Improving Pain Relief in a Rural Cancer Center

Abstract

Improving cancer pain management in a rural setting required a recognition of the contrasting characteristics between a sophisticated academic medical center and a rural community. The successful implementation of quality improvement strategies required a combination of leadership support, internal and external funding, and professional and federal recognition of the problem. Using a quality improvement approach rather than a traditional didactic approach, and fostering communication, trust, and collegiality at our outreach sites were pivotal to our success.

American Pain Society Recommendations for Improving the Quality of Acute and Cancer Pain Management

“…Solutions to these barriers include the identification and use of change agents at the local level and collaborations between organizations or across health care systems. 25,26,78,79 Familiarity with the motivational factors that affect individual and systems change is important. [80][81][82] Approaches should be chosen that enable innovative persons and early adopters of change and avoid placing blame on individuals.…”

Enhancing psychosocial care for people with cancer in rural communities: what can remote counselling offer?

“…26,27 In addition to access to specialist care, rural patients have fewer alternative supports and face issues relating to confidentiality and the stigma of mental health problems in rural communities. 22,28,29 Distance to treatment centres often means further out-of-pocket expenses associated with travel and accommodation, and disruption to family life. 19,29 …”

Alignment of Pain Reassessment Practices and National Comprehensive Cancer Network Guidelines

“…Perceived barriers to pain assessment and reassessment often cited by staff are (a) a nonfl exible work environment, (b) RNs' decision-making ability, (c) lack of leadership support, and (d) nurses who are not comfortable using research (Baltic, Whedon, Ahles, & Fanciullo, 2002;Bucknall et al, 2001;McCaughan et al, 2002;Willson, 2000). Work-related environmental barriers include an organizational culture that does not promote individual innovativeness (Thompson, 1997), failure by the organization to assist clinicians in identifying infl uences on decision making, and failure by the organization to allow staff to create unit-specifi c solutions and evaluate changes in practice (Bucknall et al).…”