Pain Standards for Accredited Healthcare Organizations (ACDON Project): A Mixed Methods Study.

Concepción Pérez,Mireia Rodríguez,José L Baquero,Juana Sánchez-Jiménez,Claudio Calvo-Espinos,Emma Folch,Mercedes Guilabert,Pedro J Ibor,Mercedes Vinuesa,José J Mira,Elisa Gallach,Carmen Beato,Manel Santiña,Jimmy Martin-Delgado,Albert Tuca,José Gomez,Ignacio Velázquez,María L Cánovas,José A Yáñez

doi:10.3390/jpm11020102

Abstract

Up to 50% of cancer patients and up to 90% of those in terminal stages experience pain associated with disease progression, poor quality of life, and social impact on caregivers. This study aimed to establish standards for the accreditation of oncological pain management in healthcare organizations. A mixed methods approach was used. First, a pragmatic literature review was conducted. Second, consensus between professionals and patients was reached using the Nominal Group and Delphi technique in a step that involved anesthesiologists, oncologists, family physicians, nurses, psychologists, patient representatives, and caregivers. Third, eight hospitals participated in a pilot assessment of the level of fulfillment of each standard. A total of 37 standards were extracted. The Nominal Group produced additional standards, of which 60 were included in Questionnaire 0 that was used in the Delphi Technique. Two Delphi voting rounds were performed to reach a high level of consensus, and involved 64 and 62 participants with response rates of 90% and 87%, respectively. Finally, 39 standards for the management of cancer pain were agreed upon. In the self-evaluation, the average range of compliance was between 56.4% and 100%. The consensus standards of the ACDON Project might improve the monitoring of cancer pain management. These standards satisfied the demands of professionals and patients and could be used for the accreditation of approaches in cancer pain management.

Highlights

Pain is experienced by more than 50% of cancer patients [1,2] and by up to 90%of patients who are in terminal stages [3]
This study included a review of the literature and qualitative techniques (Nominal Group and Delphi techniques) that were applied to identify consensus among all participants with regard to the process of addressing cancer pain
After screening a total of 563 records and assessing eligibility twenty-five articles, eight clinical practice guidelines, five organizational reports, and two quality standards reports related to the management of cancer pain were selected, a total of 28 records were excluded because did not addressed cancer related pain and were clinical trials

Summary

Introduction

Pain is experienced by more than 50% of cancer patients [1,2] and by up to 90%. Of patients who are in terminal stages [3]. The onset of chronic related cancer pain is associated with disease progression, stage of disease, and, most importantly, an impact on the patient’s quality of life [4,5]. The use and monitoring of existing treatment guidelines and the utilization of the World Health Organization analgesic ladder [8] to produce adequate pain relief, and this affects the outcomes in the management of cancer pain [9]. 50% of patients with some type of cancer pain remain underdiagnosed or mismanaged, despite the many initiatives undertaken for adequate management [10].

Objectives

Methods

Results

Discussion

Conclusion