title: Cancer pain management in Lanarkshire: a community-based audit.
abstract: BACKGROUND
  A prospective, longitudinal audit of pain management in patients with cancer was conducted in an unselected community population in Lanarkshire, Scotland.
  
  
  METHODS
  Using a modified Delphi technique, a recording form was developed and a dedicated project manager was appointed to oversee the development and implementation of the audit. Community staff recorded pain level and analgesic prescribing on consecutive home visits to patients with cancer-related pain. Areas of good and poor prescribing were assessed using standards previously developed for the Scottish Cancer Pain Audit. These results were fed back to prescribers in a variety of ways and used as a focus for a programme of primary care-based education.
  
  
  RESULTS
  Five hundred and forty-one patients have been entered in the audit between May 1999 and end October 2002. A total of 3259 visits have been recorded and 88% of general practices in Lanarkshire submitted forms during this period. Pain scores were recorded in 90% of visits. Specific gaps in prescribing practice were identified.
  
  
  CONCLUSIONS
  The audit demonstrated that it is possible to engage primary care teams in a continuing audit of cancer pain management, which is achievable within the context of normal care. It provided a means to collect and analyse serial data on pain level and pain management and to identify areas of prescribing in need of improvement. Concerted efforts to establish the legitimacy and relevance of the project in the eyes of key stakeholders proved fundamental to encouraging longer-term behavioural change in the management of cancer pain.
authors.affiliation: Fairmile Marie Curie Centre, Frogston Road West, Edinburgh EH10 7DR, UK. david.oxenham@mariecurie.org.uk
authors.forename: David
authors.initials: D
authors.lastname: Oxenham
authors.forename: Robert
authors.initials: R
authors.lastname: Duncan
authors.forename: Moira
authors.initials: M
authors.lastname: Fischbacher
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D003697:Delphi Technique; D005194:Family Practice / Q000592:standards; D006801:Humans; D008485:Medical Audit / Q000379:methods; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods; D010166:Palliative Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012606:Scotland
chemical_list: D000700:Analgesics