Multidisciplinary pain management based on a computerized clinical decision support system in cancer pain patients.
A prospective controlled intervention cohort study in cancer pain patients (n=50 per group) admitted to radiation oncology wards (62 beds, 3 wards) was conducted in a 1621-bed university hospital. We investigated the effect of an intervention consisting of daily pain assessment using the numeric visual analog scale (NVAS) and pain therapy counseling to clinicians based on a computerized clinical decision support system (CDSS) to correct deviations from pain therapy guidelines. Effects on guideline adherence (primary outcome), pain relief (NVAS) at rest and during physical activity (both groups: cross-sectional assessment on day 5; intervention group: every day assessment), co-analgesic prescription, and acceptance rates of recommendations (secondary outcomes) were assessed. The number of patients with at least one deviation from guidelines at discharge was decreased by the intervention from 37 (74%) in controls to 7 (14%, p<0.001). In the intervention group, pain (NVAS) decreased during hospital stay at rest from 3.0 (Delta(0.5) (Q(75%)-Q(25%))=3.0) on admission to 1.5 (Delta(0.5)=1.0) at discharge (p<0.01) and during physical activity from 7.0 (Delta(0.5)=4.0) on admission to 2.5 (Delta(0.5)=3.8) at discharge (p<0.001). At discharge, the number of patients treated with co-analgesics increased from 23 (46%) in controls to 33 (66%) in the intervention group (p=0.04). From 279 recommendations issued in the intervention 85% were fully accepted by the physicians. Deviations from well-established guidelines are frequent in pain therapy. A multidisciplinary pain management increased adherence to pain management guidelines.
Bertsche
Thilo
T
Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany.
Askoxylakis
Vasileios
V
Habl
Gregor
G
Laidig
Friederike
F
Kaltschmidt
Jens
J
Schmitt
Simon P W
SP
Ghaderi
Hamid
H
Bois
Angelika Zabel-du
AZ
Milker-Zabel
Stefanie
S
Debus
Jürgen
J
Bardenheuer
Hubert J
HJ
Haefeli
Walter E
WE
D000368:Aged; D000700:Analgesics; D016009:Chi-Square Distribution; D015331:Cohort Studies; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome
D000700:Analgesics