Pain assessment and registration in medical oncology clinics: operationalised through the lens of health care professionals and patients

Abstract

Background: Pain is a common symptom in patients who survive cancer and in those who live with progressive advanced disease. Systematic screening and documentation of pain are necessary to improve the quality of cancer pain treatment, because a key pain-related barrier is that patients are reluctant to discuss pain, due to fear that reporting pain will distract the healthcare professional from their cancer treatment. Methods: This study adopted an explanatory sequential mixed-methods design. Data collection incorporated three strands. The first strand involved a quantitative enquiry in which medical chart reviews of patients (n=100) attending the medical oncology outpatient clinic were examined. The second qualitative strand comprised of semi-structured interviews with patients (n=10) attending that service. The third strand was qualitative and consisted of focus group discussions with healthcare professionals (n=12). Results: All 100 patients had cancer. The quantitative findings confirmed the suboptimum assessment and subsequent recording of patient’s pain, that seemed to afford a reality check for all healthcare professionals. For patients, the outcomes of the anti-cancer treatment were their priority, and pain was perceived as inevitable, being associated with a cancer diagnosis. There were multifaceted complexities voiced amongst healthcare professionals associated with balancing the benefits and harms aligned with treating cancer pain. Conclusions: Pain assessment in medical records was not systematically recorded by healthcare professionals. Patients were reluctant to self-report pain during their medical oncology outpatient review. The expectation that patients will self-report pain can be accommodated by healthcare professionals if a personalized pain goal is part of the cancer pain management plan during each clinical encounter. Healthcare professionals reported a need to take distinct responsibility for supplementing their dearth of knowledge, skills and beliefs regarding assessing and managing patients’ cancer pain. Optimal pain management stems from an interprofessional approach that was applied in this study design.

Personalized Medicine in Cancer Pain Management

“…They examined nine BAT questions, such as “How often do you get breakthrough pain?” and “How long does a typical episode of breakthrough pain last?” [ 74 ]. O’Connor et al thought that if a tailored pain target is included in the CPM plan, healthcare practitioners may accommodate the assumption that patients will self-report the pain [ 75 ]. Ben-Arye et al investigated the outcomes of an integrative oncology (IO) therapy program that was personalized and offered to 815 eligible patients receiving cancer treatment in adjuvant, neo-adjuvant, and palliative care settings.…”

Social disparities in pain management provision in stage IV lung cancer: A national registry analysis

“…[37,38] Communication barriers include lack of systematic screening tools/documentation of pain by clinicians, and patient reluctance to discuss their pain due to fear of it interfering with their cancer therapy. [39,40] When evaluating minority patients with LC, unequal care, lower overall referral to pain specialists, and lack of effective pain control were observed in Stage IV NSCLC, consistently across the various treatment cohorts (surgery, chemotherapy, or radiation therapy) and in those who received treatment at community cancer care centers. [36] With the extensive range of options available, multidisciplinary care involving both oncologists and pain specialists becomes essential to provide patients with optimal pain control, especially when keeping in mind both patient comfort and opioid reduction.…”

“…[37,38] Communication barriers include lack of systematic screening tools/documentation of pain by clinicians, and patient reluctance to discuss their pain due to fear of it interfering with their cancer therapy. [39,40]…”