Cancer pain management in ambulatory care: can we link assessment and action to outcomes?
OBJECTIVE
Good cancer pain control requires appropriate assessment and treatment. The purpose of this study was to examine the relationships among physician, nurse practitioner, and nurse knowledge, documentation of assessment, treatment, and pain reduction in cancer patients seen in ambulatory settings.


METHODS
The study method included an assessment of pain knowledge of providers (physicians, nurse practitioners, and nurses) who worked in cancer clinics and a retrospective review of patients' records treated for cancer-related pain in their clinics. Fifty-eight providers from eight cancer clinics completed the knowledge questionnaire; 56 patient records were reviewed for assessment, treatment, and outcome data. Pain relief, the outcome, was obtained from documentation at the next clinic visit.


RESULTS
Of the 54 patient records that documented pain relief at the next clinic visit, 61.9% reported no relief. Chi square analysis revealed clinics with a higher level of pain knowledge documented a greater number of elements of an ideal pain assessment (p = 0.03) but was unrelated to treatment and pain relief reported. Assessment and treatment were unrelated to reported pain relief at the next clinic visit.


CONCLUSIONS
These data suggest that providers' pain knowledge is related to pain assessment but not treatment or outcome. In addition, these data showed no relationship between assessment, treatment prescribed, and pain relief in these ambulatory settings.
Department of Nursing, Vanderbilt University Medical Center, Nashville, TN, USA. nancy.wells@vanderbilt.edu
Nancy
N
Wells
M Rachel
MR
McDowell
Patty
P
Hendricks
Mary S
MS
Dietrich
Barbara
B
Murphy
D000553:Ambulatory Care / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D009722:Nurse Practitioners / Q000592:standards; D009726:Nurses / Q000592:standards; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D010820:Physicians / Q000592:standards; D012189:Retrospective Studies; D016896:Treatment Outcome