R. Trowbridge et al., DETERMINING THE EFFECTIVENESS OF A CLINICAL-PRACTICE INTERVENTION IN IMPROVING THE CONTROL OF PAIN IN OUTPATIENTS WITH CANCER, Academic medicine, 72(9), 1997, pp. 798-800
Citations number
10
Categorie Soggetti
Medicine, General & Internal","Education, Scientific Disciplines","Medical Informatics
Purpose. To determine the effectiveness of a clinical-practice interve
ntion in improving the control of pain in outpatients with cancer. Met
hod. Between July 5 and September 30, 1995, a randomized, controlled t
rial of 510 cancer outpatients and 13 oncologists was conducted at 23
clinics in Indiana. All the patients completed assessments of their pa
in, their pain regimens, and the degrees of relief received; they were
surveyed again by mail four weeks after their clinic visits. The inte
rvention group's clinical charts contained a summary of the completed
pain scales; the oncologists who treated these patients were instructe
d to review the summary sheet prior to an evaluation. This summary was
not available for the oncologists treating the patients in the contro
l group. Each patient's pain management index (PMI) was calculated: th
e patient's pain medication level was rated on a scale of 0 to 3; the
patients's pain level was rated on a scale of 0 to 3 and then subtract
ed from the first rating. A negative PMI was interpreted as representi
ng insufficient treatment. Data were analyzed with several statistical
tests. Results. In all, only 320 patients who reported cancer-related
pain were used in the analysis: 160 to 260 in the control group and 1
60 of 250 in the intervention group. The groups were similar with resp
ect to demographics, cancer sites, and performance status. A significa
nt difference (p = .0162) in the physicians' prescription patterns was
found. In the control group, prescriptions for 86% of the patients di
d not change, with no decrease in analgesic prescriptions; for 14% of
the patients analgesic prescriptions increased. In the intervention gr
oup, analgesic prescriptions changed for 25% of the patients, decreasi
ng for 5% and increasing for 20%. A decrease in the incidence of pain
described as more than life's usual aches and pains was found for the
intervention group (p = .05). No significant difference was found betw
een the groups for the patients undertreated for pain, as measured by
PMIs. Conclusion. Although analgesic regimens were altered significant
ly when the physicians understood more about the patient's pain, cance
r pain management remains a complex problem. Future studies should foc
us on the long-term systematic incorporation of simple gain-assessment
tools into daily outpatient oncology practices as well as on innovati
ve ways to address other aspects of managing cancer pain.