Intrathecal infusions for intractable cancer pain: a qualitative study of the impact on a case series of patients and caregivers.
BACKGROUND
The need for intrathecal infusion in a palliative care setting is infrequent. Despite established efficacy, safety and cost effectiveness, this is considered an 'extraordinary measure' in Canada. Patients requiring this approach are not typical palliative care patients, having shorter and more uncertain life expectancies.


OBJECTIVE
The present study is a qualitative exploration of the impact of intrathecal pump implantation on cancer patients, and also the impact of the intervention on the staff caring for those patients.


METHODS
Palliative care unit patients who received an implanted intrathecal pump or dome catheter for intractable cancer pain participated in multiple semistructured interviews. Doctors and nurses caring for each patient were also interviewed. Interviews were recorded and analyzed for themes. The study terminated when saturation was reached.


RESULTS
Six patients participated, with up to three interviews each. Twenty-four staff interviews took place. Patients' hopes and expectations were not always fully met, but the infusions had a profound positive effect on quality of life. Patients expressed anxiety about dependence on the device, and also on a few highly skilled individuals. Staff interviews revealed a significant impact on the 'culture' of the palliative care unit. Clear communication of the rationale for infusion was very important, as was regular education about infusion management.


CONCLUSIONS
Implanted intrathecal infusion devices are a necessary part of a tertiary level cancer pain management service for the unfortunate minority with intractable pain. Practical recommendations for care are made for palliative care programs contemplating offering intrathecal infusions.
Hawley
Philippa
P
Pain and Symptom Management/Palliative Care Program, British Columbia Cancer Agency, Vancouver, Canada. phawley@bccancer.bc.ca
Beddard-Huber
Elizabeht
E
Grose
Cameron
C
McDonald
William
W
Lobb
Daphne
D
Malysh
Louise
L
D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D017028:Caregivers / Q000523:psychology*; D016503:Drug Delivery Systems / Q000379:methods; D005260:Female; D006801:Humans; D007278:Injections, Spinal / Q000379:methods; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010147:Pain Measurement / Q000379:methods; D010148:Intractable Pain / Q000188:drug therapy / Q000209:etiology* / Q000523:psychology / Q000628:therapy*; D010166:Palliative Care / Q000379:methods* / Q000523:psychology*; D011788:Quality of Life; D012189:Retrospective Studies
D000701:Analgesics, Opioid