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abstract
Background In the
outpatient oncology clinic, pain management is often inadequate.
Incorporating a systematic pain management program
into visits is likely to improve this. We
implemented an integrated program, including a structured pain
assessment, pain
treatment protocol and patient education module.
In the present study, we investigated whether this intervention
improved
pain control.
Patients and methods
At seven oncology outpatient clinics, patients were asked to register
their pain intensity on a touch screen computer. These
scores were made available into their electronic
medical records. Additionally, a hospital-wide treatment protocol for
cancer-related
pain and a patient education module were
developed. A data warehouse system enabled us to extract patient data
from the electronic
medical record anonymously and to use them for
analysis. The primary outcome of the study was the percentage of
patients with
moderate to severe pain [current pain (CPI), NRS
> 4] measured during 2 weeks at the start and 6 months after
implementation.
As secondary outcomes, we studied the percentage
of pain registrations in specific patient groups and the percentage of
patients
treated with a curative and a palliative
intention with (moderate–severe) pain. Differences were tested with the χ2 test.
Results During the first 6 months, 3407 of the 4345 patients (78%) registered their pain intensity on the touch screen computer.
The percentage of patients with moderate to severe CPI decreased 32% (P = 0.021): from 12.5% at start to 8.5% after 6 months. More patients in the palliative phase than in the curative phase of
their disease registered their pain intensity (82% versus 75%, respectively, P < 0.005), and more patients in the palliative phase experienced moderate to severe pain (23% versus 14%, respectively, P < 0.001).
Conclusion Pain registration by patients themselves is feasible, provides insight into patients' pain intensity and may improve pain
control in outpatients with cancer-related pain.
Clinical trial number Because this is an innovation project and not a primary research project, it has no clinical trial number. The protocol and
all materials involved were approved by the Institutional Review Board of the Erasmus MC (MEC-2009-324).
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