna), Pamplona, Spain.
| | - Alicia Gutiérrez-Misis
- Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación Biomédica del Hospital Universitario La Paz (IdiPaz), Madrid, Spain
| | - Bernardo Abel Cedeño Veloz
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (Idisna), Pamplona, Spain; Centro de Investigación Biomédica de Navarra (Navarrabiomed), Pamplona, Spain
| | | | - Itxaso Marin Epelde
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (Idisna), Pamplona, Spain
| | - Teresa Alarcón Alarcón
- Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación Biomédica del Hospital Universitario La Paz (IdiPaz), Madrid, Spain; Servicio de Geriatría, Hospital Universitario La Paz, Madrid, Spain
| | - Jesús Díez-Sebastián
- Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Sección de Epidemiología Clínica del Servicio de Medicina Preventiva, Madrid, Spain
| | - Arkaitz Galbete
- Centro de Investigación Biomédica de Navarra (Navarrabiomed), Pamplona, Spain
| | | | - Nicolás Martínez Velilla
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (Idisna), Pamplona, Spain; Centro de Investigación Biomédica de Navarra (Navarrabiomed), Pamplona, Spain
| | - Juan Ignacio González-Montalvo
- Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación Biomédica del Hospital Universitario La Paz (IdiPaz), Madrid, Spain; Servicio de Geriatría, Hospital Universitario La Paz, Madrid, Spain
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Dela Pena JC, Marshall VD, Smith MA. Impact of NCCN Guideline Adherence in Adult Cancer Pain on Length of Stay. J Pain Palliat Care Pharmacother 2022; 36:95-102. [PMID: 35652581 DOI: 10.1080/15360288.2022.2066746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To improve the management of cancer related pain, the National Comprehensive Cancer Network (NCCN) publishes the Adult Cancer Pain guideline on an annual basis. However, a large majority of oncology patients still report inadequate pain control. Single-center, retrospective cohort study of adult patients admitted for uncontrolled pain or pain crisis between 3/1/19 and 06/30/20 were assigned to cohorts of either adherent or non-adherent to NCCN guideline recommendations for management of pain crises based on their initial opioid orders. Patients must have reported a pain score >/= 4 and received at least one dose of opioids within 24 hours upon admission. The length of stay (LOS), pain scores, and naloxone administration were compared between both groups. Patients in the adherent group had a shorter median LOS (3.7 days [range: 1 to 18.93] vs 5.4 days [range: 1.45 to 19.64 days], p = 0.04). Patients that received lower doses than recommended had longer LOS compared to adherent group (6.1 vs. 3.7 days; p = 0.009). When adjusted for confounders, this significance did not remain. The lowest reported pain score within 24 hours of admission was lower in the adherent group (median 3 vs 4, p = 0.04). Predictors of LOS included opioid tolerance and a pain or palliative care consult. Adherence to NCCN guidelines for acute pain crisis management in adult patients with cancer remains poor. Patients who received guideline adherent initial opioid regimens demonstrated a trend toward a shorter LOS. Opioid-tolerant patient outcomes remain inadequate; appropriate pain management for these patients need to improve.
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Singh SA, Moreland RA, Fang W, Shaikh P, Perez JM, Morris AM, Dahshan B, Krc RF, Chandran D, Holbein M. Compassion Inequities and Opioid Use Disorder: A Matched Case-Control Analysis Examining Inpatient Management of Cancer-Related Pain for Patients With Opioid Use Disorder. J Pain Symptom Manage 2021; 62:e156-e163. [PMID: 33984461 PMCID: PMC8416788 DOI: 10.1016/j.jpainsymman.2021.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 11/24/2022]
Abstract
CONTEXT The opioid epidemic spurred guidelines intended to reduce inappropriate prescribing. Although acute cancer-related pain was excluded from these recommendations, studies demonstrate reduced opioid prescribing for patients hospitalized with advanced cancer. OBJECTIVES We performed a matched case-control analysis to determine how a history of opioid use disorder (OUD) affects inpatient management of cancer pain. METHODS Charts of patients with OUD admitted for cancer pain from 2015-2020 were retrospectively reviewed. Hospitalizations were matched 1:1 by patient age and sex. Home milligram-morphine equivalent per day (MME/day) was calculated from the home medication list. Admission MME/day was the average MME/day administered during hospitalization. RESULTS A total of 80 hospitalizations (40:40) were matched for 25 patients with a history of OUD and 31 patients with no history of OUD. Cancer was metastatic/relapsed for 70% of admissions. The median overall survival was 2.3 months (95% CI 0-5.21, P = 0.13). Patients with OUD had a significantly lower change from Home to Admission MME/day (-3 vs. 37, P < 0.01) and were less likely to have any increase in Admission MME/day (OR 0.1, 95% CI 0.02-0.43, P < 0.01). When considering opioids administered after pain specialty consultation, there was no difference between groups. CONCLUSION Our results suggest that patients with OUD receive lower quality inpatient management of cancer-related pain. Provider education and early involvement of pain specialists are crucial in delivering equitable and compassionate end-of-life care for patients with OUD.
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Affiliation(s)
- Sarah A Singh
- Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia, USA.
| | - Rachel A Moreland
- Department of Psychiatry, West Virginia University, Morgantown, West Virginia, USA
| | - Wei Fang
- Department of Biostatistics, Clinical and Translational Science Institute, West Virginia University Health Sciences Center Erma Byrd Biomedical Research Center, Morgantown, West Virginia, USA
| | - Parvez Shaikh
- Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia, USA
| | - John Michael Perez
- Department of Psychiatry, West Virginia University, Morgantown, West Virginia, USA
| | - Ann M Morris
- Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia, USA
| | - Basem Dahshan
- Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia, USA
| | - Rebecca F Krc
- Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia, USA
| | - Dilip Chandran
- Department of Psychiatry, West Virginia University, Morgantown, West Virginia, USA
| | - Monika Holbein
- Department of Hematology and Oncology, West Virginia University, Morgantown, West Virginia, USA
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Haider A, Qian Y, Lu Z, Naqvi S, Zhuang A, Reddy A, Dalal S, Arthur J, Tanco K, Dev R, Williams J, Wu J, Liu D, Bruera E. Implications of the Parenteral Opioid Shortage for Prescription Patterns and Pain Control Among Hospitalized Patients With Cancer Referred to Palliative Care. JAMA Oncol 2020; 5:841-846. [PMID: 30896771 DOI: 10.1001/jamaoncol.2019.0062] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The recent parenteral opioid shortage (POS) has potential implications for cancer-related pain management in hospitalized patients. Objective This study compared changes in opioid prescriptions and clinically improved pain (CIP) among patients treated by an inpatient palliative care (PC) team before and after our institution first reported the POS. Design, Setting, and Participants A cohort study of 386 eligible patients with cancer treated at a comprehensive cancer center 1 month before and after the announcement of the POS. We reviewed data from electronic health records, including patient demographics, opioid type, route of administration, and dose. Board-certified palliative care specialists assessed CIP at follow-up day 1. Exposures The announcement of the POS by the institution's pharmacy and therapeutics committee on February 8, 2018. Main Outcomes and Measures The primary outcome was to measure the change in opioid prescription patterns of physicians, and the secondary outcome was to measure the proportion of patients who achieved CIP before and after announcement of the POS. Results Of 386 eligible patients, 196 were men (51%), 270 were white (70%), and the median age was 58 years (interquartile range, 46-67 years). Parenteral opioids were prescribed less frequently by the referring oncology teams after the POS (56 of 314 [18%]) vs before the POS (109 of 311 [35%]) (P < .001). The PC team also prescribed fewer parenteral opioids after the POS (96 of 336 [29%]) vs before the POS (159 of 338 [47%]) (P < .001). After the POS (vs before the POS), significantly fewer patients achieved CIP on follow-up day 1 (119 [62%] vs 144 [75%] of 193; P = .01). Multivariate analysis showed that before the POS, patients had an 89% higher chance of achieving CIP on follow-up day 1 (odds ratio, 1.89; 95% CI, 1.22-2.94; P = .005). Conclusions and Relevance There was a significant change in opioid prescription patterns associated with the POS. Furthermore, after the POS, fewer patients achieved CIP. These factors have potential implications for patient satisfaction and hospital length of stay.
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Affiliation(s)
- Ali Haider
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Yu Qian
- Department of Thoracic Cancer, Hubei Cancer Hospital, Wuhan, China
| | - Zhanni Lu
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Syed Naqvi
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Amy Zhuang
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Akhila Reddy
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Shalini Dalal
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Joseph Arthur
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Kimberson Tanco
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Rony Dev
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Janet Williams
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Jimin Wu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
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Evaluation of pharmacist interventions as part of a multidisciplinary cancer pain management team in a Chinese academic medical center. J Am Pharm Assoc (2003) 2020; 60:76-80. [DOI: 10.1016/j.japh.2019.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 12/24/2022]
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Tanzi S, Leo SD, Mazzini E, Castagnetti M, Turrà C, Peruselli C, Costantini M. Long-term sustainability of a quality improvement program on cancer pain management: a complex intervention in an inpatient setting. TUMORI JOURNAL 2019; 106:25-32. [DOI: 10.1177/0300891619869513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Several approaches towards pain control for admitted cancer patients have been suggested by the literature without achieving satisfactory results. In this quality improvement project, we proposed a multicomponent intervention. Measures: A set of indicators was established for each component of the project. The feasibility of both the intervention and its evaluation system was measured. According to the literature review and the analysis of the local context, 5 active components were identified, piloted, and assessed: training of ward professionals, education of patients and nonprofessional caregivers, regular pain assessment, specialist-level pain consultation procedures, and involvement of hospital management. Results: Multiprofessional training programs with daily discussions, daily pain assessment, and a readily available specialized palliative care service seem to be the active components of this complex intervention. The quality improvement project achieved 2 years sustainability. Conclusion: Consolidated educational and organizational methodologies support the feasibility of this complex intervention.
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Affiliation(s)
- Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD program, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Di Leo
- Psycho-oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Mazzini
- Medical Direction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mattia Castagnetti
- Department of Hospital Pharmacy, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Caterina Turrà
- Department of Hospital Pharmacy, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Massimo Costantini
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Bundling Interventions to Enhance Pain Care Quality (BITE Pain) in Medical Surgical Patients. Ochsner J 2019; 19:77-95. [PMID: 31258419 DOI: 10.31486/toj.18.0164] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Inadequate pain management and undertreatment remain a serious clinical issue among hospitalized adults, contributing to chronic pain syndromes and opioid dependency. Implementation of individual pain care interventions has been insufficient to improve pain care quality. The purpose of this interprofessional, patient-centered project was to implement a 6-component bundle of evidence-based pain management strategies to improve patients' perception of pain care quality and 24-hour pain experience outcomes. Methods: A quasi-experimental design was used to test the effect of a bundled pain management intervention on 3 medical surgical units. Baseline outcomes using the Pain Care Quality-Interdisciplinary (PainCQ-I©) and Pain Care Quality-Nursing (PainCQ-N©) surveys were measured monthly for 4 months preintervention and 30 months postintervention. Results: A convenience sample of 846 patients was analyzed. The effect of the intervention on pain outcomes could not be tested because unit-based adherence did not meet the goal of 80%. A subsample of 70.2% (594/846) of participants was sufficient to complete a 3-group analysis of preintervention and postintervention participants with confirmed intervention adherence. Participants in the postintervention group who received all 6 components (n=65) had significantly higher odds of higher PainCQ© scores than those in the preintervention group (n=141) (PainCQ-I©: odds ratio [OR] 2.61, 95% confidence interval [CI] 1.54-4.42; PainCQ-N©: OR 3.82, 95% CI 2.06-7.09) or those in the postintervention group receiving ≤5 components (n=388) (PainCQ-I©: OR 2.52, 95% CI 1.57-4.03; PainCQ-N©: OR 3.84, 95% CI 2.17-6.80). Conclusion: Medical surgical patients participating in this study who received the bundled 6-component intervention reported significantly higher levels of perceived pain care quality, suggesting that a bundled approach may be more beneficial than unstandardized strategies.
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Phillips JL, Heneka N, Lovell M, Lam L, Davidson P, Boyle F, McCaffrey N, Fielding S, Shaw T. A phase III wait-listed randomised controlled trial of novel targeted inter-professional clinical education intervention to improve cancer patients' reported pain outcomes (The Cancer Pain Assessment (CPAS) Trial): study protocol. Trials 2019; 20:62. [PMID: 30658657 PMCID: PMC6339283 DOI: 10.1186/s13063-018-3152-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/18/2018] [Indexed: 11/17/2022] Open
Abstract
Background Variations in care models contribute to cancer pain being under-recognised and under-treated in half of all patients with cancer. International and national cancer pain management guidelines are achievable with minimal investment but require practice changes. While much of the cancer pain research over the preceding decades has focused on management interventions, little attention has been given to achieving better adherence to recommended cancer pain guideline screening and assessment practices. This trial aims to reduce unrelieved cancer pain by improving cancer and palliative doctors’ and nurses’ (‘clinicians’) pain assessment capabilities through a targeted inter-professional clinical education intervention delivered to participants’ mobile devices (‘mHealth’). Methods A wait-listed, randomised control trial design. Cancer and/or palliative care physicians and nurses employed at one of the six participating sites across Australia will be eligible to participate in this trial and, on enrolment, will be allocated to the active or wait-listed arm. Participants allocated to the active arm will be invited to complete the mHealth cancer pain assessment intervention. In this trial, mHealth is defined as medical or public health practice supported by mobile devices (i.e. phones, patient monitoring devices, personal digital assistants and other wireless devices). This mHealth intervention integrates three evidence-based elements, namely: the COM-B theoretical framework; spaced learning pedagogy; and audit and feedback. This intervention will be delivered via the QStream online platform to participants’ mobile devices over four weeks. The trial will determine if a tailored mHealth intervention, targeting clinicians’ cancer pain assessment capabilities, is effective in reducing self-reported cancer pain scores, as measured by a Numerical Rating Scale (NRS). Discussion If this mHealth intervention is found to be effective, in addition to improving cancer pain assessment practices, it will provide a readily transferable evidence-based framework that could readily be applied to other evidence practice gaps and a scalable intervention that could be administered simultaneously to multiple clinicians across diverse geographical locations. Moreover, if found to be cost-effective, it will help transform clinical continuing professional development. In summary, this mHealth intervention will provide health services with an opportunity to offer an evidence-based, pedagogically robust, cost-effective, scalable training alternative. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12618001103257. Registered on 3 July 2018. Electronic supplementary material The online version of this article (10.1186/s13063-018-3152-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jane L Phillips
- University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia.
| | - Nicole Heneka
- University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia
| | - Melanie Lovell
- University of Sydney, City Rd, Camperdown, NSW, 2006, Australia
| | - Lawrence Lam
- University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia
| | - Patricia Davidson
- Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD, 21218, USA
| | - Frances Boyle
- University of Sydney, City Rd, Camperdown, NSW, 2006, Australia
| | - Nikki McCaffrey
- Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia
| | - Sally Fielding
- University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia
| | - Tim Shaw
- University of Sydney, City Rd, Camperdown, NSW, 2006, Australia
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Prevost V, Clarisse B, Heutte N, Leconte A, Bisson C, Bignon R, Cauchin S, Feuillet M, Gehanne S, Gicquère M, Grach MC, Guillaumé C, Le Gal C, Le Garrec J, Lecaer F, Lepleux I, Millet AL, Ropartz MC, Roux N, Sep Hieng V, Van Delook C, Bechet C, Le Chevalier A, Delorme C. [Elaboration and evaluation of a therapeutic education program in cancer pain management]. Bull Cancer 2018; 105:1074-1083. [PMID: 30327192 DOI: 10.1016/j.bulcan.2018.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/10/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
Pain, one of the most feared symptoms for patients with cancer, remains insufficiently alleviated and impairs quality of life. Therapeutic patient education (TPE) is a relevant approach to this problem while allowing patients to develop skills to better manage their pain. In the "Basse-Normandie" French region, the management of pain relies on two organized networks, thus allowing proximity and accessibility for all concerned. In this context, our team has begun a broad five-step research program that is part of a regional health policy: (1) training in TPE of 10 doctor/nurse pairs; (2) identification of educational expectations of patients and their relatives in the field of cancer pain; (3) design and optimization of a TPE program dedicated to cancer pain; (4) regional pilot study aiming to assess the feasibility, quality and transferability of the program; (5) evaluation of the TPE program by interventional comparative randomization at the national level. This article aims to present the program which originality and strengths are based on collaborative work between health stakeholders. Objectives, methodology and expected results of the research phase (stages 2, 4, 5) are notably developed. The main expected outcomes are to prove the effectiveness of the program in improving the knowledge and skills of patients in the field of pain cancer in order to promote their adherence to treatment and, consequently, to enable them to better manage it. The long-term objective is to disseminate the educational approach by modifying practices that provide a mutual benefit for caregivers and patients.
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Affiliation(s)
- Virginie Prevost
- Université de Caen Normandie, UMR 1086 Inserm, unité de recherche interdisciplinaire pour la prévention et le traitement des cancers « ANTICIPE », 14000 Caen, France; Centre régional de lutte contre le cancer François-Baclesse, 14000 Caen, France.
| | - Bénédicte Clarisse
- Centre régional de lutte contre le cancer François-Baclesse, 14000 Caen, France
| | - Natacha Heutte
- Centre régional de lutte contre le cancer François-Baclesse, 14000 Caen, France; Normandie université, UNIROUEN, CETAPS EA 3832, 76130 Mont-Saint-Aignan, France
| | - Alexandra Leconte
- Centre régional de lutte contre le cancer François-Baclesse, 14000 Caen, France
| | - Cécile Bisson
- Centre hospitalier, 14400 Bayeux, France; Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France
| | - Rachel Bignon
- Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France; Centre hospitalier, 14100 Lisieux, France
| | - Sonia Cauchin
- Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France; Centre hospitalier intercommunal Alençon-Mamers, 61000 Alençon, France
| | - Maryline Feuillet
- Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France; Centre hospitalier, 50000 Saint-Lô, France
| | - Sylvie Gehanne
- Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France; Centre hospitalier, 50000 Saint-Lô, France
| | - Maud Gicquère
- Centre régional de lutte contre le cancer François-Baclesse, 14000 Caen, France; Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France
| | - Marie-Christine Grach
- Centre régional de lutte contre le cancer François-Baclesse, 14000 Caen, France; Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France
| | - Cyril Guillaumé
- Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France; CHU, 14000 Caen, France
| | - Christine Le Gal
- Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France; Centre hospitalier, 61200 Argentan, France
| | - Joelle Le Garrec
- Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France; Centre hospitalier intercommunal Alençon-Mamers, 61000 Alençon, France
| | - Franck Lecaer
- Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France; Centre hospitalier, 61100 Flers, France
| | - Isabelle Lepleux
- Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France; Centre hospitalier, 50100 Cherbourg, France
| | - Anne-Laure Millet
- Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France; Centre hospitalier, 61100 Flers, France
| | - Marie-Claude Ropartz
- Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France; Centre hospitalier, 50400 Avranches-Granville, France
| | - Nathalie Roux
- Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France; CHU, 14000 Caen, France
| | - Virith Sep Hieng
- Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France; Centre hospitalier, 14100 Lisieux, France
| | - Carole Van Delook
- Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France; Centre hospitalier, 61200 Argentan, France
| | | | - Aline Le Chevalier
- Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France; Centre hospitalier, 50400 Avranches-Granville, France
| | - Claire Delorme
- Centre hospitalier, 14400 Bayeux, France; Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France
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12
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Eaton LH, Brant JM, McLeod K, Yeh C. Nonpharmacologic Pain Interventions: A Review of Evidence-Based Practices for Reducing Chronic Cancer Pain
. Clin J Oncol Nurs 2018; 21:54-70. [PMID: 28524909 DOI: 10.1188/17.cjon.s3.54-70] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pain is a common issue for patients with cancer and can be challenging to manage effectively. Healthcare professionals need to be knowledgeable about evidence-based nonpharmacologic interventions.
. OBJECTIVES This systematic review critically appraises the strength and quality of the empirical evidence for nonpharmacologic interventions in reducing chronic cancer pain.
. METHODS Intervention studies were critically appraised and summarized by an Oncology Nursing Society Putting Evidence Into Practice team of RNs, advanced practice nurses, and nurse scientists. A level of evidence and a practice recommendation was assigned to each intervention.
. FINDINGS Based on evidence, recommended interventions to reduce chronic cancer pain are celiac plexus block for pain related to pancreatic and abdominal cancers and radiation therapy for bone pain. Although psychoeducational interventions are considered likely to be effective, the effective components of these interventions and their dose and duration need to be determined through additional research.
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13
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Bischoff KE, O'Riordan DL, Fazzalaro K, Kinderman A, Pantilat SZ. Identifying Opportunities to Improve Pain Among Patients With Serious Illness. J Pain Symptom Manage 2018; 55:881-889. [PMID: 29030211 DOI: 10.1016/j.jpainsymman.2017.09.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
CONTEXT Pain is a common and distressing symptom. Pain management is a core competency for palliative care (PC) teams. OBJECTIVE Identify characteristics associated with pain and pain improvement among inpatients referred to PC. METHODS Thirty-eight inpatient PC teams in the Palliative Care Quality Network entered data about patients seen between December 12, 2012 and March 15, 2016. We examined patient and care characteristics associated with pain and pain improvement. RESULTS Of patients who could self-report symptoms, 30.7% (4959 of 16,158) reported moderate-to-severe pain at first assessment. Over 40% of these patients had not been referred to PC for pain. Younger patients (P < 0.0001), women (P < 0.0001), patients with cancer (P < 0.0001), and patients in medical/surgical units (P < 0.0001) were more likely to report pain. Patients with pain had higher rates of anxiety (P < 0.0001), nausea (P < 0.0001), and dyspnea (P < 0.0001). Sixty-eight percent of patients with moderate-to-severe pain improved by the PC team's second assessment within 72 hours; 74.7% improved by final assessment. There was a significant variation in the rate of pain improvement between PC teams (P < 0.0001). Improvement in pain was associated with improvement in anxiety (OR = 2.9, P < 0.0001) and dyspnea (OR = 1.4, P = 0.03). Patients who reported an improvement in pain had shorter hospital length-of-stay by two days (P = 0.003). CONCLUSION Pain is common among inpatients referred to PC. Three-quarters of patients with pain improve and improvement in pain is associated with other symptom improvement. Standardized, multisite data collection can identify PC patients likely to have marked and refractory pain, create benchmarks for the field, and identify best practices to inform quality improvement.
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Affiliation(s)
- Kara E Bischoff
- Palliative Care Program, University of California, San Francisco, San Francisco, California, USA.
| | - David L O'Riordan
- Palliative Care Program, University of California, San Francisco, San Francisco, California, USA
| | | | - Anne Kinderman
- Palliative Care Program, University of California, San Francisco, San Francisco, California, USA; San Francisco General Hospital, San Francisco, California, USA
| | - Steven Z Pantilat
- Palliative Care Program, University of California, San Francisco, San Francisco, California, USA
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14
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Eaton LH, Meins AR, Zeliadt SB, Doorenbos AZ. Using a mixed methods approach to explore factors associated with evidence-based cancer pain management practice among nurses. Appl Nurs Res 2017; 37:55-60. [PMID: 28985921 DOI: 10.1016/j.apnr.2017.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 03/08/2017] [Accepted: 07/30/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Linda H Eaton
- School of Nursing, University of Washington, Seattle, WA, USA.
| | - Alexa R Meins
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Steven B Zeliadt
- School of Public Health, University of Washington, Seattle, WA, USA
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15
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Brant JM, Mohr C, Coombs NC, Finn S, Wilmarth E. Nurses’ Knowledge and Attitudes about Pain: Personal and Professional Characteristics and Patient Reported Pain Satisfaction. Pain Manag Nurs 2017; 18:214-223. [DOI: 10.1016/j.pmn.2017.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 11/22/2016] [Accepted: 04/06/2017] [Indexed: 11/15/2022]
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16
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Odonkor CA, Kim G, Erdek M. Global cancer pain management: a systematic review comparing trials in Africa, Europe and North America. Pain Manag 2017; 7:299-310. [PMID: 28699421 DOI: 10.2217/pmt-2016-0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIM Despite the rise in cancer survivorship, few reviews have examined the quality of studies of cancer pain management and practices around the globe. With a void in trials spanning multiple geographical settings, this review evaluates the quality of cancer trials across three continents. MATERIALS & METHODS A literature review and search of established databases was conducted to identify eligible studies. The Cochrane method, the Jadad Score and a cancer pain-specific ad hoc tool were used to evaluate quality of studies. RESULTS Eighteen studies representing a total of 4693 individuals were included in the review. Study quality correlated positively with study sample size and palliative care index. Trials in all three continents were prone to use opioids for pain management, whereas trials in Europe and North America utilized other adjuvant therapies such as antidepressants and steroids. CONCLUSION This review underscores the need for better multidimensional quality assessment tools for cancer pain trials.
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Affiliation(s)
- Charles A Odonkor
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Gabriel Kim
- Department of Internal Medicine, Howard University College of Medicine, Washington, DC 20059, USA
| | - Michael Erdek
- Division of Pain Medicine, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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17
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Phillips JL, Heneka N, Hickman L, Lam L, Shaw T. Can A Complex Online Intervention Improve Cancer Nurses’ Pain Screening and Assessment Practices? Results from a Multicenter, Pre-post Test Pilot Study. Pain Manag Nurs 2017; 18:75-89. [DOI: 10.1016/j.pmn.2017.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/15/2022]
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18
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Patel B, Hacker E, Murks C, Ryan C. Interdisciplinary Pain Education: Moving From Discipline-Specific to Collaborative Practice. Clin J Oncol Nurs 2016; 20:636-643. [DOI: 10.1188/16.cjon.636-643] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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19
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Shahriary S, Shiryazdi SM, Shiryazdi SA, Arjomandi A, Haghighi F, Vakili FM, Mostafaie N. Oncology Nurses Knowledge and Attitudes Regarding Cancer Pain Management. Asian Pac J Cancer Prev 2015; 16:7501-6. [DOI: 10.7314/apjcp.2015.16.17.7501] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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20
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Zhang Q, Yu C, Feng S, Yao W, Shi H, Zhao Y, Wang Y. Physicians' Practice, Attitudes Toward, and Knowledge of Cancer Pain Management in China. PAIN MEDICINE 2015; 16:2195-203. [DOI: 10.1111/pme.12819] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 04/11/2015] [Accepted: 05/02/2015] [Indexed: 11/26/2022]
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21
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Impact of admission to hospice on pain intensity and type of pain therapies administered. Support Care Cancer 2015; 24:225-232. [DOI: 10.1007/s00520-015-2768-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 05/12/2015] [Indexed: 12/25/2022]
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22
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Adam R, Bond C, Murchie P. Educational interventions for cancer pain. A systematic review of systematic reviews with nested narrative review of randomized controlled trials. PATIENT EDUCATION AND COUNSELING 2015; 98:269-282. [PMID: 25483575 DOI: 10.1016/j.pec.2014.11.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 10/08/2014] [Accepted: 11/08/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Educational interventions are one approach to improving cancer pain management. This review aims to determine whether educational interventions can improve cancer pain management and to characterize components of cancer pain educational interventions. METHODS Medline, EMBASE, CINAHL, and Cochrane databases were searched. Systematic reviews that assessed educational interventions to improve cancer pain management were included. Randomized controlled trials (RCTs) were identified from each review. A narrative approach was taken to summarizing the nature and components of interventions. RESULTS Eight systematic reviews and 34 randomized controlled trials (RCTs) were reviewed. Interventions targeting patients can achieve small to moderate reductions in pain intensity. Interventions targeting professionals can improve their knowledge but most trials have not assessed for resultant patient benefits. All interventions included at least one of seven core components: improving knowledge about the nature of cancer pain; aiding communication about cancer pain; enhancing pain assessment; improving analgesic prescribing; tackling barriers to analgesic non-adherence; teaching non-pharmacological pain management strategies; and promoting re-assessment. CONCLUSIONS Cancer pain educational interventions can improve pain outcomes. They are complex heterogeneous interventions which often contain a combination of active components. PRACTICE IMPLICATIONS Suggestions are made to aid the development of future interventions.
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Affiliation(s)
- Rosalind Adam
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
| | - Christine Bond
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Peter Murchie
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
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23
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Shinjo T, Morita T, Hirai K, Miyashita M, Shimizu M, Tsuneto S, Shima Y. Why people accept opioids: role of general attitudes toward drugs, experience as a bereaved family, information from medical professionals, and personal beliefs regarding a good death. J Pain Symptom Manage 2015; 49:45-54. [PMID: 24929030 DOI: 10.1016/j.jpainsymman.2014.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 04/03/2014] [Accepted: 04/30/2014] [Indexed: 11/23/2022]
Abstract
CONTEXT Many surveys have evaluated patient-related barriers to pain management. OBJECTIVES To explore associations between a preference for opioids and general attitudes toward drugs, the experience and information received as a bereaved family, and beliefs regarding a good death. METHODS A cross-sectional survey, performed in 2010, of bereaved families of patients with cancer in palliative care units across Japan. Questionnaires were sent to 997 families. RESULTS A total of 66% of families responded. Of these, 224 responses were excluded because the family declined to participate in the study (n = 38), the patient was not receiving any opioid analgesics, and there were missing data (n = 164), or data were missing for the primary end points (n = 22). Thus, 432 responses were finally analyzed (43%). In total, 26%, 41%, and 31% of family members stated that they strongly want to receive, want to receive, or slightly want to receive opioids if needed in the future, respectively. Determinants associated with a preference for receiving opioid treatment were the following: a general appreciation of the drugs (P = 0.005), witnessing an improvement in the patient's quality of life as a result of pain relief (P = 0.003), information provided by medical professionals that the opioid could be discontinued if side effects developed (P = 0.042), and the belief that a good death was one that was free from pain and physical distress (P < 0.001). CONCLUSION More than 90% of bereaved families whose relatives were treated with opioid analgesics reported a preference to receive opioid analgesics for the treatment of cancer pain, if necessary, in the future.
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Affiliation(s)
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Kei Hirai
- Department of Complementary and Alternative Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Megumi Shimizu
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoru Tsuneto
- Department of Multidisciplinary Cancer Treatment Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
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24
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Lin RJ, Reid MC, Liu LL, Chused AE, Evans AT. The Barriers to High-Quality Inpatient Pain Management: A Qualitative Study. Am J Hosp Palliat Care 2014; 32:594-9. [PMID: 24728202 DOI: 10.1177/1049909114530491] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The current literature suggests deficiencies in the quality of acute pain management among general medical inpatients. The aim of this qualitative study is to identify potential barriers to high-quality acute pain management among general medical inpatients at an urban academic medical center during a 2-year period. Data are collected using retrospective chart reviews, survey questionnaires, and semistructured, open-ended interviews of 40 general medical inpatients who have experienced pain during their hospitalization. Our results confirm high prevalence and disabling impacts of pain and significant patient- and provider-related barriers to high-quality acute pain management. We also identify unique system-related barriers such as time delay and pain management culture. Efforts to improve the pain management experience of general medical inpatients will need to address all these barriers.
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Affiliation(s)
- Richard J Lin
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - M Carrington Reid
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Lydia L Liu
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Amy E Chused
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Arthur T Evans
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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25
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Does a regional comprehensive palliative care program improve pain in outpatient cancer patients? Support Care Cancer 2014; 22:2445-55. [PMID: 24705857 DOI: 10.1007/s00520-014-2232-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
CONTEXT Pain is still a major problem for cancer patients, and the effect of a population-based approach on patients' experience of pain is not fully understood. AIMS The primary aim of this study was to clarify the changes in pain intensity in outpatients before and after a regional palliative care program. The secondary aim was to clarify the prevalence of patients who had unmet needs for pain treatment and to clarify the reasons for not wanting pain treatment. SUBJECTS AND METHODS A regional palliative care program was implemented in four regions of Japan. A region-representative sample of metastatic/locally advanced cancer patients in outpatient settings took part in questionnaire surveys before and after the regional intervention. Responses were obtained from 859 from 1,880 and 857 from 2,123 in the preintervention and postintervention surveys, respectively. RESULTS After a regional palliative care program, neither worst, average, nor least pain levels in outpatients changed significantly. A total of 134 patients (16 %) reported that they needed more pain treatment. There were various reasons for not wanting pain treatment, namely, minimum interference with daily life, general nonpreference for medicines, longstanding symptoms before the diagnosis of cancer, concerns about tolerance and addiction, and experienced neuropsychiatric symptoms under current medications. CONCLUSION The regional palliative care program failed to demonstrate improvement of the pain intensity of cancer outpatients. One possible interpretation is that they are less likely to be regarded as target populations and that the study population experienced generally well-controlled pain. Future study including patients with more severe pain is needed, but to improve pain levels of cancer outpatients, intensive, patient-directed intervention seems to be more promising than region-based intervention.
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26
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Ripamonti CI, Prandi C, Costantini M, Perfetti E, Pellegrini F, Visentin M, Garrino L, De Luca A, Pessi MA, Peruselli C. The effectiveness of the quality program Pac-IficO to improve pain management in hospitalized cancer patients: a before-after cluster phase II trial. BMC Palliat Care 2014; 13:15. [PMID: 24678911 PMCID: PMC3986604 DOI: 10.1186/1472-684x-13-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/19/2014] [Indexed: 11/10/2022] Open
Abstract
Background Cancer-related pain continues to be a major healthcare issue worldwide. Despite the availability of effective analgesic drugs, published guidelines and educational programs for Health Care Professionals (HCPs) the symptom is still under-diagnosed and its treatment is not appropriate in many patients. The objective of the study is to evaluate the efficacy of the Pac-IFicO programme in improving the quality of pain management in hospitalised cancer patients. Methods/design This is a before-after cluster phase II study. After the before assessment, the experimental intervention – the Pac-IFicO programme – will be implemented in ten medicine, oncology and respiratory disease hospital wards. The same assessment will be repeated after the completion of the intervention. The Pac-IFicO programme is a complex intervention with multiple components. It includes focus group with ward professionals for identifying possible local obstacles to optimal pain control, informative material for the patients, an educational program performed through guides from the wards, and an organisational intervention to the ward. The primary end-point of the study is the proportion of cancer patients with severe pain. Secondary end-points include opioids administered in the wards, knowledge in pain management, and quality of pain management. We plan to recruit about 500 cancer patients. This sample size should be sufficient, after appropriate statistical adjustments for clustering, to detect an absolute decrease in the primary end-point from 20% to 9%. Discussion This trial is aimed at exploring with an experimental approach the efficacy of a new quality improvement educational intervention. Trial registration ClinicalTrials.gov: NCT02035098
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Affiliation(s)
- Carla Ida Ripamonti
- Supportive Care in Cancer Unit, Department of Hematology and Pediatric Onco-Hematology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy.
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Martinez KA, Aslakson RA, Wilson RF, Apostol CC, Fawole OA, Lau BD, Vollenweider D, Bass EB, Dy SM. A systematic review of health care interventions for pain in patients with advanced cancer. Am J Hosp Palliat Care 2013; 31:79-86. [PMID: 23408371 DOI: 10.1177/1049909113476129] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Poorly controlled pain is common in advanced cancer. The objective of this article was to synthesize the evidence on the effectiveness of pain-focused interventions in this population. METHODS We searched MEDLINE, CINAHL, PsycINFO, Cochrane, and DARE from 2000 through December 2011. We included prospective, controlled health care intervention studies in advanced cancer populations, focusing on pain. RESULTS Nineteen studies met the inclusion criteria; most focused on nurse-led patient-centered interventions. In all, 9 (47%) of the 19 studies found a significant effect on pain. The most common intervention type was patient/caregiver education, in 17 (89%) of 19 studies, 7 of which demonstrated a significant decrease in pain. CONCLUSIONS We found moderate strength of evidence that pain in advanced cancer can be improved using health care interventions, particularly nurse-led patient-centered interventions.
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Affiliation(s)
- Kathryn A Martinez
- 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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28
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Reich DL, Porter C, Levin MA, Lin HM, Patel K, Fallar R, Serban S, Chai E, Nash IS, Vezina M, Silverstein JH. Data-Driven Interdisciplinary Interventions to Improve Inpatient Pain Management. Am J Med Qual 2012; 28:187-95. [DOI: 10.1177/1062860612457425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Hung-Mo Lin
- Mount Sinai School of Medicine, New York, NY
| | - Kash Patel
- Mount Sinai School of Medicine, New York, NY
| | | | | | - Emily Chai
- Mount Sinai School of Medicine, New York, NY
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A region-based palliative care intervention trial using the mixed-method approach: Japan OPTIM study. BMC Palliat Care 2012; 11:2. [PMID: 22233691 PMCID: PMC3349547 DOI: 10.1186/1472-684x-11-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 01/11/2012] [Indexed: 11/16/2022] Open
Abstract
Background Disseminating palliative care is a critical task throughout the world. Several outcome studies explored the effects of regional palliative care programs on a variety of end-points, and some qualitative studies investigated the process of developing community palliative care networks. These studies provide important insights into the potential benefits of regional palliative care programs, but the clinical implications are still limited, because: 1) many interventions included fundamental changes in the structure of the health care system, and, thus, the results would not be applicable for many regions where structural changes are difficult or unfeasible; 2) patient-oriented outcomes were not measured or explored only in a small number of populations, and interpretation of the results from a patient's view is difficult; and 3) no studies adopted a mixed-method approach using both quantitative and qualitative methodologies to interpret the complex phenomenon from multidimensional perspectives. Methods/designs This is a mixed-method regional intervention trial, consisting of a pre-post outcome study and qualitative process studies. The primary aim of the pre-post outcome study is to evaluate the change in the number of home deaths, use of specialized palliative care services, patient-reported quality of palliative care, and family-reported quality of palliative care after regional palliative care intervention. The secondary aim is to explore the changes in a variety of outcomes, including patients' quality of life, pain intensity, family care burden, and physicians' and nurses' knowledge, difficulties, and self-perceived practice. Outcome measurements used in this study include the Care Evaluation Scale, Good Death Inventory, Brief pain Inventory, Caregiving Consequence Inventory, Sense of Security Scale, Palliative Care Knowledge test, Palliative Care Difficulties Scale, and Palliative Care Self-reported Practice Scale. Study populations are a nearly representative sample of advanced cancer patients, bereaved family members, physicians, and nurses in the region. Qualitative process studies consist of 3 studies with each aim: 1) to describe the process in developing regional palliative care in each local context, 2) to understand how and why the regional palliative care program led to changes in the region and to propose a model for shaping regional palliative care, and 3) to systemically collect the barriers of palliative care at a regional level and potential resolutions. The study methodology is a case descriptive study, a grounded theory approach based on interviews, and a content analysis based on systemically collected data, respectively. Discussion This study is, to our knowledge, one of the most comprehensive evaluations of a region-based palliative care intervention program. This study has 3 unique aspects: 1) it measures a wide range of outcomes, including quality of care and quality of life measures specifically designed for palliative care populations, whether patients died where they actually preferred, the changes in physicians and nurses at a regional level; 2) adopts qualitative studies along with quantitative evaluations; and 3) the intervention is without a fundamental change in health care systems. A comprehensive understanding of the findings in this study will contribute to a deeper insight into how to develop community palliative care. Trial Registration UMIN Clinical Trials Registry (UMIN-CTR), Japan, UMIN000001274.
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Brouwers MC, Garcia K, Makarski J, Daraz L. The landscape of knowledge translation interventions in cancer control: what do we know and where to next? A review of systematic reviews. Implement Sci 2011; 6:130. [PMID: 22185329 PMCID: PMC3284444 DOI: 10.1186/1748-5908-6-130] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 12/20/2011] [Indexed: 01/08/2023] Open
Abstract
Background Effective implementation strategies are needed to optimize advancements in the fields of cancer diagnosis, treatment, survivorship, and end-of-life care. We conducted a review of systematic reviews to better understand the evidentiary base of implementation strategies in cancer control. Methods Using three databases, we conducted a search and identified English-language systematic reviews published between 2005 and 2010 that targeted consumer, professional, organizational, regulatory, or financial interventions, tested exclusively or partially in a cancer context (primary focus); generic or non-cancer-specific reviews were also considered. Data were extracted, appraised, and analyzed by members of the research team, and research ideas to advance the field were proposed. Results Thirty-four systematic reviews providing 41 summaries of evidence on 19 unique interventions comprised the evidence base. AMSTAR quality ratings ranged between 2 and 10. Team members rated most of the interventions as promising and in need of further research, and 64 research ideas were identified. Conclusions While many interventions show promise of effectiveness in the cancer-control context, few reviews were able to conclude definitively in favor of or against a specific intervention. We discuss the complexity of implementation research and offer suggestions to advance the science in this area.
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te Boveldt N, Engels Y, Besse K, Vissers K, Vernooij-Dassen M. Rationale, design, and implementation protocol of the Dutch clinical practice guideline pain in patients with cancer: a cluster randomised controlled trial with Short Message Service (SMS) and Interactive Voice Response (IVR). Implement Sci 2011; 6:126. [PMID: 22142327 PMCID: PMC3248867 DOI: 10.1186/1748-5908-6-126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 12/06/2011] [Indexed: 11/23/2022] Open
Abstract
Background One-half of patients with cancer have pain. In nearly one out of two cancer patients with pain, this was undertreated. Inadequate pain control still remains an important problem in this group of patients. Therefore, in 2008 a national, evidence-based multidisciplinary clinical practice guideline 'pain in patients with cancer' has been developed. Yet, publishing a guideline is not enough. Implementation is needed to improve pain management. An innovative implementation strategy, Short Message Service with Interactive Voice Response (SVS-IVR), has been developed and pilot tested. This study aims to evaluate on effectiveness of this strategy to improve pain reporting, pain measurement and adequate pain therapy. In addition, whether the active role of the patient and involvement of caregivers in pain management may change. Methods/design A cluster randomised controlled trial with two arms will be performed in six oncology outpatient clinics of hospitals in the Southeastern region of the Netherlands, with three hospitals in the intervention and three in the control condition. Follow-up measurements will be conducted in all hospitals to study the long-term effect of the intervention. The intervention includes training of professionals (medical oncologists, nurses, and general practitioners) and SMS-IVR to report pain in patients with cancer to improve pain reporting by patients, pain management by medical oncologists, nurses, and general practitioners, and decrease pain intensity. Discussion This innovative implementation strategy with technical tools and the involvement of patients, may enhance the use of the guideline 'pain in patients with cancer' for pain management. Short Message Service alerts may serve as a tool to support self-management of patients. Therefore, the SMS-IVR intervention may increase the feeling of having control over one's life. Trail registration Netherlands Trial Register (NTR): NTR2739
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Affiliation(s)
- Nienke te Boveldt
- Department Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre (RUNMC), Nijmegen, 6500 HB, The Netherlands.
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Abstract
INTRODUCTION Current treatment for metastatic bone pain is mainly palliative. Recent insights into the molecular mechanisms involved in bone metastases have led to the identification of promising therapeutic targets. This review offers an update of preclinical and clinical data on new drugs for metastatic bone pain. AREAS COVERED Biphosphonates are the gold standard of bone-targeted therapy in bone metastases, for their anti-resorptive and analgesic effects. New drugs aim at breaking the 'vicious cycle' of bone metastatic disease, due to the bidirectional interaction between cancer cells and bone microenvironment. Osteoprotegerin, RANK/RANKL interaction, cathepsin K, the Wnt/beta-catenin pathway and sclerostin are emerging targets for modulation of cancer-induced bone desorption. Other promising targets are those expressed in cancer cells that metastasize to bone, including Src, nerve growth factor, endothelin A, TGF-beta and CXCR4. Interesting therapeutic options include targets on nociceptors that innervate the bone, such as TPRV1, Trk and cannabinoid receptors. EXPERT OPINION Emerging therapies promise, in the next 10 years, a significant expansion in the array of therapeutic options for bone metastases. Most of these drugs are still in an early phase of development. Further clinical trials are needed to support the evidence of their efficacy and tolerability profile.
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Affiliation(s)
- Flaminia Coluzzi
- SAPIENZA University of Rome, Department of Medical and Surgical Sciences and Biotechnologies, Italy.
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Kravitz RL, Tancredi DJ, Grennan T, Kalauokalani D, Street RL, Slee CK, Wun T, Oliver JW, Lorig K, Franks P. Cancer Health Empowerment for Living without Pain (Ca-HELP): effects of a tailored education and coaching intervention on pain and impairment. Pain 2011; 152:1572-1582. [PMID: 21439726 DOI: 10.1016/j.pain.2011.02.047] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 01/25/2011] [Accepted: 02/23/2011] [Indexed: 11/15/2022]
Abstract
We aimed to determine the effectiveness of a lay-administered tailored education and coaching (TEC) intervention (aimed at reducing pain misconceptions and enhancing self-efficacy for communicating with physicians) on cancer pain severity, pain-related impairment, and quality of life. Cancer patients with baseline "worst pain" of ≥4 on a 0-10 scale or at least moderate functional impairment due to pain were randomly assigned to TEC or enhanced usual care (EUC) during a telephone interview conducted in advance of a planned oncology office visit (265 patients randomized to TEC or EUC; 258 completed at least one follow-up). Patients completed questionnaires before and after the visit and were interviewed by telephone at 2, 6, and 12 weeks. Mixed effects regressions were used to evaluate the intervention adjusting for patient, practice, and site characteristics. Compared to EUC, TEC was associated with increased pain communication self-efficacy after the intervention (P<.001); both groups showed significant (P<.0001), similar, reductions in pain misconceptions. At 2 weeks, assignment to TEC was associated with improvement in pain-related impairment (-0.25 points on a 5-point scale, 95% confidence interval -0.43 to -0.06, P=.01) but not in pain severity (-0.21 points on an 11-point scale, -0.60 to 0.17, P=.27). The improvement in pain-related impairment was not sustained at 6 and 12 weeks. There were no significant intervention by subgroup interactions (P>.10). We conclude that TEC, compared with EUC, resulted in improved pain communication self-efficacy and temporary improvement in pain-related impairment, but no improvement in pain severity.
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Affiliation(s)
- Richard L Kravitz
- Department of Internal Medicine and Center for Healthcare Policy and Research, University of California at Davis, USA Department of Pediatrics and Center for Healthcare Policy and Research, University of California at Davis, USA Kaiser Permanente, Northern California, USA Department of Anesthesiology and Pain Management and Center for Healthcare Policy and Research, University of California at Davis, USA Department of Communication, Texas A&M University and Houston Center for Quality and Utilization Studies, Baylor College of Medicine, USA Center for Healthcare Policy and Research, University of California at Davis, USA Division of Hematology-Oncology, University of California at Davis and the Northern California VA Health Care System, USA Oliver Consulting, USA Department of Medicine, Stanford University, USA Department of Family and Community Medicine and Center for Healthcare Policy and Research, University of California at Davis, USA
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Current world literature. Curr Opin Support Palliat Care 2011; 5:65-8. [PMID: 21321522 DOI: 10.1097/spc.0b013e3283440ea5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aldairy Y, Nguyen PL, Jatoi A. Bone pain from granulocyte colony stimulating factor: does clinical trial sponsorship by a pharmaceutical company influence its reporting? Eur J Cancer Care (Engl) 2011; 20:72-6. [PMID: 19708947 PMCID: PMC6014964 DOI: 10.1111/j.1365-2354.2009.01136.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It is alleged that pharmaceutical companies sometimes unfairly present clinical trial results. To our knowledge, studies have not explored whether such alleged unfair reporting also occurs in the testing of palliative care agents in cancer patients, a particularly vulnerable group. Therefore, a systematic search was conducted to retrieve all published, prospective clinical trials that used granulocyte colony stimulating factor starting in 2003. Because granulocyte colony stimulating factor can cause severe bone pain - a concerning but historically under-reported symptom in cancer patients - this symptom was assessed to determine whether differences in reporting occurred based on pharmaceutical company-sponsorship. A total of 239 published clinical trials met the present study's eligibility criteria and were retrievable. Within this entire group of studies, 65 (27%) were pharmaceutical company-sponsored, and only 31 (13%) reported on bone pain. However, pharmaceutical company-sponsored trials reported on bone pain at a higher rate compared with other studies: 23% versus 9% (P= 0.005), and this conclusion did not change after adjusting for dose, use of the slow release formulation and year of publication. The reporting of adverse events from cancer symptom control and palliative care interventions should be improved - especially in trials not sponsored by pharmaceutical companies.
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Affiliation(s)
- Y Aldairy
- Division of Hematopathology, Mayo Clinic, Rochester, MN 55905, USA
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Professional survey on knowledge and clinical patterns of pain management in Spanish medical oncology. Clin Transl Oncol 2010; 12:819-24. [PMID: 21156412 DOI: 10.1007/s12094-010-0603-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Cancer pain is still not treated adequately. The barriers impeding its appropriate treatment include lack of knowledge, erroneous beliefs and inappropriate attitudes with regard to pain, which are sustained by some or all of those involved in the problem. The present study shows the results of an exploratory survey using a large sample of specialists in clinical oncology. Its main objective is to evaluate daily analgesic practices and compliance with clinical guidelines in order to identify areas that should be improved in this particular therapeutic field. Information collection from the responders was in the form of a self-administered written questionnaire, structured in three thematic areas: clinical patterns and resources used in pain treatment in clinical practice, pain and pain-relief therapy, and theoretical knowledge and decision-making in clinical practice. The study identified those skills that most need improvement in the treatment of pain (scientific and technical knowledge and clinical decision-making capacity of professionals) in order to reduce the unjustified variability in current clinical practice.
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Haller G, Agoritsas T, Luthy C, Piguet V, Griesser AC, Perneger T. Collaborative quality improvement to manage pain in acute care hospitals. PAIN MEDICINE 2010; 12:138-47. [PMID: 21143760 DOI: 10.1111/j.1526-4637.2010.01020.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Collaborative quality improvement programs have been successfully used to manage chronic diseases in adults and acute lung complications in premature infants. Their effectiveness to improve pain management in acute care hospitals is currently unknown. The purpose of this study was to determine whether a collaborative quality improvement program implemented at hospital level could improve pain management and overall pain relief. DESIGN To assess the effectiveness of the program, we performed a before-after trial comparing patient's self-reported pain management and experience before and after program implementation. We included all adult patients hospitalized for more than 24 hours and discharged either to their home or to a nursing facility, between March 1, 2001 and March 31, 2001 (before program implementation) and between September 15, 2005 and October 15, 2005 (after program implementation). SETTING A teaching hospital of 2,096 beds in Geneva, Switzerland. PATIENTS All adult patients hospitalized for more than 24 hours and discharged between 1 to 31 March 2001 (before program) and 15 September to 15 October 2005 (after program implementation). INTERVENTIONS Implementation of a collaborative quality improvement program using multifaceted interventions (staff education, opinion leaders, patient education, audit, and feedback) to improve pain management at hospital level. OUTCOME MEASURES Patient-reported pain experience, pain management, and overall hospital experience based on the Picker Patient Experience questionnaire, perceived health (SF-36 Health survey). RESULTS After implementation of the program only 2.3% of the patients reported having no pain relief during their hospital stay (vs 4.5% in 2001, P=0.05). Among nonsurgical patients, improvements were observed for pain assessment (42.3% vs 27.9% of the patients had pain intensity measured with a visual analog scale, P=0.012), pain management (staff did everything they could to help in 78.9% vs 67.9% of cases P=0.003), and pain relief (70.4% vs 57.3% of patients reported full pain relief P=0.008). In surgical patients, pain assessment also improved (53.7.3% vs 37.6%) as well as pain treatment. More patients received treatments to relieve pain regularly or intermittently after program implementation (95.1% vs 91.9% P=0.046). CONCLUSION Implementation of a collaborative quality improvement program at hospital level improved both pain management and pain relief in patients. Further studies are needed to determine the overall cost-effectiveness of such programs.
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Affiliation(s)
- Guy Haller
- Department of Anesthesiology, Pharmacology and Intensive Care-Division of Anaesthesiology, Geneva University Hospital, 4 rue Perret-Gentil, Geneva, Switzerland.
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Wu JSY, Beaton D, Smith PM, Hagen NA. Patterns of pain and interference in patients with painful bone metastases: a brief pain inventory validation study. J Pain Symptom Manage 2010; 39:230-40. [PMID: 20152587 DOI: 10.1016/j.jpainsymman.2009.07.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2008] [Revised: 07/07/2009] [Accepted: 07/15/2009] [Indexed: 11/29/2022]
Abstract
Bone metastases are prevalent, painful, and carry a poorer prognosis for pain control compared with other cancer pain syndromes. Standard tools to measure pain have not been validated in this patient population, and particular subgroups with more challenging symptoms have yet to be identified and studied. The objectives of this study were 1) to validate the psychometric properties of the Brief Pain Inventory (BPI) and its Pain and Interference subscales in patients with clinically significant metastatic bone pain requiring palliative radiotherapy and 2) to examine differences in BPI subscales among predefined subgroups of bone metastases patients. A total of 258 patients evaluated and treated through a rapid access radiation therapy clinic between July 2002, and November 2006, were included in the analysis. High internal consistency of the BPI subscales of Pain, Activity interference, and Affect interference was demonstrated by Cronbach's alpha between 0.81 and 0.89. Removing sleep interference improved model fit in confirmatory factor analysis. The BPI revealed an alarming pattern in patients with lower body metastases, who reported substantial interference of activity even though pain levels were mild or moderate. Such patients may require prompt clinical attention to better meet their needs. Finally, the allocation of interference from sleep within the BPI framework, in our population of pain patients, requires further study.
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Affiliation(s)
- Jackson S Y Wu
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta T2N 4N2, Canada.
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Helfand M, Freeman M. Assessment and management of acute pain in adult medical inpatients: a systematic review. PAIN MEDICINE 2010; 10:1183-99. [PMID: 19818030 DOI: 10.1111/j.1526-4637.2009.00718.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To review the literature addressing effective care for acute pain in inpatients on medical wards. METHODS We searched Medline, PubMed Clinical Queries, and the Cochrane Database for systematic reviews published in 1996 through April 2007 on the assessment and management of acute pain in inpatients, including patients with impaired self-report or chemical dependencies. We conducted a focused search for studies on the timing and frequency of assessment, and on the use of patient-controlled analgesia (PCA) for nonsurgical pain. Two investigators performed a critical analysis of the literature and compiled narrative summaries to address the key questions. RESULTS We found no evidence that directly linked the timing, frequency, or method of pain assessment with outcomes or safety in medical inpatients. There is good evidence that treating abdominal pain does not compromise timely diagnosis and treatment of the surgical abdomen. Pain management teams and other systemwide interventions improve assessment and use of analgesics, but do not clearly affect pain outcomes. The safety and effectiveness of PCA in medical patients have not been studied. There is weak evidence that most cognitively impaired individuals can understand at least one self-assessment measure. Almost no evidence is available to guide management of pain in delirium. Evidence for managing pain in patients with substance abuse disorders or chronic opioid use is weak, being derived from case reports, retrospective studies, and expert opinion. CONCLUSIONS Pain is a prevalent problem for medical inpatients. Clinical research is needed to guide the assessment and management of pain in this setting.
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Affiliation(s)
- Mark Helfand
- Evidence-Based Synthesis Program, Portland Veterans Affairs Medical Center, Portland, OR 97239, USA.
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Yanjun S, Changli W, Ling W, Woo JCAL, Sabrina K, Chang L, Lei Z. A survey on physician knowledge and attitudes towards clinical use of morphine for cancer pain treatment in China. Support Care Cancer 2009; 18:1455-60. [DOI: 10.1007/s00520-009-0768-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Accepted: 10/20/2009] [Indexed: 11/24/2022]
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Evidence-based pain management: analyzing the practice environment and clinical expertise. CLIN NURSE SPEC 2009; 23:245-51. [PMID: 19710570 DOI: 10.1097/nur.0b013e3181b20745] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/OBJECTIVES Evidence regarding pain and pain control has been available for more than 30 years. Implementation of evidence-based pain management (EBPM) is impacted by both individual and organizational factors. Clinical nurse specialists, responsible for EBPM implementation need information to help target interventions. Using the Theory of Planned Behavior, the purpose of this study was to analyze the effect of the perception of the practice environment and clinical expertise on the adoption of EBPM. DESIGN A descriptive, retrospective study took place in 2006. SAMPLE A convenience sample of 85 nurses from 2 teaching hospitals and 3 surgical units in the Northeast volunteered to participate. METHODS Nurses completed the Practice Environment Scale of the Revised Nursing Work Index and the Clinical Nursing Expertise instruments to measure the independent variables. The researcher then reviewed 4 of their pain management documentation entries. Each entry was scored using the Samuels' Pain Management Documentation Rating Scale and averaged to compute an individual rating score for each nurse. Data were analyzed first descriptively, then with multiple regression. FINDINGS Results showed that the perception of the practice environment did not contribute to pain management documentation, whereas clinical expertise explained 4.4% of the variance. The more clinically expert practitioners had relatively poorer documentation scores. CONCLUSIONS : Expertise may impact the implementation of evidence especially in areas where practice patterns are well established. IMPLICATIONS Adapting implementation strategies to target expertise levels are warranted.
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Affiliation(s)
- Tawee Tanvetyanon
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Okon TR, Lutz PS, Liang H. Improved pain resolution in hospitalized patients through targeting of pain mismanagement as medical error. J Pain Symptom Manage 2009; 37:1039-49. [PMID: 19278818 DOI: 10.1016/j.jpainsymman.2008.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 05/30/2008] [Accepted: 06/16/2008] [Indexed: 11/30/2022]
Abstract
Current strategies to reduce excess pain among hospitalized patients remain inadequate. New, effective approaches are urgently needed. In this prospective observational study of a performance-improvement intervention, we studied the effect of computer-generated, real-time alerts used by nurses on the rate of a medical error in pain management defined as lack of reassessment within 120 minutes from the last observation of severe pain. We also studied duration of severe pain events and frequency of treatment of opioid-related adverse effects. Analyses of 51,619 consecutive observations of severe pain were performed in monthly intervals. Significant decrease in error rate (delayed pain reassessment) was observed postintervention (mean+/-standard error [SE]: 35.8%+/-0.7%) compared with preintervention rate (56.2%+/-1.4%, P<0.0001). Among 6305 unique severe pain events examined during four months pre- and postintervention, time to resolution of severe pain decreased significantly (median time preintervention [January 2006] of 195 minutes compared with median time postintervention of 117, 106, and 101 minutes [January, April, and June 2007], P<0.0001). Hospital-wide, unanticipated monthly naloxone administration decreased postintervention (mean+/-SE: 1.48+/-0.21 per month per 1000 inpatients) compared with preintervention (2.69+/-0.35, P=0.0130). Hospital-wide implementation of real-time, computer-generated alerts identifying instances of delayed pain reassessment resulted in sustained reduction of error rate and faster resolution of severe pain without oversedation.
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Affiliation(s)
- Tomasz R Okon
- Department of Palliative Medicine, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
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Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group. Br J Cancer 2009; 100:1566-74. [PMID: 19401688 PMCID: PMC2696765 DOI: 10.1038/sj.bjc.6605053] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61% of cases were received a WHO-level III opioid; 25.3% were classified as potentially undertreated, with wide variation (9.8–55.3%) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on follow-up) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76%. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients’ outcomes.
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Costantini M, Ripamonti C, Beccaro M, Montella M, Borgia P, Casella C, Miccinesi G. Prevalence, distress, management, and relief of pain during the last 3 months of cancer patients’ life. Results of an Italian mortality follow-back survey. Ann Oncol 2009; 20:729-35. [DOI: 10.1093/annonc/mdn700] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Morrison RS, Flanagan S, Fischberg D, Cintron A, Siu AL. A novel interdisciplinary analgesic program reduces pain and improves function in older adults after orthopedic surgery. J Am Geriatr Soc 2009; 57:1-10. [PMID: 19054187 PMCID: PMC2729399 DOI: 10.1111/j.1532-5415.2008.02063.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To examine the effect of a multicomponent intervention on pain and function after orthopedic surgery. DESIGN Controlled prospective propensity score-matched clinical trial. SETTING New York City acute rehabilitation hospital. PARTICIPANTS Two hundred forty-nine patients admitted to rehabilitation after hip fracture repair (n=51) or hip (n=64) or knee (n=134) arthroplasty. INTERVENTION Pain assessment at rest and with physical therapy (PT) by staff using numeric rating scales (1 to 5). Physician protocols for standing analgesia and preemptive analgesia before PT were implemented on the intervention unit. Control unit patients received usual care. MEASUREMENTS Pain, analgesic prescribing, gait speed, transfer time, and percentage of PT sessions completed during admission. Pain and difficulty walking at 6, 12, 18, and 24 weeks after discharge. RESULTS In multivariable analyses intervention patients were significantly more likely than controls to report no or mild pain at rest (66% vs 49%, P=.004) and with PT (52% vs 38%, P=.02) on average for the first 7 days of rehabilitation, had faster 8-foot-walk times on Days 4 (9.3 seconds vs 13.2 seconds, P=.02) and 7 (6.9 vs 9.2 seconds, P=.02), received more analgesia (23.6 vs 15.6 mg of morphine sulfate equivalents per day, P<.001), were more likely to receive standing orders for analgesia (98% vs 48%, P<.001), and had significantly shorter lengths of stay (10.1 vs 11.3 days, P=.005). At 6 months, intervention patients were less likely than controls to report moderate to severe pain with walking (4% vs 15%, P=.02) and that pain did not interfere with walking (7% vs 18%, P=.004) and were less likely to be taking analgesics (35% vs 51%, P=.03). CONCLUSION The intervention improved postoperative pain, reduced chronic pain, and improved function.
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Affiliation(s)
- R Sean Morrison
- Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York 10029, USA.
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