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Adoptation of an evidence-based clinical practice guideline in cancer pain management by medical oncologists: a case vignette study

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Abstract

Purpose

Pain is a major problem in all cancer stages. Cancer pain guidelines are developed to improve management of pain. It is unclear whether these recommendations are applied in daily practice. Therefore, the objective of this study was to assess medical oncologists’ adherence to an evidence-based clinical practice guideline in cancer pain management and their confidence in treatment choices.

Methods

A cross-sectional case vignette survey describing a patient with intractable pancreatic cancer and pain was sent to all 268 medical oncologists registered at the Netherlands Association of Internal Medicine. Descriptive statistics were conducted.

Results

Sixty-three of 268 medical oncologists (24 %) completed the survey. Adherence to the different recommendations of the guideline ranged from 18 to 100 %. Confidence for treatment choice ranged from 5.6 to 9.5 on a Numeric Rating Scale (0–10). Most of the responding oncologists (94 %) adhered to prescribing paracetamol as first-line pain treatment, and all prescribed a laxative in combination with opioids to prevent constipation. However, only 24 % of the respondents adhered to the guideline when first-line treatment had insufficient effect. Additionally, only 35 % adhered to the recommendation for insomnia treatment providing psychosocial support or using a multidimensional pain questionnaire besides pharmacological treatment. Finally, only 18 % adhered to the recommendation to perform a multidimensional pain assessment when disease worsens and pain increases.

Conclusions

The recommendations of the guideline have been partly adopted in cancer pain practice by medical oncologists. Particularly, pain assessment is not applied in the recommended manner. Therefore, implementation strategies should focus on adequate pain assessment in patients with cancer.

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Acknowledgments

This study was funded by KWF (Dutch Cancer Society) and “Bergh in het Zadel” (private funding association).

Conflict of interest

Authors have no conflict of interest.

Author contributions

NtB was principal investigator. All authors contributed to the conception and design of the study. NtB was responsible for data collection and for analysis and data interpretation. All authors were responsible for writing the manuscript. All authors approved the final manuscript. Medical writers were involved (KV, KB).

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center (Radboudumc), PO Box 9101, 6500 HB, Nijmegen, The Netherlands

    Nienke te Boveldt, Kees Besse, Kris Vissers & Yvonne Engels

  2. Department of IQ Healthcare, Radboud university medical center (Radboudumc), PO Box 9101, 6500 HB, Nijmegen, The Netherlands

    Myrra Vernooij-Dassen

  3. Kalorama Foundation, Beek-Ubbergen, The Netherlands

    Myrra Vernooij-Dassen

Authors
  1. Nienke te Boveldt
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  2. Myrra Vernooij-Dassen
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  3. Kees Besse
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  4. Kris Vissers
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  5. Yvonne Engels
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Corresponding author

Correspondence to Nienke te Boveldt.

Appendices

Appendix 1: case vignette

Appendix 2 additional references Table 2

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te Boveldt, N., Vernooij-Dassen, M., Besse, K. et al. Adoptation of an evidence-based clinical practice guideline in cancer pain management by medical oncologists: a case vignette study. Support Care Cancer 23, 1409–1420 (2015). https://doi.org/10.1007/s00520-014-2472-0

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  • DOI: https://doi.org/10.1007/s00520-014-2472-0

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