Multidisciplinary pain management based on a computerized clinical decision support system in cancer pain patients

Abstract

A prospective controlled intervention cohort study in cancer pain patients (n=50 per group) admitted to radiation oncology wards (62 beds, 3 wards) was conducted in a 1621-bed university hospital. We investigated the effect of an intervention consisting of daily pain assessment using the numeric visual analog scale (NVAS) and pain therapy counseling to clinicians based on a computerized clinical decision support system (CDSS) to correct deviations from pain therapy guidelines. Effects on guideline adherence (primary outcome), pain relief (NVAS) at rest and during physical activity (both groups: cross-sectional assessment on day 5; intervention group: every day assessment), co-analgesic prescription, and acceptance rates of recommendations (secondary outcomes) were assessed. The number of patients with at least one deviation from guidelines at discharge was decreased by the intervention from 37 (74%) in controls to 7 (14%, p<0.001). In the intervention group, pain (NVAS) decreased during hospital stay at rest from 3.0 (Delta(0.5) (Q(75%)-Q(25%))=3.0) on admission to 1.5 (Delta(0.5)=1.0) at discharge (p<0.01) and during physical activity from 7.0 (Delta(0.5)=4.0) on admission to 2.5 (Delta(0.5)=3.8) at discharge (p<0.001). At discharge, the number of patients treated with co-analgesics increased from 23 (46%) in controls to 33 (66%) in the intervention group (p=0.04). From 279 recommendations issued in the intervention 85% were fully accepted by the physicians. Deviations from well-established guidelines are frequent in pain therapy. A multidisciplinary pain management increased adherence to pain management guidelines.

Can patient-reported measurements of pain be used to improve cancer pain management? A systematic review and meta-analysis

“…Twenty trials were RCTs, and two were controlled trials 19 23. The trials were published between 1997 and 2015 and were conducted in the USA, the Netherlands, Norway, Canada, Germany and the UK (table 2).…”

“…Aubin et al 19 conducted a non-randomised study which had high dropouts due to death and hospital admission. The study by Bertsche et al 23 was also a non-randomised trial. Methodological details were lacking in the studies by Trowbridge et al 40 and Vallières et al 41 and the risk of bias in these studies was unclear.…”

“…Nine trials used pen and paper,19 23 25 26 28 34 40 45 four used touch screen devices or personal digital assistants to collect the data,20 36 37 41 three used automated telephone monitoring,17 18 35 one used web-based systems,21 and in two trials, the patient was interviewed by a nurse27 or a health educator29 for the data. One study offered a choice between automated telephone monitoring or online monitoring 33…”

“…Pain and symptom monitoring took place immediately before planned outpatient visits in five studies without the option of home symptom monitoring,20 29 37 40 42 and one study23 collected PROMs during an inpatient stay. The remaining studies offered the ability to monitor symptoms at home as required, or at set intervals ranging from twice daily to monthly.…”

“…One study19 also used a symptom threshold concept within their paper diary intervention, instructing patients to contact their nurse if pain intensity or analgesic use crossed a threshold. Four studies23 26 27 33 linked patient-reported data to specific management algorithms to support clinical decision-making.…”