Erik Torbjørn Løhre1,2, Morten Thronæs3,4, Cinzia Brunelli5,6, Stein Kaasa3,6, Pål Klepstad7,8. 1. Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology , N-7491, Trondheim, Norway. erik.t.lohre@ntnu.no. 2. Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. erik.t.lohre@ntnu.no. 3. Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology , N-7491, Trondheim, Norway. 4. Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. 5. Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 6. European Palliative Care Research Centre (PRC), Department of Oncology and Institute of Clinical Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway. 7. Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway. 8. Department of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Abstract
PURPOSE: A clinical care pathway for pain management in a palliative care unit was studied with outcomes related to patients, physicians, and health care service. Mandatory use of patient-reported outcome measures (PROMs) and physician-directed decision support (DS) were integrated parts of the pathway. METHODS: Adult cancer patients with pain intensity (PI) ≥ 5 (NRS 0-10) at admission were eligible. The patients reported average and worst PI at admission, day four, and discharge. The physicians completed the DS at admission and day four. The DS presented potential needs for treatment changes based on pain severity and pathophysiology. The physicians reported treatment changes due to input from the DS system. The two primary outcomes were average and worst PI changes from admission to discharge. Hospital length of stay (LOS) was registered. RESULTS: Of 52 included patients, 41 were discharged alive. For those, the mean average PI at admission and at discharge was 5.8 and 2.4, respectively, a reduction of 3.4 points (CI 95% 2.7-4.1). The corresponding worst pain intensities were 7.9 and 3.8, a reduction of 4.1 points (CI 95% 3.4-4.8). The physicians completed DS forms for all patients. Fifty-five percent (CI 95% 41-69) of the patients had pain intervention changes based on the DS. A significant reduction in LOS (4.4 days, CI 95% 0.5-8.3) was observed during the study period. CONCLUSIONS: The interventions were implemented according to the intentions and PI was reduced as hypothesized. For evaluation of generalizability, the interventions should be studied in other settings and with a controlled design.
PURPOSE: A clinical care pathway for pain management in a palliative care unit was studied with outcomes related to patients, physicians, and health care service. Mandatory use of patient-reported outcome measures (PROMs) and physician-directed decision support (DS) were integrated parts of the pathway. METHODS: Adult cancerpatients with pain intensity (PI) ≥ 5 (NRS 0-10) at admission were eligible. The patients reported average and worst PI at admission, day four, and discharge. The physicians completed the DS at admission and day four. The DS presented potential needs for treatment changes based on pain severity and pathophysiology. The physicians reported treatment changes due to input from the DS system. The two primary outcomes were average and worst PI changes from admission to discharge. Hospital length of stay (LOS) was registered. RESULTS: Of 52 included patients, 41 were discharged alive. For those, the mean average PI at admission and at discharge was 5.8 and 2.4, respectively, a reduction of 3.4 points (CI 95% 2.7-4.1). The corresponding worst pain intensities were 7.9 and 3.8, a reduction of 4.1 points (CI 95% 3.4-4.8). The physicians completed DS forms for all patients. Fifty-five percent (CI 95% 41-69) of the patients had pain intervention changes based on the DS. A significant reduction in LOS (4.4 days, CI 95% 0.5-8.3) was observed during the study period. CONCLUSIONS: The interventions were implemented according to the intentions and PI was reduced as hypothesized. For evaluation of generalizability, the interventions should be studied in other settings and with a controlled design.
Entities:
Keywords:
Cancer pain; Clinical care pathway; Decision support; Palliative care
Authors: S L Du Pen; A R Du Pen; N Polissar; J Hansberry; B M Kraybill; M Stillman; J Panke; R Everly; K Syrjala Journal: J Clin Oncol Date: 1999-01 Impact factor: 44.544
Authors: A R Du Pen; S Du Pen; J Hansberry; B Miller-Kraybill; J Millen; R Everly; N Hansen; K Syrjala Journal: Pain Manag Nurs Date: 2000-12 Impact factor: 1.929
Authors: Maria B Ospina; Kelly Mrklas; Lesly Deuchar; Brian H Rowe; Richard Leigh; Mohit Bhutani; Michael K Stickland Journal: Thorax Date: 2016-09-09 Impact factor: 9.139
Authors: Cinzia Brunelli; Michael I Bennett; Stein Kaasa; Robin Fainsinger; Per Sjgren; Sebastiano Mercadante; Erik T Løhre; Augusto Caraceni Journal: Pain Date: 2014-10-02 Impact factor: 6.961
Authors: Greg Ogrinc; Louise Davies; Daisy Goodman; Paul Batalden; Frank Davidoff; David Stevens Journal: BMJ Qual Saf Date: 2015-09-14 Impact factor: 7.035
Authors: Michael I Bennett; Elon Eisenberg; Sam H Ahmedzai; Arun Bhaskar; Tony O'Brien; Sebastiano Mercadante; Nevenka Krčevski Škvarč; Kris Vissers; Stefan Wirz; Chris Wells; Bart Morlion Journal: Eur J Pain Date: 2019-01-06 Impact factor: 3.931
Authors: Morten Thronæs; Erik Torbjørn Løhre; Anne Kvikstad; Elisabeth Brenne; Robin Norvaag; Kathrine Otelie Aalberg; Martine Kjølberg Moen; Gunnhild Jakobsen; Pål Klepstad; Arne Solberg; Tora Skeidsvoll Solheim Journal: Support Care Cancer Date: 2021-05-03 Impact factor: 3.603