Interdisciplinary community oncology clinic intervention to improve pain control for all patients.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 63-63
Author(s):  
Jeanne Elnadry ◽  
Tina Duarte ◽  
Gregory John C. Yang ◽  
Ambuga Badari
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Pain Score ◽  
Pain Control ◽  
Severe Pain ◽  
Collaborative Practice ◽  
Clinical Staff ◽  
Cancer Center ◽  
Practice Model ◽  
Medical Assistants

63 Background: In rural Yuma, AZ there are too few palliative care specialists to meet the needs of the population. This report presents a unique approach to interdisciplinary care for pain management beginning early in cancer care. To address this need a palliative care specialist collaborated with the entire clinical staff of the community cancer center, including physicians, nurses, social worker, pharmacist, and medical assistants, to initiate a new distress screening tool and develop an interdisciplinary collaborative practice model for pain management. Methods: Data was analyzed from 274 consecutive patients using a review of systems form which was modified 3/2014 to include more information regarding pain, depression/anxiety, communication about illness, spiritual needs, and educational needs, and from 55 patients admitted to home hospice. All clinical staff reviewed the data together and mapped clinical processes. A pain assessment protocol was developed for nurses and medical assistants, who gave the assessment summary to the physician seeing the patient. Further training for nurses taught an algorithm to collaborate with physicians for pain medication orders driven by the assessment findings. Results: About 1/3 of patients had significant concerns about pain. End-of-life data showed that 31% of 55 patients admitted from the cancer center to a local hospice had moderate to severe pain (pain score 4-10) at the time of hospice admission. 88% of these patients’ pain was controlled within 48 hours of admission to home hospice, with pain score 0-3. Data for 274 consecutive clinic patients showed that 30% of patients had concerns about pain, 30% about advanced care planning and communication, and 32% about anxiety, depression, and coping. Of the 162 patients who reported distress, 57% reported distress in 2 or more domains. Conclusions: Hospice data showed that nearly all cancer patients with moderate to severe pain could have pain control within 48 hours. Patients undergoing treatment should be able to have similar results, but were not. Follow-up data collection to assess effect of the collaborative practice model intervention is planned for August 2014.

The experience of pain among cancer patients at the University of the Philippines: Philippine General Hospital Cancer Institute—A cross-sectional study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24078-e24078
Author(s):  
Harold Nathan C. Tan ◽  
Rogelio Nona Velasco ◽  
Lance Isidore Garcenila Catedral ◽  
Michael Ducusin San Juan ◽  
Corazon Ngelangel ◽  
...  
Keyword(s):  
Pain Management ◽  
Cancer Patients ◽  
Pain Control ◽  
Severe Pain ◽  
Cross Sectional Study ◽  
The Philippines ◽  
Pain Interference ◽  
Cancer Center ◽  
Cross Sectional ◽  
Adequate Pain Management

e24078 Background: Pain is one of the most common and dreaded sequelae of cancer, occurring in approximately 55% of patients. The experience of pain takes a toll on the patients’ quality of life. However, many patients do not receive adequate pain management. This study aimed to determine the prevalence of pain, its severity, and the adequacy of pain management among cancer patients in the Philippines. Methods: A cross-sectional study was conducted at a representative cancer center in the Philippines, enrolling 351 cancer patients. Pain severity was assessed using the Brief Pain Inventory-Short Form (BPI-SF) Filipino. The BPI evaluates pain severity and its impact on daily functioning (pain interference). To ascertain the adequacy of pain control, the pain management index (PMI) was calculated by subtracting the subtracting the severity of pain reported by the patient from the type of analgesic treatment received. Logistic regression analysis was conducted to evaluate the factors associated with worst pain and adequacy of pain management. Data were analyzed using Stata version 16.0, with statistical significance set at p < 0.05. Results: Three hundred three cancer patients (86.3%) experienced pain. Approximately 3 out of 5 patients (n = 208) did not receive adequate pain control, and one-third of patients experienced severe pain (n = 121). Patients who reported severe pain interference (n = 110) had three times greater odds to experience severe pain (OR 3.2, 95% CI 1.82-5.61, p < 0.001). Those patients who had regular follow up were 65% less likely to experience severe pain (OR 0.35, 95% CI 0.16 – 0.78, p = 0.01). Patients who used pain medications (n = 196) were 14 times more likely to experience adequate pain management (OR 14.19, 95% CI 6.53 – 30.83, p < 0.001). Patients who were referred to pain service (n = 25) were seven times more likely to report adequate pain control (OR 6.62, 95% CI 2.50 – 17.56, p < 0.001). Conversely, those patients who reported a severe rating on total pain interference were 75% less likely to experience adequate pain management (OR 0.25, 95% CI 0.17 – 0.35, p < 0.001). Conclusions: Unexpectedly, there was a high prevalence of pain among cancer patients at a representative cancer center in the Philippines. Pain exerts a heavy toll on patients, affecting daily functioning. The undertreatment of pain discovered in this study (59% of cancer patients) is alarming. Timely pain evaluation can help identify the presence of pain and the need for appropriate use of analgesics. The assessment and management of pain is a critical component of cancer care that should not be neglected.

Pain Management

2019 ◽  
pp. 116-131
Author(s):  
Judith A. Paice
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
End Of Life ◽  
Family Communication ◽  
Pain Control ◽  
Care Program ◽  
Palliative Care Program ◽  
Institutional Policies ◽  
Team Members ◽  
Serious Illness

Pain is one of the most common and most feared symptoms experienced by those with serious illness. The nurse’s role begins with assessment and continues through the development of a plan of care and its implementation. During this process, the nurse provides education and counseling to the patient, family, and other team members. Nurses also are critical for developing institutional policies and monitoring outcomes that ensure good pain management for all patients within their palliative care program. To provide optimal pain control, all healthcare professionals must understand the frequency of pain at the end of life, the barriers that prevent good management, the comprehensive assessment of this syndrome, and the treatments used to provide relief. Effective pain control and alleviation of suffering is highly dependent upon the strength of clinician, patient, and family communication and relationship. These are key strengths of nursing, at all phases of palliative care.

Cancer pain management in Mexico

2019 ◽  
pp. bmjspcare-2019-001871
Author(s):  
Sarah Barry Lincoln ◽  
Enrique Soto-Perez-de-Celis ◽  
Yanin Chavarri-Guerra ◽  
Alfredo Covarrubias-Gomez ◽  
Mariana Navarro ◽  
...  
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Cancer Pain ◽  
Latin American ◽  
Low Income ◽  
Pain Control ◽  
Current Status ◽  
Cancer Pain Management ◽  
Middle Income ◽  
Care Training

BackgroundPain control is an essential component of high-quality palliative care. Unfortunately, many low-income and middle-income countries lack an appropriate infrastructure to provide palliative care and suffer from a severe lack of access to opioid analgesics to alleviate pain from various conditions such as cancer.ObjectivesWe aimed to review the history and current status of cancer pain management in Mexico, a middle-income Latin American country. Our objective was to identify existing barriers to proper, effective opioid use, as well as provide practical recommendations for improvement.MethodsUsing a search of EBSCOhost database, PubMed and Google, we found official documents and peer-reviewed articles related to health legislation, opioid consumption, palliative care infrastructure and palliative care training in Mexico.ResultsDespite advances in palliative care and access to opioids in Mexico, there are still several barriers that undermine effective pain management, showing a major gap between policy and practice. Although Mexican legislation and guidelines include adequate palliative care and pain control as a right for all patients with cancer, the lack of adequate infrastructure and trained personnel severely hampers the implementation of these policies. Additionally, there are important barriers to prescribing opioids, many of which are related to attempts at reducing the consumption of recreational drugs.ConclusionsAlthough Mexico has made significant improvements in pain control and palliative care, much needs to be done. Expansion of drug availability, improvement of palliative care training, and constant oversight of regulations and guidelines will help to strengthen Mexico’s palliative care services.

Impact of palliative care clinic (PCC) referrals on pain control in genitourinary (GU) cancer patients: Retrospective analysis at Roswell Park Cancer Institute (RPCI).

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 57-57
Author(s):  
Neha Gupta ◽  
Shipra Gandhi ◽  
Sidra Anwar ◽  
Katy Wang ◽  
Yashodhara Satchidanand
Keyword(s):  
Palliative Care ◽  
Pain Score ◽  
Cancer Patients ◽  
Retrospective Review ◽  
Pain Control ◽  
Medical Oncology ◽  
Screening Tools ◽  
Chi Square ◽  
Care Clinic

57 Background: Many cancer patients (pts) with GU cancer suffer from uncontrolled pain, and may benefit from more focused palliative care. We assessed the frequency and impact of specialist PCC referrals on pain management of our GU Medical oncology clinic (GUMOC) pts. Methods: 239 consecutive pts were collected from a retrospective review of GUMOC records from 12/1/2013 to 2/28/2014. This group of pts was used to assess the frequency of PCC referral. Pts were divided into two arms- Arm A= GUMOC pts referred to PCC; Arm B: GUMOC pts not referred to PCC. To be able to detect a 15% between the two arms at 95% significance, 37 additional pts (who were already being seen at GUMOC) were collected from retrospective review of PCC records over 9/1/2013 to 2/28/2014. Total 276 pts were divided into Arm A (n=49), Arm B (n=227 pts). Data for baseline pain score and 4-week follow up pain scores were collected. A palliative care screening tool (retrieved from Center to Advance Palliative care [CAPC] website) was used to assign palliative care screening score (PCSS) to all study pts. Chi square test and T-test were used for statistical analysis. Results: Out of the 239 initially collected GUMOC pts, 5% were referred to PCC. 10% (n=24) had PCSS score of ≥ 4, and 33% pts with PCSS ≥ 4 were referred to PCC. Arm A had worse baseline symptoms, ECOG status and more advanced cancer stage. 4-week pain score follow up revealed significant improvement in Arm A -2.74 vs. Arm B -0.13 (p<0.01). Conclusions: GU cancer pts who are referred to PCC from medical oncology clinic have significant decrease in pain symptoms. Frequency of PCC consultation is still low in comprehensive cancer institutes, and not in congruence with the available palliative care screening tools criteria suggested by CAPC. Standardized tools should be developed to guide PCC referrals, and routine use of these tools will significantly help in pain control by seeking specialist palliative care.

Impact of parenteral opioid shortage on opioid prescriptions among patients seen by the palliative care team of a comprehensive cancer center.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 201-201
Author(s):  
Ali Haider ◽  
Yu Qian ◽  
Zhanni Lu ◽  
Syed Mussadiq Ali Akbar Naqvi ◽  
Amy Zhuang ◽  
...  
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Cancer Pain ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Cancer Type ◽  
Cancer Pain Management ◽  
Before And After ◽  
The Impact

201 Background: Recent parenteral opioid shortage (POS) has the potential to impact cancer pain management in hospitalized patients. This study aims to compare changes in the opioid prescriptions by the inpatient palliative care (PC) team before and after the institution first reported the POS. Methods: We reviewed and compared the electronic health records of 386 consecutive eligible consultations seen by the inpatient PC team equally in one month before and after the announcement of POS on February 8, 2018. The eligibility criteria include (1) cancer diagnosis, (2) ≥18 years of age, (3) taking opioid medication at the time of consultation, and (4) having at least two consecutive visits with the PC team. Patient demographics, cancer type, opioid type, route, and dose defined as the morphine equivalent daily dose were assessed. Results: POS was associated with less use of parenteral opioids (patient controlled analgesia, and intravenous breakthrough) and more use of non-parenteral opioids (extended release, transdermal, and oral breakthrough) by the referring oncology teams, and PC team (P≤.001) (Table 1). At first PC follow-up, significantly less proportion of patients achieved better pain control after POS [119/193 (62%) versus 144/193 (75%) (P=.006)] However, at second PC follow-up, the proportion of pain improvement was similar in both cohorts. Conclusions: There is a significant change in opioid routes associated with POS. POS was associated with worse analgesia. More research is needed to better understand the impact of POS on cancer pain management.[Table: see text]

An Ethical Analysis of the Barriers to Effective Pain Management

2000 ◽  
Vol 9 (1) ◽  
pp. 54-70 ◽  
Author(s):  
BEN A. RICH
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Pain Management ◽  
Clinical Education ◽  
Severe Pain ◽  
Medical Literature ◽  
Ethical Analysis ◽  
Icu Patients ◽  
Inadequate Care ◽  
Hospital Inpatients

Among the most significant findings of SUPPORT was that 50% of ICU patients suffered from moderate to severe pain during the last days of life. At the time of its publication late in 1995, SUPPORT was merely the latest in a long series of articles in the medical literature documenting the widespread and significant undertreatment of pain, beginning with a 1973 study of hospital inpatients. Much has been written about the phenomenon of undertreated pain and inadequate care of patients at the end of life, and many positive suggestions for reform of clinical education and clinical practice have been iterated and reiterated in the two decades separating the studies. Proposals for modifying clinician behaviors in this aspect of patient care have tended to focus on particular barriers to effective pain management and palliative care.

scholarly journals An Interactive Pain Application (MServ) Improves Postoperative Pain Management

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Richard Gordon-Williams ◽  
Andreia Trigo ◽  
Paul Bassett ◽  
Amanda Williams ◽  
Stephen Cone ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Nursing Staff ◽  
Pain Control ◽  
Standard Care ◽  
Severe Pain ◽  
Postoperative Pain Management ◽  
Pain Scale ◽  
Opioid Prescription ◽  
Patient Reported

Background. Most patients have moderate or severe pain after surgery. Opioids are the cornerstone of treating severe pain after surgery but cause problems when continued long after discharge. We investigated the efficacy of multifunction pain management software (MServ) in improving postoperative pain control and reducing opioid prescription at discharge. Methods. We recruited 234 patients to a prospective cohort study into sequential groups in a nonrandomised manner, one day after major thoracic or urological surgery. Group 1 received standard care (SC, n = 102), group 2 were given a multifunctional device that fed back to the nursing staff alone (DN, n = 66), and group 3 were given the same device that fed back to both the nursing staff and the acute pain team (DNPT, n = 66). Patient-reported pain scores at 24 and 48 hours and patient-reported time in severe pain, medications, and satisfaction were recorded on trial discharge. Findings. Odds of having poor pain control (>1 on 0–4 pain scale) were calculated between standard care (SC) and device groups (DN and DNPT). Patients with a device were significantly less likely to have poor pain control at 24 hours (OR 0.45, 95% CI 0.25, 0.81) and to report time in severe pain at 48 hours (OR 0.62, 95% CI 0.47–0.80). Patients with a device were three times less likely to be prescribed strong opioids on discharge (OR 0.35, 95% CI 0.13 to 0.95). Interpretation. Using an mHealth device designed for pain management, rather than standard care, reduced the incidence of poor pain control in the postoperative period and reduced opioid prescription on discharge from hospital.

scholarly journals Analysis of Severe Pain and its Treatment in a Palliative Care Unit in a Regional Cancer Centre

2017 ◽  
Vol 7 (3) ◽  
pp. 103
Author(s):  
Kannan P ◽  
Gunaseelan K ◽  
Parthasarathy V
Keyword(s):  
Palliative Care ◽  
Cancer Pain ◽  
Pain Score ◽  
Cancer Patients ◽  
Severe Pain ◽  
Palliative Care Unit ◽  
Cancer Centre ◽  
Prevalence Of Pain ◽  
Regional Cancer Centre

<p><strong>Objective</strong>: Pain is one of the most common symptoms that troubles cancer patients and precludes satisfactory quality of life. Globally, nearly 80% of the cancer patients receive little or no pain medication and cancer pain is barely controlled. This study was done to analyse the prevalence of pain and pain treatment in patients presenting to palliative care unit in a regional cancer centre.</p><p><br /><strong>Methods</strong>: Palliative care registry and follow-up forms of 2142 patients who got registered in our palliative care unit were analysed to obtain the demographic details, treatment characteristics and to determine the prevalence of pain, its severity, and treatment in cancer patients in our regional cancer centre.</p><p><br /><strong>Results</strong>: Nearly 50% of the cancer population had head and neck and gastrointestinal tract malignancies and received only best supportive care. Stage IV disease was found in 40% of patients, and skeletal metastasis (52%) was most common. This study showed a 92.4% prevalence of cancer pain in our centre. About 40% of patients with pain had a pain score of 7-10 by Numerical rating scale on initial presentation to the palliative care unit. About 65% of the patients with severe pain had a response to treatment withmorphine during their first follow-up to palliative care unit after initial registration. The average overall pain score of the patients per visit decreased from around 7 to 4 at a median follow-up of ten months.</p><p><br /><strong>Significance of results</strong>: Thus, there is a high prevalence of pain in cancer patients and patients with severe pain receive little or no opioid medication at all probably due to the lack of adequate education and training to the primary oncologists and residents regarding prescription of strong opioids. This audit may help in the modification of existing and formulation of new policies in the delivery of palliative care.</p>

The adequacy of pain treatment in advance stage non-small cell lung cancer: A longitudinal study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 17016-17016
Author(s):  
T. Mendoza ◽  
X. Wang ◽  
G. Mobley ◽  
G. Palos ◽  
C. Cleeland
Keyword(s):  
Lung Cancer ◽  
Longitudinal Study ◽  
Pain Management ◽  
Severe Pain ◽  
Small Cell ◽  
Cancer Center ◽  
Small Cell Lung ◽  
Strong Opioids ◽  
Tertiary Cancer Center ◽  
Over Time

17016 Background: Pain is a prevalent symptom in advance stage non-small- cell lung cancer (NSCLC). Previous studies have shown these patients to be at risk for inadequate pain management. This longitudinal study evaluated pain and analgesic management in this patient population. Patients were treated at a major tertiary cancer center. Methods: Data from 102 patients receiving chemotherapy were used. Their pain was assessed weekly using the pain item from the M.D. Anderson Symptom Inventory, administered through an interactive voice response system. Analgesic orders were collected three times every two cycles of chemotherapy across 18 weeks (T1, T2 and T3). Adequacy of pain management was evaluated by the Pain Management Index (PMI). Chi-square tests were used to test for differences in proportions. Results: This analysis was based on all available data, as sensitivity analyses of pain trajectory by dropout as a function of time did not show differences. At baseline, 60% of 102 patients reported pain (ratings of 1 or greater on a 0- 10 scale) with the following distributions: 39% mild, 14% moderate and 7% severe. The proportions of patients with moderate to severe pain were 21%, 15%, 17% and 20% at baseline, T1, T2 and T3, respectively. The proportion of patients with moderate to severe pain did not increase over time. According to the PMI, there were 21%, 18%, 15% and 21% of patients who were inadequately treated at baseline, T1, T2 and T3, respectively. The percentages of patient receiving orders for strong opioids were 19%, 25%, 26% and 41% at baseline, T1, T2 and T3, respectively. Conclusions: About 80% of patients seen in a major tertiary cancer center were adequately treated for pain, while about 20% of patients experienced moderate to severe pain. Both these percentages were seen over time and did not significantly change during the course of their cancer treatment. These may be accounted for by a significant increase in the prescription orders for strong opioids by twice as much during the latter stage of their treatment. No significant financial relationships to disclose.

Implications of uninterrupted preoperative transdermal buprenorphine use on postoperative pain management

2019 ◽  
Vol 44 (3) ◽  
pp. 342-347 ◽  
Author(s):  
Yvette N Martin ◽  
Amy C S Pearson ◽  
John R Tranchida ◽  
Toby N Weingarten ◽  
Phillip J Schulte ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Pain Score ◽  
Recovery Room ◽  
Severe Pain ◽  
Receptor Agonist ◽  
Postoperative Pain Management ◽  
Opioid Use ◽  
Intravenous Morphine ◽  
Matched Study

Background and objectivesBuprenorphine is a partial µ-receptor agonist resistant to displacement from receptors by conventional opioids, which can block the effect of conventional opioids and may interfere with postoperative pain management. We aimed to quantify perioperative opioid use in patients receiving transdermal buprenorphine (TdBUP).MethodsWe identified patients receiving TdBUP who underwent surgery between 2004 and 2016. To compare opioid requirements (intravenous morphine equivalents (IV-MEq)), we constructed a matched study, matching each TdBUP patient with two opioid-naive patients by sex, age, and type of anesthesia and procedure.ResultsNineteen unique patients underwent 22 procedures while receiving TdBUP. Total (IQR) amounts of IV-MEq (intraoperative, recovery room, and 24 hours after recovery-room discharge) were 98 (63, 145) and 46 (30, 65) mg IV-MEq for TdBUP and opioid-naive patients, respectively (p<0.001). Postoperative IV-MEq requirements were 54 (38, 90) and 15 (3, 35) mg for TdBUP and opioid-naive patients, respectively (p<0.001). Among TdBUP patients, higher preoperative doses of TdBUP were associated with greater postoperative opioid requirements (p=0.02). Specifically, patients with a 20 µg/hour TdBUP patch required 133.8 mg IV-MEq more postoperatively than patients with a 5 µg/hour patch (p=0.002). Following discharge from the recovery room, 17 (77%) TdBUP patients and 15 (34%) opioid-naive patients reported severe pain (OR 6.6 (95% CI 2.0 to 21.3); p<0.001; adjusting for baseline pain score, 5.0 (95% CI, 1.4 to 17.8); p=0.01).ConclusionsAnalgesic management for patients receiving TdBUP therapy must account for increased opioid needs, and greater preoperative doses of TdBUP were associated with greater postoperative opioid requirements.

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