HSR19-098: Opportunities and Challenges of Managing Breakthrough Cancer Pain (BTCP): An Educational Exercise

2019 ◽  
Vol 17 (3.5) ◽  
pp. HSR19-098
Author(s):  
Dean J. Mariano
Keyword(s):  
Cancer Pain ◽  
Cancer Patients ◽  
Nurse Practitioners ◽  
Negative Impact ◽  
Physician Assistants ◽  
Positive Outcome ◽  
Oncology Nurses ◽  
Breakthrough Cancer Pain ◽  
Post Test

Background: Cancer pain is one of the most feared symptoms of cancer and is usually moderate to severe in intensity, particularly in later stages. Opioids are the mainstay maintenance treatment of chronic cancer-related pain. However, between one third and two thirds of cancer patients treated with opioids still experience episodes of severe and debilitating pain known as breakthrough cancer pain (BTCP). Given the number of available treatment approaches for BTCP, healthcare professionals (HCPs) need guidance in selecting the treatment that best meets their patient’s needs and provide the best opportunity for a positive outcome. Aim: Describe the pathophysiology and characteristics of BTCP, its prevalence, and the negative impact on patients. Discuss the characteristics of ideal BTCP treatments and available options. Evaluate the concepts of dependence, addiction, and diversion; ways to minimize risk in cancer patients using opioids; and strategies to address issues. Apply shared decision-making resources to improve collaboration with clinician and patient for optimal BTCP management outcomes by providing best standard of care. Methods: 12 live expert faculty meetings held in oncology/hematology departments in community hospitals, regional cancer centers, and academic centers nationwide from November 17, 2017–June 01, 2018 (Table 1). Target audience of hematologists/oncologists, oncology nurses, physician assistants (PAs), nurse practitioners (NPs), palliative care physicians, pain management specialists, pharmacists, and other HCPs involved in the treatment of patients with BTCP. Results: Overall participation: 321 (anticipated 265; 186 CME completers); 193 oncology MDs; 61 oncology nurses/NP; 17 pharmacists; 22 PAs; 28 other HCPs interested in BTCP. Pre/post-test and 90-day follow-up surveys assessed. 0% commercial bias. Satisfaction of program rated 97%–100%; 96% intend to apply what they acquired to their practice; 97% have a strategy to combat BTCP; 99% are better able to describe BTCP and its negative impact on patients; 98% can better evaluate dependence, addiction, and diversion and to minimize risk of using opioids. +35% average pre- to post-test change with 4 of 5 questions achieving a P≤.0001 at 90-day follow-up. 72% of participants implemented practice changes by 90-day follow-up. Conclusion: Results suggest that participation in this activity is associated with increased competence and positive practice changes for BTCP.

scholarly journals AN EFFECT OF A DIRECT METHOD ON 5TH GRADE STUDENTS’ ACQUISITION OF VERB INFLECTION MORPHEMES (- S, - ES, - ED, - ING)

2018 ◽  
Vol 6 (6) ◽  
pp. 310-321
Author(s):  
Tossapol Pongpuen ◽  
Lugsamee Nuamthanom Kimura ◽  
Wachiraporn Kijpoonphol ◽  
Jarunee Anupan
Keyword(s):  
Language Proficiency ◽  
Teaching Method ◽  
Direct Method ◽  
Positive Outcome ◽  
Post Test ◽  
Inflectional Morphemes ◽  
5Th Grade ◽  
Listening And Speaking ◽  
A Direct Method

The purpose of this study was to investigate whether or not a direct method could help 5th graders acquire the target verb inflectional morphemes (- s, - es , - ed , - ing) at Assumption College Ubon Ratchathani (ACU), Ubon Ratchathani, Thailand. The participants were 6 5th grade students who were divided into two groups based on their English proficiency: low language proficiency and high language proficiency. Data were collected from different sources: the scores of the pre – test and post – test, the participants’ usage of verb inflectional morphemes (-s, -es, -ed, and – ing) as shown in the Video (VDO) transcript, and the follow-up interview, which was mainly concerned with the students on the direct method. Results obtained from the present study showed that this teaching method yielded a positive outcome related to the participants’ acquisition of verb inflectional morphemes. They also proved useful for developing the participants’ proficiency in other language skills, such as listening and speaking.

The impact of live education on the competence and performance of oncology practitioners who care for patients with ovarian cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e23010-e23010
Author(s):  
Vanessa Carranza ◽  
Bryan Carson Taylor ◽  
Susan H. Gitzinger ◽  
Joan B. Fowler ◽  
Jessica Hall
Keyword(s):  
Ovarian Cancer ◽  
Genetic Testing ◽  
Cancer Patients ◽  
Parp Inhibitor ◽  
Inhibitor Therapy ◽  
Community Based ◽  
Educational Initiatives ◽  
Post Test ◽  
Chi Square Analysis

e23010 Background: About a third of ovarian cancer patients in the US have limited access to a gynecologic oncologist (GO) due to geographic disparities. A survey by The Society of Gynecologic Oncology (SGO) found that the majority of GOs found it was vital to coordinate local access to care, from diagnosis to survivorship, for patients living in areas of disparity. This allows rural/underserved patients broader access to novel therapies, as they increasingly become standard of care. It is critical for not only GOs to be current on the latest ovarian cancer data, but all clinicians who care for these patients. Methods: CEC Oncology developed two educational initiatives focused on PARP inhibitor therapy in ovarian cancer, which was targeted to all US healthcare professionals caring for ovarian cancer patients. Evaluations were collected from attendees attending an SGO Symposium and Ground Round (GR) series to assess impact on practice, increased competency, and intent to make a change in practice. Learning, knowledge, and competence was objectively assessed by analyzing pre-test, post-test, and follow-up survey data (sent 4-6 weeks post-activity). Chi-square analysis was conducted with a priori significance set at 0.05. Results: A total of 830 clinicians were educated, with SGO attendees primarily practicing in academic settings and GR attendees mostly from community practices. SGO attendees were asked case questions at baseline, immediately after the activity, and 4-6 weeks after the activity. Knowledge increased from pre- to post-test regarding current genetic testing recommendations (23% increase; P= .004) and appropriate selection of PARP inhibitor therapy (25% increase; P= .017). Knowledge was sustained at follow-up analysis. At follow-up, 90% of SGO and 84% of GR attendees made a change as a result of attending the activities. More attendees were able to incorporate germline multigene testing into practice, than originally intended; increase of 29% for SGO and 7% for GR audiences. All attendees experienced the barrier lack of patient education about the importance of genetic testing/counseling more than anticipated; increase of 7% for SGO and 13% for GR audiences. At follow-up, there was a 9% increase in GR attendees listing staying current with trial data and practice guidelines as a barrier. Conclusions: There were some notable differences seen in competence/performance among attendees of the two ovarian cancer educational initiatives. Differences may be attributed to practice setting (SGO primarily academic; GR primarily community.) Overall, GR attendees were more likely to face barriers, suggesting that community-based clinicians have fewer resources and experience more barriers to implementing best practices. Thus, it is vital to offer education for clinicians in community-based practices, particularly in areas that are considered ‘geographically disparate’.

scholarly journals Follow-up of ischemic cardiopathy, an essential moment in the communication between in-patient and out-patient setting: problems and opportunities

2008 ◽  
Vol 2 (4) ◽  
pp. 169-179
Author(s):  
Italo Paolini
Keyword(s):  
Cardiovascular Disease ◽  
Patient Education ◽  
Nurse Practitioners ◽  
Critical Time ◽  
Physician Assistants ◽  
Outpatient Setting ◽  
Pharmacological Therapy ◽  
Appropriate Treatment ◽  
Errors In Treatment

It is known that the transition from the inpatient to the outpatient setting is a critical time. Evidence suggests that contact between patients and providers (i.e., physicians, nurse practitioners, and physician assistants) during this interval may be crucial for appropriate treatment modifications and recognition of errors in treatment. Ambulatory follow-up provides opportunities for clinical assessment, patient education, and medication review, which may in turn improve outcomes. However, little is known about the appropriate timing and type of follow-up that is necessary following hospitalization for AMI. In Italian System of Heath contact between general pratictioner and specialists, after dicharge, is critical moment for management of chronic pharmacological and non pharmacological therapy. If professional approaches are not integrated can reduce patients compliance and effectiveness of therapies themselves. Good management of chronic cardiovascular disease requires attention to stenghtening the continuity of information and management of patients.

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>

scholarly journals Careful Breakthrough Cancer Pain Treatment through Rapid-Onset Transmucosal Fentanyl Improves the Quality of Life in Cancer Patients: Results from the BEST Multicenter Study

2020 ◽  
Vol 9 (4) ◽  
pp. 1003
Author(s):  
Arturo Cuomo ◽  
Marco Cascella ◽  
Cira Antonietta Forte ◽  
Sabrina Bimonte ◽  
Gennaro Esposito ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Rating Scale ◽  
Assessment System ◽  
P Value ◽  
Breakthrough Cancer Pain ◽  
Pain Clinics ◽  
Eortc Qlq

Objectives: To explore the effect of breakthrough cancer pain (BTcP) treatment on quality of sleep and other aspects of the health-related quality of life (HRQoL) in patients with cancer pain. Methods: In an observational, multicenter, cohort study, cancer patients from palliative care units, oncology departments, and pain clinics and affected by BTcP were included. Enrolled patients were assessed at the four visits: T0 (baseline), T7, T14, and T28. Stable chronic background pain (numeric rating scale, NRS ≤ 4) during the whole study period was mandatory. BTcP was treated through transmucosal fentanyl. Three questionnaires were used to measure the HRQoL: EORTC QLQ-C15-PAL, Pittsburgh Sleep Quality Index (PSQI), and the Edmonton Symptom Assessment System (ESAS). RESULTS: In 154 patients, the HRQoL showed a significant improvement for all physical and emotional characteristics in the EORTC QLQ-C15-PAL, except for nausea and vomiting (linear p-value = 0.1) and dyspnea (Linear p-value = 0.05). The ESAS and PSQI questionnaires confirmed these positive results (p < 0.0001 and p = 0.002, respectively). Conclusions: This prospective investigation by an Italian expert group, has confirmed that careful management of BTcP induces a paramount improvement on the HRQoL. Because in cancer patients there is a high prevalence of BTcP and this severe acute pain has deleterious consequences, this information can have an important clinical significance.

scholarly journals Psikoedukasi “Bidan Cerdas” untuk Menurunkan Stigma terhadap Orang dengan HIV/AIDS (ODHA)

2019 ◽  
Vol 3 (2) ◽  
pp. 93
Author(s):  
Adhesatya Ningsih Moodoeto ◽  
Esti Hayu Purnamaningsih
Keyword(s):  
Health Workers ◽  
Negative Impact ◽  
People Living With Hiv ◽  
Mixed Design ◽  
Post Test ◽  
Living With Hiv ◽  
Experimental Group ◽  
Hiv Aids

Lack of knowledge about HIV /AIDS makes people including health workers stigmatize people living with HIV (PLWHA). It has a negative impact on PLWHA because of the constraints of quality of service, lowering of health, reluctance of VCT, and non-compliance of ARVs. The aim of this research to reduce the stigma of midwives against PLWHA through psychoeducation program of "Bidan Cerdas". Subject of this research is midwife. This research uses the experiment design of Non Random Untreated Kontrol Group Design with Dependent Pretest and Posttest Samples. Stigma to PLWHA measurement uses stigma scale developed by Genberg, et., al (2009). The research hypothesis was tested with Mixed Design ANOVA. The results of the analysis in the experimental group showed p<0.05 in Pre Test to Post Test, and p<0.05 on Post Test data to Follow Up. It concluded that psychoeducation program of "Bidan Cerdas" can reduce stigma against PLWHA.

scholarly journals Nurse practitioners and physician assistants working in ambulance care: A systematic review

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1182
Author(s):  
Risco van Vliet ◽  
Remco Ebben ◽  
Nicolette Diets ◽  
Thomas Pelgrim ◽  
Jorik Loef ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Resource Use ◽  
Selection Process ◽  
Physician Assistants ◽  
Referral And Consultation ◽  
Cochrane Library ◽  
Process Of Care

Background: This review aims to describe the activities of nurse practitioners (NPs) and physician assistants (PAs) working in ambulance care, and the effect of these activities on patient outcomes, process of care, provider outcomes, and costs. Methods: PubMed, MEDLINE (EBSCO), EMBASE (OVID), Web of Science, the Cochrane Library (Cochrane Database of Systematic Review), CINAHL Plus, and the reference lists of the included articles were systematically searched in November 2019. All types of peer-reviewed designs on the three topics were included. Pairs of independent reviewers performed the selection process, the quality assessment, and the data extraction. Results: Four studies of moderate to poor quality were included. Activities in medical, communication and collaboration skills were found. The effects of these activities were found in process of care and resource use outcomes, focusing on non-conveyance rates, referral and consultation, on-scene time, or follow-up contact Conclusions: This review shows that there is limited evidence on activities of NPs and PAs in ambulance care. Results show that NPs and PAs in ambulance care perform activities that can be categorized into the Canadian Medical Education Directives for Specialists (CanMED) roles of Medical Expert, Communicator, and Collaborator. The effects of NPs and PAs are minimally reported in relation to process of care and resource use, focusing on non-conveyance rates, referral and consultation, on-scene time, or follow-up contact. No evidence on patient outcomes of the substitution of NPs and PAs in ambulance care exists. PROSPERO registration: CRD42017067505 (07/07/2017)

Psychopharmacology in Cancer Care

2020 ◽  
Author(s):  
Andrew Roth ◽  
Chris Nelson
Keyword(s):  
Cancer Patients ◽  
Nurse Practitioners ◽  
Cancer Care ◽  
Physical Therapists ◽  
Psychosocial Interventions ◽  
Physician Assistants ◽  
Cognitive Changes ◽  
Medical Practitioners ◽  
Physical Support ◽  
Psychiatric Syndrome

Clinicians who care for adult cancer patients have many tools to manage symptoms of depression, anxiety, cognitive changes, insomnia, and fatigue. Non-prescribing clinicians, such as psychologists, nurses, social workers, and occupational and physical therapists, provide frontline psychosocial interventions and physical support for cancer patients. Psychotropic treatments are sometimes required to resolve complex syndromes that mingle both medical and psychiatric features. Psychiatric medications are most frequently prescribed to cancer patients by oncologists, general medical practitioners, general psychiatrists, and psychiatric advanced practice providers such as nurse practitioners and physician assistants, as few oncology practices have dedicated psycho-oncologists. Non-prescribing practitioners who care for people with cancer are often the first to identify a psychiatric syndrome that requires a referral for psychopharmacologic intervention. They can also play an important role in educating patients about how psychopharmacologic agents can augment their cancer care. After psychotropic medications are started, non-prescribers can observe for improvement and detect problematic side effects if they arise, thus improving adherence with medication regimens. Practitioners who read this book will benefit from the highlighted clinical pearls to follow, and the potholes to avoid, regarding the tricky diagnostics and pharmacologic treatment of psychiatric syndromes. All clinicians will learn communication strategies that bridge distances of professional specialty and geography so that treatment by multiple providers may be more seamless, which it is hoped will enrich outcomes, both medical and emotional.

Sign in / Sign up

Export Citation Format

Share Document