R López López1, C Camps Herrero2, P Khosravi-Shahi3, V Guillem Porta4, A Carrato Mena5, J Garcia-Foncillas6, J J Cruz Hernández7, P Gascón Vilaplana8, A Antón Torres9, E Diaz-Rubio10, M Feyjoo Saus11, E Aranda Aguilar12. 1. Comisión Permanente Fundación ECO, Servicio de Oncología Médica, Complejo Universitario de Santiago de Compostela, Rúa Choupana s/n, 15706, Santiago De Compostela, A Coruña, Spain. rafael.lopez.lopez@sergas.es. 2. Comisión Permanente Fundación ECO, Hospital General Universitario de Valencia, Valencia, Spain. 3. Servicio de Oncología Médica, Hospital Universitario de Torrejón, Madrid, Spain. 4. Comisión Permanente Fundación ECO, Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología, Valencia, Spain. 5. Comisión Permanente Fundación ECO, Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, Spain. 6. Patrono Fundación ECO, Servicio de Oncología Médica, Hospital Universitario "Fundación Jiménez Díaz", Madrid, Spain. 7. Comisión Científica Fundación ECO, Servicio de Oncología Médica, Hospital Universitario de Salamanca, Salamanca, Spain. 8. Comisión Científica Fundación ECO, Servicio de Oncología, Fundació Clínic, Barcelona, Spain. 9. Comisión Científica Fundación ECO, Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, Spain. 10. Presidente Fundación ECO, Servicio de Oncología Médica, Hospital Clínico Universitario San Carlos, Madrid, Spain. 11. Servicio de Oncología Médica, Hospital Sanitas La Moraleja, Madrid, Spain. 12. Comisión Permanente Fundación ECO, Maimonides Institute of Biomedical Research, Hospital Universitario Reina Sofía, Córdoba, Spain.
Abstract
PURPOSE: Breakthrough cancer pain (BTcP) has been shown to be a prevalent and poor prognostic factor for oncologic patients, which remain under diagnosed and undertreated. In 2012, the Spanish Society of Medical Oncology (SEOM) published a clinical practice guideline (CPG) for the treatment of cancer pain which specifically addressed the management of BTcP. METHODS: Fundación ECO designed a qualitative study using an Internet-based survey to investigate the attitudes toward, compliance with, and use of SEOM Guideline. RESULTS: A total of 83 oncologists with a mean experience of 13 years responded. Overall, 82% were aware of different guidelines to manage BTcP. Notably, attitudes toward guidelines were highly positive and there was nearly unanimous agreement that CPG provided the best scientific evidence available (99%), on the minimum information to be gathered for the medical history (100%), on the need for a specific treatment for BTcP (100%), and fentanyl as the first-choice drug (99%). Interestingly, there were discrepancies between what oncologists agreed with and what they do in clinical practice. In fact, 87.6% declare full compliance with SEOM guideline, although adherence to registration of BTcP data in medical records ranged from 30.1 to 91.6% (mean 64.5%); therapeutic management compliance was higher ranging from 75.9 to 91.6%. Main barriers identified were time pressure together with vague statements and limited dissemination of the guidelines. CONCLUSION: Despite oncologist's clinical practice is increasingly guided by GPC, it suffers from limited compliance, at least in part due to suboptimal statements. Improved dissemination and education are needed to enhance guideline implementation.
PURPOSE:Breakthrough cancer pain (BTcP) has been shown to be a prevalent and poor prognostic factor for oncologic patients, which remain under diagnosed and undertreated. In 2012, the Spanish Society of Medical Oncology (SEOM) published a clinical practice guideline (CPG) for the treatment of cancer pain which specifically addressed the management of BTcP. METHODS: Fundación ECO designed a qualitative study using an Internet-based survey to investigate the attitudes toward, compliance with, and use of SEOM Guideline. RESULTS: A total of 83 oncologists with a mean experience of 13 years responded. Overall, 82% were aware of different guidelines to manage BTcP. Notably, attitudes toward guidelines were highly positive and there was nearly unanimous agreement that CPG provided the best scientific evidence available (99%), on the minimum information to be gathered for the medical history (100%), on the need for a specific treatment for BTcP (100%), and fentanyl as the first-choice drug (99%). Interestingly, there were discrepancies between what oncologists agreed with and what they do in clinical practice. In fact, 87.6% declare full compliance with SEOM guideline, although adherence to registration of BTcP data in medical records ranged from 30.1 to 91.6% (mean 64.5%); therapeutic management compliance was higher ranging from 75.9 to 91.6%. Main barriers identified were time pressure together with vague statements and limited dissemination of the guidelines. CONCLUSION: Despite oncologist's clinical practice is increasingly guided by GPC, it suffers from limited compliance, at least in part due to suboptimal statements. Improved dissemination and education are needed to enhance guideline implementation.
Entities:
Keywords:
Attitude of health personnel; Breakthrough pain; Clinical competence; Oncologists; Pain management; Practice guidelines
Authors: Marjolein Lugtenberg; Jako S Burgers; Casper F Besters; Dolly Han; Gert P Westert Journal: BMC Fam Pract Date: 2011-09-22 Impact factor: 2.497