Assessing the quality of pain care in ambulatory patients with advanced stage cancer.
BACKGROUND
Pain is common among patients with advanced cancer despite the dissemination of clinical pain care guidelines.


OBJECTIVE
We sought to assess the quality of pain care among patients with advanced disease.


METHODS
We reviewed the records of 85 adult ambulatory patients with advanced breast, lung, and gastrointestinal cancer treated in 2004-2006. Patients' screening pain intensity scores were at least 7 of 10. Nurse reviewers completed medical record reviews of care rendered at the index visit and over the subsequent 30 days based on the 2004 National Comprehensive Cancer Network pain guideline. An expert panel then rated the quality of the evaluation, treatment, and overall pain care. We used a multivariable model to analyze guideline compliance and resolution of severe pain.


RESULTS
Among advanced cancer patients with severe pain, clinicians adjusted pain medications only half the time and made few timely referrals for pain-related consultations. By 30 days after the index visit, 34% of patients continued to report severe pain. The expert panel judged the overall quality of pain care as "fair" or "poor" in about two-thirds of cases because more timely and effective intervention could have reduced the severity and duration of pain. Resolution of severe pain was associated with adjustment of pain medications at the index visit (adjusted odds ratio 3.8, 95% CI 1.3-10.6).


CONCLUSIONS
There is room for improvement in the pain care of patients with advanced cancer. Additional research is needed to understand the reasons for poor performance.
Center for Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA. saul_weingart@dfci.harvard.edu
Saul N
SN
Weingart
Angela
A
Cleary
Sherri O
SO
Stuver
Maureen
M
Lynch
Douglas
D
Brandoff
Kristen G
KG
Schaefer
Junya
J
Zhu
Donna L
DL
Berry
Susan
S
Block
Jane C
JC
Weeks
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000592:standards*; D001900:Boston; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000451:nursing*; D010146:Pain / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D010147:Pain Measurement; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013727:Terminal Care