Effect of Cancer Pain Guideline Implementation on Pain Outcomes Among Adult Outpatients With Cancer-Related Pain

Abstract

IMPORTANCEAn evidence-practice gap exists for cancer pain management, and cancer pain remains prevalent and disabling. OBJECTIVES To evaluate the capacity of 3 cancer pain guideline implementation strategies to improve pain-related outcomes for patients attending oncology and palliative care outpatient services. DESIGN, SETTING, AND PARTICIPANTS A pragmatic, stepped wedge, cluster-randomized, nonblinded, clinical trial was conducted between 2014 and 2019. The clusters were cancer centers in Australia providing oncology and palliative care outpatient clinics. Participants included a consecutive cohort of adult outpatients with advanced cancer and a worst pain severity score of 2 or more out of 10 on a numeric rating scale (NRS).

Roles and effectiveness of knowledge brokers for translating clinical practice guidelines in health-related settings: a systematic review

“…We included 16 studies (online supplemental appendix 3), 6 RCTs (1 RCT,22 3 cluster RCTs,23–25 1 stepped wedge RCT26 and 1 stepped wedge cluster RCT,27 8 uncontrolled preintervention–postintervention studies,28–35 1 controlled prefeasibility–postfeasibility study36 and 1 interrupted time series 37. Studies were conducted in Australia,23 24 26 27 37 the USA,30–33 36 Canada,25 28 Malaysia,22 Netherlands,35 Nicaragua29 and Norway 34.…”

“…We included 16 studies (online supplemental appendix 3), 6 RCTs (1 RCT,22 3 cluster RCTs,23–25 1 stepped wedge RCT26 and 1 stepped wedge cluster RCT,27 8 uncontrolled preintervention–postintervention studies,28–35 1 controlled prefeasibility–postfeasibility study36 and 1 interrupted time series 37. Studies were conducted in Australia,23 24 26 27 37 the USA,30–33 36 Canada,25 28 Malaysia,22 Netherlands,35 Nicaragua29 and Norway 34. Majority of studies (n=14) were conducted in a hospital setting (including emergency departments, specialist clinics and outpatient clinics); 1 was conducted in community mental health clinics36; and 1 was conducted across settings in health and aged care organisations 37…”

“…CPGs implemented in the included studies mostly related to appropriate screening and assessment of patients (n=7),23 24 26 27 32–34 provision of non-pharmacological advice (n=6)26 27 32 33 35 37 and pharmacological management of conditions (n=8) 24 25 27–31 36. Four studies included CPGs of more than one type.…”

“…The majority of CPGs (n=7) were related to management of neurological conditions (eg, stroke, closed head injury and dementia) 23 24 32–35 37. Other CPGs related to management of infectious diseases,30 31 pregnancy and labour,26 29 colorectal surgery,28 dialysis,25 mental illness36 and cancer pain 27. One study involved a CPG relating to health professional compliance with hand hygiene 22…”

“…Outcome assessors were clearly blinded in half of the RCTs 23 24 26. RCT trial designs were mostly appropriate, but one stepped-wedge study had inconsistent time at each step and was therefore appraised as unclear 27. Guideline implementation outcomes were clearly measured using an objective, reproducible method in three studies,22–24 a method deemed unclear in two studies25 27 and a subjective method involving self-report by patients in one study 26.…”