Quality Of Cancer Pain Management Research Articles

EVALUATION OF THE QUALITY OF PAIN MANAGEMENT IN CANCER PATIENTS: STUDY OF 60 MOROCCAN PATIENTS AND LITERATURE REVIEW

Cancer is a chronic disease that affects patients quality of life, hence the need to evaluate the quality of care in its globality without forgetting cancer pain. This study aims to acknowledge the pain in cancer patients, evaluate it using international scales, and see to what extent this pain is managed in its totality. This is a prospective study to evaluate the quality of cancer pain management, 60 patients were included, 26 women and 34 men, with an average age of 52.2 years. The evaluation of pain concerned different cancer pathologies, according to the simple verbal scale and the visual analog scale, the majority of our patients (83.4%) had pain, 68.4% had moderate to severe pain, the use of level III analgesics occurred in 35% of patients. Among our sample 37% of cancer patients had negative pain management index scores, indicating inadequate analgesic treatment. This study shows that the management of cancer pain is still insufficient for reasons of organization and lack of information. This situation cannot be improved without the establishment of a global strategy for the management of cancer pain.

Cross-cultural adaptation, validity, and reliability of the Chinese version of revised American Pain Society patient outcome questionnaire for patients with cancer pain

Objective To introduce Revised American Pain Society Patient Outcome Questionnaire for patients with cancer pain in China, and to test its reliability and validity. Methods Cross-cultural adjustment was conducted on the basis of the Revised American Pain Society Patient Outcome Questionnaire of the American Pain Association published on the official website through expert review and pre-experiment. A convenience sample of 153 hospital patients with cancer pain was recruited. And the data were analyzed for reliability and validity. Results The adjusted Revised American Pain Society Patient Outcome Questionnaire contains 18 core items, which are easy to understand and can be completed within 10 minutes. Reliability test: the Cronbach α coefficient of internal consistency for the total scale was 0.735. The Cronbach α coefficient of pain intensity dimension was 0.233, the Cronbach α coefficient of sleep interference dimension was 0.891, the Cronbach α coefficient of activity interference dimension was 0.830, the Cronbach α coefficient of emotion dimension was 0.846, the Cronbach α coefficient of pain management related side effects dimension was 0.591, and the Cronbach α coefficient of perception dimension of pain care was 0.633. Validity test: The total content validity of the scale was 0.98, and the content validity of each item ranged from 0.82 to 1.00. Conclusion The adjusted Revised American Pain Society Patient Outcome Questionnaire has good reliability and validity, providing an effective assessment tool for medical institutions to evaluate the quality of cancer pain management. Key words: Pain; Cancer; Transcultural adaptation

Cancer pain management and the opioid crisis in America: How to preserve hard-earned gains in improving the quality of cancer pain management.

Cancer pain remains a feared consequence of the disease and its treatment. Although prevalent, cancer pain can usually be managed through the skillful application of pharmacologic and nonpharmacologic interventions. Unfortunately, access to these therapies has been hampered by interventions designed to contain another serious public health problem: the opioid misuse epidemic. This epidemic and the unintended consequences of efforts to control this outbreak are leading to significant barriers to the provision of cancer pain relief. Oncologists and other professionals treating those with cancer pain will require new knowledge and tools to provide safe and effective pain control while preventing additional cases of substance use disorders (SUDs), helping patients in recovery to maintain sobriety, and guiding those not yet in recovery to seek treatment. How do these 2 serious epidemics intersect and affect oncology practice? First, oncology professionals will need to adopt practices to prevent SUDs by assessing risk and providing safe pain care. Second, oncology practices are likely to see an increased number of patients with a current or past SUD, including opioid misuse. Few guidelines exist for the direct management of pain when opioids may be indicated in these individuals. Third, modified prescribing practices along with the education of patients and families are warranted to prevent the exposure of these medications to unintended persons. Finally, advocacy on behalf of those with cancer pain is imperative to avoid losing access to essential therapies, including opioids, for those who might benefit. Cancer 2018;124:2491-7. © 2018 American Cancer Society.

Establishment and effect of cancer pain nursing quality indicators in oncology department

Objective To establish the cancer pain nursing quality indicators, and to explore the effect on improving the quality of cancer pain nursing in the oncology department. Methods Based on the literature review and cross-sectional survey, according to the characteristic of oncology department and cancer pain nursing needs, guided by previous research findings of standard cancer pain nursing management framework, according to the nursing procedure of admission-cancer pain assessment-nursing intervention-cancer pain control evaluation-discharge follow up , eight cancer pain nursing quality indicators were established, including nurse-to-patient ratio, comprehensive assessment rate for cancer pain, dynamic assessment rate, patients' awareness rate of pain knowledge, cancer pain intervention efficiency, qualified rate of nursing records, patients' satisfaction rate with cancer pain control, and the follow-up rate. These indicators were applied in the oncology department to manage the nursing quality, and the data were supervised and analyzed regularly to improve the quality of cancer pain management continuously. Results After six months of the application of cancer pain management quality indicators, the comprehensive assessment rate for cancer pain increased from 86.1% to 100.0%; the dynamic assessment rate increased from 83.3% to 97.5%; patients' awareness rate of pain knowledge increased from 77.8% to 95.0%; the cancer pain intervention efficiency increased from 77.8% to 97.5%; the qualified rate of nursing records increased from 80.0% to 95.0%; patients' satisfaction rate with pain control increased from 83.3% to 96.7%; the follow-up rate increased from 80.0% to 96.0% (χ2=3.90, 3.01, 3.53, 5.29, 4.11, 5.93, 4.25; P<0.05) . Conclusions The application of cancer pain nursing quality indicators can promote the normalization and quality of cancer pain nursing. It can provide evidence for continuous quality improvement of cancer pain nursing and help improve the cancer pain management. Key words: Neoplasms; Pain; Nursing care; Quality indicators; Cancer pain management

Educational program for medical residents in cancer pain management.

198 Background: Studies have shown significant deficits in the knowledge of physicians in Cancer Pain Management (CPM). We implemented an educational program on CPM for medical residents with pre and post-testing to assess baseline knowledge and the improvement after education. Methods: The content of the lecture was derived from the Cancer Pain Education Resource (CAPER). It included assessment, non-pharmacological interventions, equi-analgesic conversions , titration, side effects, withdrawal, dependence and addiction. An online questionnaire was created to assess the baseline knowledge and the residents accessed it using their mobile phones. After the lecture the same was used to assess the improvement in knowledge. 22 residents from Newark Beth Israel Internal Medicine Residency Program participated in the lecture and the pre/post-tests. After the lecture, they were given a pocket card with opioid equi-analgesic dosing calculations.Two months later, the same questionnaire was used to assess the retained knowledge. Results: The pretest score was 71% and after the lecture it improved to 81%. After 2 months the score was 72%. Notably, the knowledge of equi-analgesic conversions had increased. 95 % of the residents were very satisfied with the lecture and wanted more education on CPM. Improvement in knowledge on specifics of CPM are shown in Table. Conclusions: One of the ways to improve CPM is to focus on education of residents. After a single lecture, there was improvement in all areas of deficiency.The use of simple tools like pocket cards can help to improve knowledge. Our plan is to expand this program to medical students and have additional lectures. We believe that these lectures will improve the quality of CPM in patients. [Table: see text]

Improving the quality of cancer pain management in an academic medical center emergency department.

The impact and outcomes of the implementation of a pain management guideline and pain assessment standard operating procedure (SOP) in a cancer-specific emergency department are evaluated in this article. After implementation of the SOP, the number of pain assessments conducted per patient during hospitalization increased, as did the percentage of patients who underwent a pain assessment at admission, within one hour after analgesic medication was administered, and at regular intervals.

Quality of Cancer Pain Management: An Update of a Systematic Review of Undertreatment of Patients With Cancer

Pain is a frequent symptom in patients with cancer, with substantial impact. Despite the availability of opioids and updated guidelines from reliable leading societies, undertreatment is still frequent. We updated a systematic review published in 2008, which showed that according to the Pain Management Index (PMI), 43.4% of patients with cancer were undertreated. This review included observational and experimental studies reporting negative PMI scores for adults with cancer and pain published from 2007 to 2013 and retrieved through MEDLINE, Embase, and Google Scholar. To detect any temporal trend and identify potential determinants of undertreatment, we compared articles published before and after 2007 with univariable, multivariable, and sensitivity analyses. In the new set of 20 articles published from 2007 to 2013, there was a decrease in undertreatment of approximately 25% (from 43.4 to 31.8%). In the whole sample, the proportion of undertreated patients fell from 2007 to 2013, and an association was confirmed between negative PMI score, economic level, and nonspecific setting for cancer pain. Sensitivity analysis confirmed the robustness of results. Analysis of 46 articles published from 1994 to 2013 using the PMI to assess the adequacy of analgesic therapy suggests the quality of pharmacologic pain management has improved. However, approximately one third of patients still do not receive pain medication proportional to their pain intensity.

How is race/ethnicity associated with patient reporting of cancer pain in recently diagnosed colorectal and lung cancer?

50 Background: Racial and ethnic disparities in the quality of cancer pain treatment are widely documented. The purpose of this study was to examine adjusted differences by race/ethnicity in the odds of reporting pain and differences in pain severity. Methods: This study used data from Cancer Care Outcomes Research and Surveillance Consortium (CanCORS), a nationally representative cohort study of colorectal and lung cancer patients. Patients were identified following incident colorectal or lung cancer diagnosis via rapid case ascertainment. Surveys were administered between three and five months following diagnosis. Pain was assessed via patient self-report using the Brief Pain Inventory. Control variables included sex, age, education, wealth, fatalism, marital status, survey language, self-reported health status, depression, cancer stage, and care at a Veterans Administration (VA) facility. Each control variable was first individually assessed as a potential mediator in the relationship between race/ethnicity and pain severity. Final models were fully adjusted with all control variables. Results: Among 3,216 individuals with colorectal cancer (16.4% black), 40% reported pain; among 2,545 with lung cancer (12% black), 57% reported pain. The odds of reporting pain did not differ by race/ethnicity in lung or colorectal cancer patients in adjusted analyses. None of the included covariates significantly mediated this relationship. However, among those reporting pain, pain severity was higher for black relative to white patients in both lung (p=0.002) and colorectal cancer (p=0.000). Conclusions: The odds of reporting presence of pain did not differ by race/ethnicity. However, among those reporting pain, blacks reported higher pain severity than whites in both cancer types, even after adjusting for patient and health status characteristics. Differential pain severity by race/ethnicity, particularly for black patients, may be an important consideration in assessing the quality of cancer pain management.

What Really Matters in Pain Management for Terminally Ill Cancer Patients in Taiwan

The paradox of patients who are in pain yet satisfied with their pain management has been documented repeatedly. Pain relief constitutes only one part of patient satisfaction with pain management. The quality of cancer pain management in Taiwan has not been evaluated from the patient's perspective. A cross-sectional design was used to survey 1,370 terminally ill cancer patients in Taiwan to characterize the status of, and satisfaction with cancer pain management by investigating the relative importance of pain intensity, pain relief experiences, and clinicians' pain management practices. Cancer patients with pain had unsatisfactory pain relief within one week of admission (47.4 percent) and inadequate pain medication (23.6 percent). However, these patients perceived that clinicians adequately informed them about pain treatment. Patient satisfaction with pain management was primarily determined by examining the perceptions that medication dose was just right, responses to requests for pain medication were prompt, and understandable and consistent information about pain treatment was offered. In conclusion, Taiwanese cancer patients' satisfaction with pain management was influenced more by perceived pain management practices than by pain relief itself.

Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group

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.

Pain management of opioid‐treated cancer patients in hospital settings in Denmark

To evaluate the performance and quality of cancer pain management in hospital settings. Anaesthesiologists specialised in pain and palliative medicine studied pain management in departments of oncology and surgery. Study days were randomly chosen and patients treated with oral opioids were included. Information regarding pain aetiology and mechanisms, pain medications and opioid side effects were registered from the medical records and by examining patients. Pain intensity was assessed using the Brief Pain Inventory. In total, 59 cancer patients were included. In 49 (83%) patients pain aetiology was assessed by the physicians of the departments of oncology and surgery. In only 19 (32%) patients they assessed pain mechanisms. The median oral morphine dose was 120 mg/day (range: 10-720 mg/day). Seventy-eight per cent of patients received opioids at adequate regular intervals according to the duration of action. In 88% of the patients supplemental short-acting oral opioids were given on demand and the median supplemental oral dose was 16.5% of the daily dose. Seven patients with neuropathic pain received adjuvant drugs, whereas six patients with non-neuropathic pain received adjuvant drugs. Regarding opioid side effects only constipation and nausea were treated in the majority of the patients. Average pain intensity in the last 24 h for the total number of patients (n=59) < or =5 cm was 88.1% (confidence interval 77.1-95.1). Cancer pain was prevalent in opioid-treated patients in hospital settings: however, focussing on average pain intensity, the outcome seems favourable compared with other countries. Pain mechanisms were seldom examined and adjuvant drugs were not specifically used for neuropathic pain. Opioid dosing intervals and supplemental opioid doses were most often adequate. However, opioid side effects were highly prevalent and most side effects were left untreated.

Unequal Quality of Cancer Pain Management: Disparity in Perceived Control and Proposed Solutions

To examine poverty-related and racial and ethnic disparity in cancer pain management. Published articles, conference proceedings, testimony, and clinical case studies. Disparity in the quality of cancer pain management exists resulting from interactions among patient, provider, and environmental factors. Irrespective of etiology, disparity results in inadequate management of cancer pain for vulnerable populations (poor patients, ethnic and racial group members, older adults) and is unacceptable in cancer care. Inadequate symptom management affects cancer treatment tolerance, exacerbating disparity in treatment outcomes and affecting end-of-life care. Evidence-based solutions include a systems approach, quality-improvement and quality-assurance processes that expose disparities and enforce evidence-based treatment per national guidelines, and statewide comprehensive cancer planning to target pain management outcomes. Oncology nurses and interdisciplinary teams must be aware of disparities in cancer pain management for vulnerable groups, intervene to empower patients through customized educational approaches, and simultaneously implement systemwide strategies to ensure effective pain management and targeted monitoring for high-risk patients.

The Quality of Cancer Pain Management for Racial and Ethnic Minority Americans

(2006). The Quality of Cancer Pain Management for Racial and Ethnic Minority Americans. Journal of Cancer Pain & Symptom Palliation: Vol. 2, No. 1, pp. 19-27.

A Multidisciplinary Project to Improve the Quality of Cancer Pain Management in Italy

Pain afflicts most cancer patients, mainly in the advanced and metastatic phases of the disease. Despite the existence of several guidelines for cancer pain management that are based on the recommendations by the World Health Organization and the availability of effective treatments for 70% to 90% of cases, undertreatment is well documented and can involve up to 40% of patients. Undertreatment is usually attributed to an incorrect use of opioids for reasons often conceptualized in terms of barriers related to healthcare provider, patient, family, institution, and society. In Italy, opioid consumption rates are among the lowest in Europe despite some of recent efforts to improve the analgesic prescription and utilization. In the context of a wide project coordinated by the Mario Negri Institute, a non-for-profit private foundation located in Milan, Italy, 4 activities were launched: (1) a critical appraisal of information available on the Web, with the preparation and publication of a meta-site to facilitate the use of selected resources; (2) an evaluation of prescriptions of analgesic drugs in a cohort of cancer patients using a large administrative database; (3) a nationwide outcome research study to assess the epidemiology, quality, and effectiveness of different analgesic strategies; and (4) a multimodal, community-based intervention based on information, education, and training programs to change the knowledge, opinions, and attitude toward cancer pain treatment. Activities started in 2005. Some results and outputs are already available; others will be ready by the end of 2007.

The Quality of Cancer Pain Management for Racial and Ethnic Minority Americans

(2006). The Quality of Cancer Pain Management for Racial and Ethnic Minority Americans. Journal of Cancer Pain & Symptom Palliation: Vol. 2, No. 1, pp. 19-27.

New approaches for evaluating the quality of cancer pain management in the outpatient setting

Both retrospective and prospective methods can be used to evaluate the quality of cancer pain management in the outpatient setting. Retrospective evaluations of the quality of cancer pain management in the outpatient setting provide benchmark data that can be used to change clinical practice for groups of patients or for specific types of cancer pain problems. Prospective evaluations of the quality of cancer pain management with patient diaries in the outpatient/home care setting can help clinicians do “real-time” evaluations and modify the pain management plan for individual patients. This report provides practical suggestions for evaluating the quality of cancer pain management in the outpatient setting. © 2001 by the American Society of Pain Management Nurses

Disclosure of the Cancer Diagnosis as It Relates to the Quality of Pain Management Among Patients with Cancer Pain in Taiwan

This study was designed to explore: (1) who is responsible for disclosing to Taiwanese cancer patients the diagnosis of cancer, (2) the extent of disclosure, and (3) the relationship between the disclosure of the cancer diagnosis and the quality of cancer pain management as perceived by the patients experiencing cancer pain. One hundred twelve cancer patients with pain were recruited from three teaching hospitals in Taiwan. The major findings in this study were as follows: the majority of the patients with pain (79%) had been informed that the diagnosis was cancer, and for the majority (89%) the disclosure of cancer had been made by their physicians; older patients and those with lower levels of education were less likely to be told that they had been diagnosed with cancer; and patients to whom it was disclosed that the diagnosis was cancer tended to experience lower levels of pain intensity, lower levels of pain interference, and higher levels of satisfaction with pain management provided by clinicians. These findings provide significant implications for disclosure practice for Taiwanese oncology clinicians.

Barriers to Cancer Pain Relief: Fear of Tolerance and Addiction

The purposes of this study were to (a) test the feasibility of the Cancer Total Quality Pain Management™ (TQPM™) Patient Assessment Tool in a population of oncology inpatient and outpatients; and (b) identify factors associated with poor pain relief. The Cancer TQPM Tool was adapted from the American Pain Society’s Quality Assurance Standards on Acute Pain and Cancer Pain and was tested in a convenience sample of 200 patients. The majority of patients reported that the TQPM Tool was easy to understand and to use, providing evidence for the feasibility of the tool. Factors associated with higher pain intensity included the inpatient setting, the presence of metastatic disease, hesitancy in bothering the nurse, and concerns regarding tolerance and addiction. Although there was a strong relationship between concern about addiction and concern about tolerance, fear of tolerance appeared to have a greater effect on pain intensity scores than did fear of addiction. The findings from this study suggest that the Cancer TQPM Patient Assessment Tool can be used effectively in both inpatients and outpatients to determine outcomes and the quality of cancer pain management, as well identify factors associated with poor pain control. Clinical implications include more effective education of patients and caregivers, including equivalent emphasis on tolerance and addiction.

Enhancing management of cancer pain: contribution of the internal working model.

The purpose of this article is to organize the current knowledge regarding patient-related factors that can have an impact on cancer pain management by using the construct of the internal working model: a theoretical framework for integrating current knowledge and interpreting and predicting factors related to the management of cancer pain. These factors include patients' beliefs and misconceptions about cancer pain and pain treatment, meanings that patients ascribe to their pain, their expectations about pain relief, and communication between patients and clinicians about pain control. The construct of the internal working model predicts and explains factors related to pain control and provides implications for practice. It has potential utility in enhancing the quality of cancer pain management.

Assessing the Quality of Cancer Pain Management

Assessing the Quality of Cancer Pain Management