Improving the management of pain from advanced cancer in the community: study protocol for a pragmatic multicentre randomised controlled trial

Allsop, Matthew J; Wright-Hughes, Alexandra; Black, Kath; Hartley, Suzanne; Fletcher, Marie; Ziegler, Lucy; Bewick, Bridgette M.; Meads, David; Hughes, Nic; Closs, S. José; Hulme, Claire; Taylor, Sally; Flemming, Kate; Hackett, Julia; O’Dwyer, John; Bennett, Mike

doi:10.1136/bmjopen-2018-021965

Cited by 11 publications

(16 citation statements)

References 42 publications

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“…Baseline and post-consultation follow-up patient questionnaires were developed based on validated pain measurement tools used in the IMPACCT study [ 27 , 28 ]. Drafts were piloted with the study PPI group and feedback was obtained.…”

Section: Methodsmentioning

confidence: 99%

A community pharmacist medicines optimisation service for patients with advanced cancer pain: a proof of concept study

2019

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Background Patients with advanced cancer commonly experience pain and it is least controlled in community settings. Community pharmacists in the UK already offer medicines optimisation consultations although not for this patient group. Objective To determine whether medicines consultations for patients with advanced cancer pain are feasible and acceptable. Setting Community-dwelling patients with advanced cancer pain were recruited from primary, secondary and tertiary care using purposive sampling in one UK city. Methods One face-to-face or two telephone delivered medicines optimisation consultations by pharmacists were tested. These were based on services currently delivered in UK community pharmacies. Feedback was obtained from patients and healthcare professionals involved to assess feasibility and acceptability. Main outcome measure Recruitment, acceptability and drug related problems. Results Twenty-three patients, (range 33–88 years) were recruited, 19 completed consultation(s) of whom 17 were receiving palliative care services. Five received face-to-face consultations and 14 by telephone during which 47 drug related problems were identified from 33 consultations (mean 2.5). Advice was provided for 34 drug related problems in 17 patients and referral to other healthcare professionals for 13 in 8 patients, 2 patients had none. Eleven patients returned questionnaires of which 8 (73%) would recommend the consultations to others. Conclusion The consultations were feasible as patients were recruited, retained, consultations delivered, and data collected. Patients found the 20–30 min intervention acceptable, found a self-perceived increase in medicines knowledge and most would recommend it to others. Community pharmacists were willing to carry out these services however they had confidence issues in accessing working knowledge. Most drug related problems were resolved by the pharmacists and even among patients receiving palliative care services there were still issues concerning analgesic management. Pharmacist-conducted medicines consultations demonstrate potential which now needs to be evaluated within a larger study in the future.

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Section: Methodsmentioning

confidence: 99%

A community pharmacist medicines optimisation service for patients with advanced cancer pain: a proof of concept study

2019

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“…A full protocol for the trial has been published. 29 Patients were recruited from six of the eight participating oncology clinics across the United Kingdom who met the eligibility criteria (outlined in the transition section of Table 1). A process evaluation was undertaken during this stage as part of the trial.…”

Section: Methodsmentioning

confidence: 99%

“…PainCheck stemmed from a large research program (IMPACCT [Improving the Management of Pain From Advanced Cancer in the Community; ISRCTN registry No. 18281271]) in the United Kingdom, 29 with a specific work stream dedicated to routine assessment and monitoring of pain in patients with advanced cancer. Complementary parallel work streams explored pathways of care for patients with advanced cancer, the role of educational interventions to support self-management of pain, opioid-prescribing practices, and the cost effectiveness of reducing pain and related distress.…”

Section: Methodsmentioning

confidence: 99%

“…It has now been implemented in palliative care settings. 29 We document the methodology adopted for undertaking research and working with system developers, alongside reporting the experience of patient and health professional users of PainCheck in the context of routine care as part of a clinical trial. Our aim is to share our methodology to provide a template to support research-led development of HIT systems for palliative care.…”

Section: Introductionmentioning

confidence: 99%

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Multidisciplinary Software Design for the Routine Monitoring and Assessment of Pain in Palliative Care Services: The Development of PainCheck

Allsop

Johnson

Taylor

et al. 2019

JCO Clinical Cancer Informatics

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PURPOSEThe use of health information technology (HIT) to support patient and health professional communication is emerging as a core component of modern cancer care. Approaches to HIT development for cancer care are often underreported, despite their implementation in complex, multidisciplinary environments, typically supporting patients with multifaceted needs. We describe the development and evaluation of an e-health tool for pain management in patients with advanced cancer, arising from collaboration between health researchers and a commercial software development company.METHODSWe adopted a research-led development process, involving patients with advanced cancer and their health professionals, focusing on use within real clinical settings. A software development approach (disciplined agile delivery) was combined with health science research methods (ie, diary studies, face-to-face interviews, questionnaires, prototyping, think aloud, process reviews, and pilots). Three software iterations were managed through three disciplined agile delivery phases to develop PainCheck and prepare it for use in a clinical trial.RESULTSFindings from development phases (inception, elaboration, and construction) informed the design and implementation of PainCheck. During the transition phase, where PainCheck was evaluated in a randomized clinical trial, there was variation in the extent of engagement by patients and health professionals. Prior personal experience and confidence with HIT led to a gatekeeping effect among health professionals, who were reluctant to introduce PainCheck to patients. Patients who did use PainCheck seemed to benefit, and no usability issues were reported.CONCLUSIONHealth science research methods seemed to help in the development of PainCheck, although a more rigorous application of implementation science methodologies might help to elucidate further the barriers and facilitators to adoption and inform an evidence-based plan for future implementation.

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“…A 2009 systematic review of these could not identify any such interventions which unequivocally resulted in clinical improvements in pain outcomes (52). However it is also increasingly recognised that complex interventions combining a number of different approaches are more likely to be effective than those applied in isolation (70). For example, a US RCT examined the effect of automated symptom monitoring, combined with telephone-based care management, according to evidence-based guidelines (71).…”

Section: Patient Barriers To Opioid Prescribing Were Examined By Wardmentioning

confidence: 99%

Access to Opioids for Patients with Advanced Disease

Edwards

Bennett

2019

CPD

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Pain at the end of life is common in both malignant and non-malignant disease. It is feared by patients, their families and careers, and professionals. Effective pain control can be achieved for the majority of patients at the end of life using a multimodal approach. Pharmacological management relies predominantly on strong opioids. In spite of this, evidence suggests that under treatment of pain is common resulting in unnecessary suffering. Multiple barriers to use of opioids have been identified. Patient barriers include reluctance to report pain and to take analgesics. Professional barriers include inadequate pain assessment and lack of specialist knowledge and confidence in opioid therapy. Fear of side effects including respiratory depression affects patients and professionals alike. The impact of the “opioid epidemic”, with increasing prescribed and illicit opioid use around the world, has also led to increasingly stringent regulation and concern about under prescribing in palliative care. System barriers to use of opioids at the end of life result from limited opioid availability in some countries and also inconsistent and limited access to palliative care. Multiple interventions have been developed to address these barriers, targeted at patients, professionals and systems. There is increasing evidence to suggest that complex interventions combining a number of different approaches are most effective in optimising pain outcomes for patients at the end of life.

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Improving the management of pain from advanced cancer in the community: study protocol for a pragmatic multicentre randomised controlled trial

Cited by 11 publications

References 42 publications

A community pharmacist medicines optimisation service for patients with advanced cancer pain: a proof of concept study

A community pharmacist medicines optimisation service for patients with advanced cancer pain: a proof of concept study

Multidisciplinary Software Design for the Routine Monitoring and Assessment of Pain in Palliative Care Services: The Development of PainCheck

Access to Opioids for Patients with Advanced Disease

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