Feasibility of quantitative pain assessment in outpatient oncology practice

Purpose: Although physicians view failure to assess pain systematically as the most important barrier to outpatient cancer pain management, little is known about pain assessment in this setting. We sought to determine whether pain is routinely assessed and whether routine quantitative pain assessmen t is feasible in a busy outpatient oncology practice, Patients and Methods: We conducted a pre- and postintervention chart review of 520 randomly selected medical and radiation oncology patient visits at a community hospital-based private outpatient practice. The intervention co nsisted of training health assistants (HAs) to measure and document patient pain scores by using a visual analog scale. The main outcome measures incl uded HA documentation of patient pain scores, quantitative and qualitative mention of pain in the physician note, and analgesic treatment before and a fter the intervention. Results: Alter the intervention, HA documentation of pain scores increased from 1% to 75.6% (P <,0001). Physician documentation increased from 0% to 4 .8% for quantitative documentation (P <.01), and from 60.0% to 68.3% for qu alitative documentation (not significant), Of all the patients, 23.1% repor ted significant pain. Subgroups with greater pain included patients activel y receiving radiation treatments and patients with lung cancer. Of patients with significant pain, 28.2% had no mention of pain in the physician note and 47.9% had no documented analgesic treatment. Conclusion: Quantitative pain assessment was virtually absent before our in tervention but easily implemented and sustained in a busy outpatient oncolo gy practice, Pain score collection identified a high prevalence of pain, pa tient subgroups at risk for pain, and a significant proportion of patients with pain that was neither evaluated nor treated by their oncologists, J Cl in Oncol 19:501-508, (C) 2001 by American Society of Clinical Oncology.