Abstract
Goals
The aim of this prospective study was to assess the quality of pain management hospitalized cancer patients.
Patients and methods
In a quantitative and qualitative evaluation from six oncology centers in Italy, all consecutive cancer patients complaining of pain and hospitalized during the same 2 weeks were requested to fill in a McGill pain questionnaire (MPQ), a present pain intensity scale (PPI), and a hospital anxiety and depression acale (HADS), and to answer a questionnaire focused (QF) on the quality of medical and nursing care. The healthcare provider's antalgic prescriptions were assessed by an index of pain management (IPM).
Main results
Of 120 patients with pain admitted to oncology divisions (65 men and 52 women; mean age 57 years, range 21–79 years), 117 completed the questionnaires. The quantitative evaluation (PPI) showed a significant pain reduction between admission and discharge pain levels—from 2.65 to 1.50 (p<0.001). While a significant reduction of anxiety (HADS) was also found—from 10.24 to 9.11 (p<0.001)—depression did not improve (9.83 and 9.72). The most relevant information from qualitative evaluation (QF) was: in 37.6% of patients, pain level was higher overnight; 47% waited for spontaneous decrease of pain intensity before asking for nurse or physician intervention; 69% asked for nurse help when pain level was really high. The health care response to patients' pain was not completely satisfactory, since analgesic prescription was adequate in 56.52% but inadequate in 43.47%.
Conclusions
Pain control in hospitalized cancer patients is not completely satisfactory. The physician's attitude is to underestimate and undertreat pain, while nurses are not adequately trained for timely intervention despite published guidelines for pain management. The findings of this study support the concern of inadequate knowledge and inappropriate attitudes regarding pain management, even in cancer patients hospitalized in medical oncology divisions.
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References
Au E, Loprinzi CL, Dhodapkar M, Nelson T, Novotny P, Hammack J et al (1994) Regular use of a verbal pain scale improves the understanding of oncology in patient's pain intensity. J Clin Oncol 12(12):2751–2755
Brown ST, Bowman JM, Eason FR (1999) Assessment's of nurses'attitudes and knowledge regarding pain management. J Cont Educ Nurs 30(3):132–139
Bruera E, Brenneis C, Michaud Mm MacDonald RN (1989) Influence of the pain and symptom control team (PSCT) on the patterns of treatment of pain and other symptoms in a cancer center. J Pain Sympt Manag 4(3):112–116
Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA et al (1994) Pain and its treatment in outpatients with metastatic cancer. New Engl J Med 330:592–596
Cleeland CS (1996) Reply to Mercadante Comments on Wang et al Pain 67:106
Grossman SA (1993) Undertreatment of cancer pain: barriers and remedies {Suppl] Care Cancer 1:74–78
Jacox A, Carr DB, Payne R (1994) New clinical-practice guidelines for the management of pain in patients with cancer. New Engl J Med 330:651–655
Kravitz RL, Delafield JP, Hays RD, Drazin R, Connolly M (1996) Bedside charting of pain levels in hospitalized patients with cancer: a randomised controlled trial. J Pain Sympt Manag 1(2):81–87
Lin CC (2000) Applying the American Pain Society's QA standards to evaluate the quality of pain management among surgical, oncology and hospice inpatients in Taiwan. Pain 87(1):43–49
Manfredi PL, Chandler S, Pigazzi A, Payne R (2000) Outcome of cancer pain consultations Cancer 89(4):920–924
Maniani G, Sanavio E (1985) Semantics of pain in Italy: the italian version of the McGill Pain Questionnaire. Pain 2:399–405
McGuire DB (1984) Assessment of pain in cancer inpatients using the McGill Pain Questionnaire. Onc Nurs Forum 11(6):32–37
Melzack R (1975) The McGill Pain Questionnaire: major properties and scoring methods. Pain 1:277–299
Melzack R (1987) The short form McGill Pain Questionnaire. Pain 30:18
Mercadante S (1999) Pain treatment and outcomes for patients with advanced cancer who receive follow-up care at home. Cancer 85:1849–1858
Mercadante S (1996) Comments on Wang et al Pain 67:106
Minotti V, Betti M (1997) Attitudes of Italian general practitioners in the treatment of cancer pain. Tumori 83:729–731
Paice JA, Toy C, Shott S (1998) Barriers to cancer pain relief: fear of tolerance and addiction. J Pain Symptom Manag 16(1):1–9
Portenoy RK (1989) Cancer pain: epidemiology and syndromes. Cancer 63:2298–2307
Ripamonti C, Zecca E, Brunelli C, Groff L, Boffi R, Caraceni A et al (2000) Pain experienced by patients hospitalized at the National Cancer Institute of Milan: research project "towards a pain-free hospital". Tumori 86(5):412–418
Von Roenn JH, Cleeland CS, Gonin R, Hatfield AK, Pandya KJ (1993) Physician attitudes and practice in cancer pain management: a survey from the Eastern Cooperative Oncology Group. Ann Int Med 119:121–126
World Health Organisation (1996) Cancer Pain relief with a Guide to Opioid Availability.Geneva, World Health Organisation
Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psyc Scand 67(6):361–370
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Cascinu, S., Giordani, P., Agostinelli, R. et al. Pain and its treatment in hospitalized patients with metastatic cancer. Support Care Cancer 11, 587–592 (2003). https://doi.org/10.1007/s00520-003-0491-3
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DOI: https://doi.org/10.1007/s00520-003-0491-3