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Trio of implementation strategies for cancer pain guidelines fails to help

JAMA Network Open
Reuters Health - 21/02/2022  - A suite of strategies designed to help deliver cancer-pain management guidelines failed to improve cancer-related pain in a randomized controlled trial.

These findings suggest that "cancer-pain screening and subsequent management will need to be highly valued, supported by adequate resources embedded within the clinical workflow, and supported by electronic data systems to be successful," Dr. Melanie Lovell, with the Palliative Care Department, HammondCare, in Greenwich, Australia, told Reuters Health by email.

Cancer pain is common and disabling and there is a gap between evidence and practice for cancer-pain management, Dr. Lovell and her colleagues point out in JAMA Network Open.

In a cluster-randomized clinical trial, they evaluated the ability of three cancer-pain-guideline-implementation strategies to improve pain-related outcomes for 544 patients attending oncology and palliative-care outpatient services at eight centers in Australia.

The strategies employed were 1) audit of adherence to six key guideline recommendations and feedback delivered in one to two cycles; 2) health-professional education using email-administered spaced education; and 3) an education booklet and a patient self-management resource.

The proportions of patients with at least a 30% reduction in a pain score of 5 or more of 10 at baseline (primary outcome) were not different in the control and intervention phases of the study (11.9% and 11.8%), the team reports.

In this study, "guideline implementation strategies at the level of the clinical service, health professional, and patient did not deliver a 30% or greater improvement in patients' pain compared with usual care," they write.

"This finding was despite the combined use of a conceptual framework, evidence-based implementation strategies, and services with clinical champions," they note.

There were also no significant differences in secondary outcomes, which included average pain, patient empowerment, fidelity to the intervention and quality of life.

"The uptake of the three implementation strategies was lower than expected," Dr. Lovell told Reuters Health.

"Further evaluation is needed to determine the required clinical resources needed to enable wide-scale uptake of the fundamental elements of cancer pain care. Ongoing quality improvement activities should be supported to improve sustainability," she and her colleagues write.

SOURCE: https://bit.ly/3h0GRMi JAMA Network Open, online February 21, 2022.

By Megan Brooks

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