Advertisement

Pharmacy World and Science

, 28:342 | Cite as

Design and validation of a medication assessment tool for cancer pain management

  • Gro Dahlseng HåkonsenEmail author
  • Steve Hudson
  • Thrina Loennechen
Original Paper

Abstract

Objective

A clinical tool to examine prescribing in cancer pain management may provide a means to help establish acceptable standards of adherence to treatment guidelines. The study aim was to design and validate a Medication Assessment Tool for Cancer Pain Management (MAT-CP).

Setting

Hospitals in Northern Norway

Method

The MAT-CP was designed from guideline criteria based on a previously developed method. The tool was validated by peer review before and during field-testing on a study sample of cancer patients experiencing pain.

Main outcome measure

Perceived relevance, utility, and clarity of individual criteria, and reliability of their application to clinical documentation. Frequency of adherence to agreed definitions of guideline criteria.

Results

The final tool comprised 36 criteria covering six different aspects of cancer pain management: (1) pain assessment and information transfer, (2) start of strong opioid therapy; (3) current continuous analgesia; (4) current intermittent analgesia; (5) follow-up of therapy, and; (6) other care issues. The tool was tested on 109 cancer patients experiencing pain (57 males), mean (SD) age 60.8 (11.5) years. Guideline adherence overall was 61% (n = 1704 applicable criteria). The field-testing informed the modification of the MAT-CP to optimise its clarity and utility when applied to patients’ clinical documentation. Good inter- and intra-rater reliability (Cohen’s kappa κ = 0.86 and κ = 0.95, respectively) were demonstrated in the application. The preliminary application of the tool during field-testing has highlighted the following for further study: (a) Low adherence (<50%) to 14 standards concerning start of opioid treatment and pain therapy follow-up, clinical assessment of risk of gastro-intestinal adverse effects among patients on non-steroidal anti-inflammatory drugs (NSAID), current treatment of breakthrough pain, management of nausea/vomiting; (b) High adherence (>75%) to standards of prescribing of continuous analgesia.

Conclusion

A clinical tool to examine prescribing in cancer pain management has been designed. Face and content validity have been informed by field-testing. The tool requires further study among palliative care specialists as part of the validation required before it can be recommended for clinical use.

Keywords

Clinical guidelines Clinical assessment tool Cancer pain Norway Pain management Pharmaceutical care Prescribing 

Notes

Acknowledgements

We sincerely thank the cancer patients for their important contribution. To our colleagues Rikke Lind, Trude Giverhaug, Zahra Abdullahi, Sigrid Brækkan and Morten Moe (University of Tromsø, Norway), Susan McKellar and John McAnaw (University of Strathclyde, UK), and Tone Nordøy (University Hospital of North Norway). Thanks to the hospitals’ and pharmacy staffs, especially Inger Dagsvold and Inger Kronen. The project was supported by grants from Erna and Olav Aakre’s Legacy for Cancer Research and the Norwegian Pharmaceutical Association.

References

  1. 1.
    Foley KM. Pain assessment and cancer pain syndromes. In: Doyle D, Hanks GWC, MacDonald N, editors. Oxford textbook of palliative medicine. 2nd ed. Oxford: Oxford University Press; 1998. p. 310–31. ISBN 0-19-263057-1.Google Scholar
  2. 2.
    Meuser T, Pietruck C, Radbruch L, Stute P, Lehmann KA, Grond S. Symptoms during cancer pain treatment following WHO-guidelines: a longitudinal follow-up study of symptom prevalence, severity and etiology. Pain 2001;93:247–57PubMedCrossRefGoogle Scholar
  3. 3.
    Zech DF, Grond S, Lynch J, Hertel D, Lehmann KA. Validation of World Health Organisation Guidelines for cancer pain relief: a 10-year prospective study. Pain 1995;63:65–76PubMedCrossRefGoogle Scholar
  4. 4.
    Caraceni A, Portenoy RK, a working group of the IASP Task Force on Cancer Pain. An international survey of cancer pain characteristics and syndromes. Pain 1999;82:263–74.PubMedCrossRefGoogle Scholar
  5. 5.
    Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA, et al. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 1994;330:592–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Rhodes DJ, Koshy RC, Waterfield WC, Wu AW, Grossman SA. Feasibility of quantitative pain assessment in outpatient oncology practice. J Clin Oncol 2001;19:501–8.PubMedGoogle Scholar
  7. 7.
    Zhukovsky DS, Gorowski E, Hausdorff J, Napolitano B, Lesser M. Unmet analgesic needs in cancer patients. J Pain Symptom Manage 1995;10:113–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Sepúlveda C, Marlin A, Yoshida T, Ullrich A. Palliative care: The World Health Organisation’s global perspective. J Pain Symptom Manage 2002;24:91–6.PubMedCrossRefGoogle Scholar
  9. 9.
    WHO. Cancer pain relief: with a guide to opioid availability. 2nd ed. Geneva: World Health Organisation; 1996. ISBN 92-4-154482-1.Google Scholar
  10. 10.
    de Wit R, van Dam F, Abu-Saad HH, Loonstra S, Zandbelt L, van Buuren A, et al. Empirical comparison of commonly used measures to evaluate pain treatment in cancer patients with chronic pain. J Clin Oncol 1999;17:1280–7.PubMedGoogle Scholar
  11. 11.
    Mercadante S. Comments on Wang et al., Pain, 67 (1996) 407–416. Pain 1998;74:106.Google Scholar
  12. 12.
    de Wit R, van Dam F, Loonstra S, Zandbelt L, van Buuren A, van der Heijden K, et al. The Amsterdam Pain Management Index compared to eight frequently used outcome measures to evaluate the adequacy of pain treatment in cancer patients with chronic pain. Pain 2001;91:339–49.PubMedCrossRefGoogle Scholar
  13. 13.
    Hutt E, Pepper GA, Vojir C, Fink R, Jones KR. Assessing the appropriateness of pain medication prescribing practices in nursing homes. J Am Geriatr Soc 2006;54:231–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Du Pen SL, Du Pen AR, Polissar N, Hansberry J, Kraybill BM, Stillman M, et al. Implementing guidelines for cancer pain management: results of a randomized controlled clinical trial. J Clin Oncol 1999;17:361–70.PubMedGoogle Scholar
  15. 15.
    Du Pen AR, Du Pen S, Hansberry J, Miller-Kraybill B, Millen J, Everly R, et al. An educational implementation of a cancer pain algorithm for ambulatory care. Pain Management Nursing 2000;1:116–28.CrossRefGoogle Scholar
  16. 16.
    Nissen LM, Tett SE, Cramond T, Williams B, Smith MT. Opioid analgesic prescribing and use—an audit of analgesic prescribing by general practitioners and the Multidisciplinary Pain Centre at Royal Brisbane Hospital. Br J Clin Pharmacol 2001;52:693–8PubMedCrossRefGoogle Scholar
  17. 17.
    Jenkins BG, Tuffin PHR, Choo CL, Schug SA. Opioid prescribing: an assessment using quality statements. J Clin Pharm Ther 2005;30:597–602PubMedCrossRefGoogle Scholar
  18. 18.
    Wallace KG, Graham KM, Bacon DR, Chang JI, Doyle KM, Fallacaro MD, et al. The development and testing of the Patient Record Pain Management Assessment Tool. J Nurs Care Qual 1999;13:34–46PubMedGoogle Scholar
  19. 19.
    Ferrel BR, Wisdom C, Rhiner M, Alletto J. Pain management as a quality of care outcome. J Nurs Qual Assur 1991;5:50–8Google Scholar
  20. 20.
    Javed N, Tully MP. Content validity of indicators of the appropriateness of long-term prescribing started during a hospital admission. Int J Pharm Pract 2002;10(suppl):R55Google Scholar
  21. 21.
    McAnaw J, Hudson S, McGlynn S. Development of an evidence-based medication assessment tool to demonstrate the quality of drug therapy use in patients with hearth failure. Int J Pharm Pract 2003;11(suppl):R17Google Scholar
  22. 22.
    McAnaw JJ. Development of novel approaches to demonstrate quality of drug therapy use [PhD thesis]. University of Strathclyde, Glasgow, 2002Google Scholar
  23. 23.
    Morris CJ, Cantrill JA, Bate JR. How the use of preventable drug-related morbidity indicators can improve medicines management in primary care. Pharm J 2003;271:682–6Google Scholar
  24. 24.
    Chinwong S, Reid F, McGlynn S, Hudson S, Flapan A. The need for pharmaceutical care in the prevention of coronary heart disease: an exploratory study in acute myocardial infarction patients. Pharm World Sci 2004;26:96–101PubMedCrossRefGoogle Scholar
  25. 25.
    Ernst A, Kinnear M, Hudson S. Quality of prescribing: a study of guideline adherence of medication in patients with diabetes mellitus. Pract Diab Int 2005;22:285–90CrossRefGoogle Scholar
  26. 26.
    Scottish Intercollegiate Guidelines Network. Control of Pain in Patients with Cancer. Edinburgh: SIGN Secretariat. 2000. ISBN 1899893-17-2.Google Scholar
  27. 27.
    DNL. Retningslinjer for smertebehandling i Norge. [Guidelines for the management of pain in Norway.] Oslo: Den norske legeforening. 2004. ISBN 82-80700-14-5Google Scholar
  28. 28.
    Kaasa S, editor. Palliativ behandling og pleie. [Palliative care.] Oslo: Ad Notam Gyldendal. 1998. ISBN 82-417-0901-3Google Scholar
  29. 29.
    NFPM. Standard for palliasjon. [Palliation standards.] Norsk Forening for Palliativ Medisin (NFPM) og Den norske legeforening, 2004;1–44Google Scholar
  30. 30.
    SLV. Palliativ behandling på sykehus og i hjemmet. [Palliative care in the secondary and primary care setting.] Norwegian Medicines Agency, 2001Google Scholar
  31. 31.
    Klepstad P, Loge JH, Borchgrevink PC, Mendoza TR, Cleeland CS, Kaasa S. The Norwegian brief pain inventory questionnaire: translation and validation in cancer pain patients. J Pain Symptom Manage 2002;24:517–25PubMedCrossRefGoogle Scholar
  32. 32.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993;85:365–76PubMedCrossRefGoogle Scholar
  33. 33.
    Robson C. Real world research. A resource for social scientists and practitioner–researchers. 2nd ed. Malden: Blackwell Publishing; 2002. ISBN 0-631-21305-8Google Scholar
  34. 34.
    Felleskatalogen. [Norwegian National Formulary.] 47th ed. Oslo: Felleskatalogen AS. 2005. ISBN 8-207-02077-6Google Scholar
  35. 35.
    Jadad AR, Browman GP. The WHO analgesic ladder for cancer pain management. Stepping up the quality of its evaluation. JAMA 1995;274:1870–3PubMedCrossRefGoogle Scholar
  36. 36.
    Breivik H. Opioids in cancer and chronic non-cancer pain therapy—indications and controversies. Acta Anaesthesiol Scand 2001;45:1059–66PubMedCrossRefGoogle Scholar
  37. 37.
    Forskrift om pasientjournal med merknader. [Patient health record regulations.] Forskrift 21. desember 2000 nr.1385. Norwegian Ministry of Social Affairs and Health, 2000Google Scholar
  38. 38.
    Klepstad P, Kaasa S, Jystad Å, Hval B, Borchgrevink PC. Immediate- or sustained-release morphine for dose finding during start of morphine to cancer patients: a randomized, double-blind trial. Pain 2003;101:193–8PubMedCrossRefGoogle Scholar
  39. 39.
    Hanks G, Portenoy RK, MacDonald N, Forbes K. Difficult pain problems. In: Doyle D, MacDonald N, Hanks GWC, editors. Oxford textbook of palliative medicine. 2nd ed. Oxford: Oxford University Press; 1998. p. 454–77. ISBN 0-19-263057-1Google Scholar
  40. 40.
    Gunnarsdottir S, Donovan HS, Serlin RC, Voge C, Ward S. Patient-related barriers to pain management: the barriers questionnaire II (BQ-II). Pain 2002;99:385–96Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • Gro Dahlseng Håkonsen
    • 1
    Email author
  • Steve Hudson
    • 2
  • Thrina Loennechen
    • 1
  1. 1.Institute of Pharmacy, Faculty of MedicineUniversity of TromsøTromsøNorway
  2. 2.Strathclyde Institute of Pharmacy and Biomedical SciencesUniversity of StrathclydeGlasgowScotland

Personalised recommendations