DETERMINING THE EFFECTIVENESS OF A CLINICAL-PRACTICE INTERVENTION IN IMPROVING THE CONTROL OF PAIN IN OUTPATIENTS WITH CANCER

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.