scholarly journals Usability, Acceptability, and Usefulness of an mHealth App for Diagnosing and Monitoring Patients With Breakthrough Cancer Pain (Preprint)

2018 ◽  
Author(s):  
Jaime Boceta ◽  
Daniel Samper ◽  
Alejandro de la Torre ◽  
Rainel Sánchez-de la Rosa ◽  
Gloria González
Keyword(s):  
Cancer Pain ◽  
Breakthrough Pain ◽  
Eastern Cooperative Oncology Group ◽  
Mobile App ◽  
Public Hospitals ◽  
Additional Patient ◽  
Educational Content ◽  
Breakthrough Cancer Pain ◽  
Patients With Cancer ◽  
Clinical Records

BACKGROUND Breakthrough pain is a major problem and a source of distress in patients with cancer. We hypothesized that health care professionals may benefit from a real-time mobile app to assist in the diagnosis and monitoring of breakthrough cancer pain (BTcP). OBJECTIVE This study aimed to test the usability, acceptability, and usefulness in real-world practice of the mobile App INES·DIO developed for the management of patients with BTcP. METHODS This study consisted of a survey of a multidisciplinary sample of 175 physicians who evaluated the mobile app after testing it with 4 patients with BTcP each (for a total of 700 patients). The digital profile of the physicians, use of the different resources contained in the app, usefulness of the resources, acceptability, usability, potential improvements, intention to use, and additional resources to add were recorded. RESULTS Of the 175 physicians, 96% (168/175) were working in public hospitals. They had an average of 12 (SD 7) years of experience in BTcP and almost all (174/175, 99.43%) had an active digital profile. The Eastern Cooperative Oncology Group and Karnofsky performance scales, the Visual Analogue Scale, and the Davies algorithm to diagnose BTcP were the most frequently used tools with patients and were assessed as very useful by more than 80% (140/175) of physicians. The majority (157/175, 90%) answered that App INES·DIO was well designed and 94% (165/175) would probably or very probably recommend it to other colleagues. More than two-thirds indicated that the report provided by the app was worth being included in patients’ clinical records. The most valued resource in the app was the recording of the number, duration, and intensity of pain flares each day and baseline pain control to enhance diagnosis of BTcP. Additional patient-oriented cancer pain educational content was suggested for inclusion in future versions of App INES·DIO. CONCLUSIONS Our study showed that App INES·DIO is easy to use and useful for physicians to help diagnose and monitor breakthrough pain in patients with cancer. Participants suggested the implementation of additional educational content about breakthrough pain. They agreed on the importance of adding new clinical guidelines/protocols for the management of BTcP, improving their communication skills with patients, and introducing an evidence-based video platform that gathers new educational material on BTcP.

Shared decision-making preferences and pain characterization in patients with cancer.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 30-30 ◽  
Author(s):  
Jeannine M. Brant ◽  
Carrie Tompkins Stricker ◽  
Alison Petok ◽  
Regina Sih-Meynier ◽  
Debra Wujcik
Keyword(s):  
Decision Making ◽  
Cancer Pain ◽  
Shared Decision Making ◽  
Breakthrough Pain ◽  
Activity Level ◽  
Shared Decision ◽  
Patients With Cancer ◽  
Care Plans ◽  
Pain Outcomes ◽  
Pain Care

30 Background: Cancer pain prevalence is high (52%-77%) with breakthrough pain flares and end-of-dose failure adding to patient suffering and increased health care utilization. Shared decision-making (SDM), incorporating patient-stated preferences, goals, and concerns, can foster comprehensive pain assessment (CPA) and improve pain outcomes. Methods: This study will evaluate SDM and CPA in patients with cancer to manage chronic and breakthrough pain. Eligible patients have pain or are taking opioids to manage chronic cancer pain. Patients complete a tablet-based survey at enrollment to record baseline pain and activity levels, pain flare severity and length, end-of-dose pain, and SDM preferences. Results are presented on an electronic dashboard and the provider and patient collaboratively establish a pain care plan. The effectiveness of SDM on pain outcomes will be measured with the Pain Care Quality Survey. Results: Pain characterization is described for the first 43 patients enrolled, of which 42% (n=18) desire to share decision-making with the provider, while 35% (n=15) prefer to make the final decision after considering provider input. Patients are 57% (n=26) female with a mean age of 56 (range 20-93); baseline mean pain scores were 5.4, and overall distress scores were 5.43, (scale 0-10); 91% had a pain flare in the last seven days with mean severity of 5.53; 72% of flares lasted longer than 30 minutes. All patients had end-of-dose pain. Less than half (42%) have restricted activity and 23% manage self-care but cannot work. Participants reported incident pain associated with certain activity (63%) as well as insidious pain not associated with activity (65%). Enrolled patients selected 143 pain descriptors: burning (16), achy (24), sharp and stabbing (21), pins and needles (15), cramping (14) radiating (14), intermittent (19), and continuous (20). Conclusions: The majority (77%) of patients desire SDM. Although most patients were already taking opioids at presentation, they had moderate pain and distress, frequent flares and end of dose pain, and limitations on activity level due to the pain. Baseline pain characterization with a drill down CPA offers opportunity to use SDM to develop effective pain care plans and measure outcomes. Clinical trial information: NCT03304145.

Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey

2004 ◽  
Vol 18 (3) ◽  
pp. 177-183 ◽  
Author(s):  
Augusto Caraceni ◽  
Cinzia Martini ◽  
Ernesto Zecca ◽  
Russell K Portenoy ◽  
Keyword(s):  
Cancer Pain ◽  
Breakthrough Pain ◽  
International Survey ◽  
Patients With Cancer ◽  
Pain Characteristics

Breakthrough cancer pain (BTcP) management: a review of international and national guidelines

2018 ◽  
Vol 8 (3) ◽  
pp. 241-249 ◽  
Author(s):  
Andrew Neil Davies ◽  
Frank Elsner ◽  
Marilène Jeanne Filbet ◽  
Josep Porta-Sales ◽  
Carla Ripamonti ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Rescue Medication ◽  
Low Grade ◽  
National Guidelines ◽  
International Consensus ◽  
Breakthrough Cancer Pain ◽  
Patients With Cancer ◽  
Personal Opinion ◽  
Diagnosis Criteria ◽  
Current Guidelines

ObjectiveBreakthrough cancer pain (BTcP) is common and has a significant impact on the quality of life of patients with cancer. This review compares current national/international BTcP guidelines in order to identify disparities and priorities for further research.MethodsRelevant guidelines were identified using searches of PubMed, the National Guideline Clearinghouse, the internet (commercial search engines), and correspondence with key opinion leaders and relevant pharmaceutical companies. Identified guidelines were compared, using the Association for Palliative Medicine of Great Britain and Ireland recommendations as the ‘reference’ guideline.ResultsTen specific BTcP guidelines were identified/reviewed, as well as major international generic cancer pain guidelines. In general, there was good agreement between the specific BTcP guidelines, although there remain some differences in terms of definition, diagnostic criteria and treatment of BTcP. Disparities between the different BTcP guidelines invariably reflect personal opinion rather than research evidence. Generic cancer pain guidelines continue to support the use of oral opioids as rescue medication, while specific BTcP guidelines invariably endorse the use of transmucosal opioids as rescue medication.ConclusionCurrent guidelines agree on many aspects of the management of BTcP. However, the evidence to support current guidelines remains low grade, and so more research is needed in this area of care. Moreover, there needs to be an international consensus on the definition and diagnosis criteria of BTcP.

Breakthrough pain in community-dwelling patients with cancer pain and noncancer pain, Part 2: Impact on function, mood, and quality of life

2010 ◽  
Vol 6 (2) ◽  
pp. 109-116 ◽  
Author(s):  
Russell K. Portenoy, MD ◽  
Daniel Bruns, PsyD ◽  
Bonnie Shoemaker, BSN ◽  
Steven A. Shoemaker, MD
Keyword(s):  
Quality Of Life ◽  
Cancer Pain ◽  
Breakthrough Pain ◽  
Community Dwelling ◽  
Patients With Cancer ◽  
Noncancer Pain

scholarly journals Breakthrough Cancer Pain Clinical Features and Differential Opioids Response: A Machine Learning Approach in Patients With Cancer From the IOPS-MS Study

2020 ◽  
pp. 1339-1349
Author(s):  
Francesco Pantano ◽  
Paolo Manca ◽  
Grazia Armento ◽  
Tea Zeppola ◽  
Angelo Onorato ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Clinical Features ◽  
Learning Algorithm ◽  
Large Data ◽  
Optimal Dose ◽  
Rapid Onset ◽  
Opioid Use ◽  
Data Set ◽  
Breakthrough Cancer Pain ◽  
Patients With Cancer

PURPOSE A large proportion of patients with cancer suffer from breakthrough cancer pain (BTcP). Several unmet clinical needs concerning BTcP treatment, such as optimal opioid dosages, are being investigated. In this analysis the hypothesis, we explore with an unsupervised learning algorithm whether distinct subtypes of BTcP exist and whether they can provide new insights into clinical practice. METHODS Partitioning around a k-medoids algorithm on a large data set of patients with BTcP, previously collected by the Italian Oncologic Pain Survey group, was used to identify possible subgroups of BTcP. Resulting clusters were analyzed in terms of BTcP therapy satisfaction, clinical features, and use of basal pain and rapid-onset opioids. Opioid dosages were converted to a unique scale and the BTcP opioids-to-basal pain opioids ratio was calculated for each patient. We used polynomial logistic regression to catch nonlinear relationships between therapy satisfaction and opioid use. RESULTS Our algorithm identified 12 distinct BTcP clusters. Optimal BTcP opioids-to-basal pain opioids ratios differed across the clusters, ranging from 15% to 50%. The majority of clusters were linked to a peculiar association of certain drugs with therapy satisfaction or dissatisfaction. A free online tool was created for new patients’ cluster computation to validate these clusters in future studies and provide handy indications for personalized BTcP therapy. CONCLUSION This work proposes a classification for BTcP and identifies subgroups of patients with unique efficacy of different pain medications. This work supports the theory that the optimal dose of BTcP opioids depends on the dose of basal opioids and identifies novel values that are possibly useful for future trials. These results will allow us to target BTcP therapy on the basis of patient characteristics and to define a precision medicine strategy also for supportive care.

Improved patient functioning after treatment of breakthrough cancer pain: an open-label study of fentanyl buccal tablet in patients with cancer pain

2015 ◽  
Vol 23 (7) ◽  
pp. 2135-2143 ◽  
Author(s):  
Andrew Davies ◽  
Ulrich R. Kleeberg ◽  
Jerzy Jarosz ◽  
Sebastiano Mercadante ◽  
Philippe Poulain ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Open Label ◽  
Open Label Study ◽  
Label Study ◽  
Patient Functioning ◽  
Breakthrough Cancer Pain ◽  
Patients With Cancer ◽  
Fentanyl Buccal Tablet ◽  
Buccal Tablet

The reasons and timing of the oral transmucosal fentanyl administration in Japan.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21665-e21665
Author(s):  
Shinya Kajiura ◽  
Tatsuhiko Kashii ◽  
Akiyoshi Takaki ◽  
Shingo Chikaoka ◽  
Naomi Hayashi ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Breakthrough Pain ◽  
Rapid Onset ◽  
University Hospital ◽  
Aggressive Treatment ◽  
Fentanyl Patch ◽  
Oral Medicine ◽  
Breakthrough Cancer Pain ◽  
Chemotherapy Administration ◽  
Ecog Ps

e21665 Background: The oral transmucosal fentanyl disintegrating tablet, Abstral, is a formulation by which fentanyl can be rapidly absorbed across the oral mucosa producing rapid onset analgesia, and which may be effective for breakthrough cancer pain. It can be administered for the patients who cannot take the oral medicine. It has been marketed since 2014 in Japan. Methods: We selected patients who were administered Abstral for breakthrough cancer pain between 2014 and 2016 at Toyama University Hospital in Japan. We retrospectively investigated administration reasons based on medical record of those patients. Results: There were 111 patients who were administered Abstral. Primary lesions of lung/Gastrointestin/others were 43/52/16, respectively. ECOG PS 0-2/3-4 were 27/84, respectively. The median age was 66 y.o. (range 35-91 y.o.). Regularly using opioid were fentanyl patch prescribed for all patients. Median dose of fentanyl patch was 25mcg/hr (range 12.5-250mcg/hr). 90 patients (81%) had difficulties in the administration of oral medicine, which was the main reason of Abstral administration. Four patients (4%) were to reduce constipation and vomiting as side effects of oxycodone. Seven patients (6%) were to start a fentanyl patch. Three patients (3%) were assessed poor effect for short-acting opioid. Only seven patients (6%) were expected of rapid onset of analgesia effect. Abstral was administered in 27 patients (24%) during aggressive treatment such as chemotherapy administration and in 84 patients (76%) after aggressive treatment. Conclusions: The oral transmucosal fentanyl was administered for the patients who cannot take the oral medicine in Japan while it is expected to be administered to those who want to relieve breakthrough pain fast. Affirming a common understanding of the efficacy of the oral transmucosal fentanyl and breakthrough cancer pain is necessary in Japan.

Breakthrough pain: characteristics and impact in patients with cancer pain

Pain ◽  
1999 ◽  
Vol 81 (1) ◽  
pp. 129-134 ◽  
Author(s):  
Russell K. Portenoy ◽  
David Payne ◽  
Paul Jacobsen
Keyword(s):  
Cancer Pain ◽  
Breakthrough Pain ◽  
Patients With Cancer ◽  
Pain Characteristics
Sign in / Sign up

Export Citation Format

Share Document