title: Australian survey of current practice and guideline use in adult cancer pain assessment and management: perspectives of palliative care physicians.
abstract: BACKGROUND
  Cancer pain continues to be undertreated, despite the availability of evidence-based guidelines. The Australian National Pain Strategy identified establishment of systems and guidelines to adequately manage cancer pain as a high priority.
  
  
  OBJECTIVE
  This study aimed to identify barriers and facilitators to adult cancer pain assessment and management as perceived by Australian health professionals; establish the perceived need for new Australian guidelines and implementation strategies; identify which guidelines are used; and identify barriers and facilitators to guideline use. This article focuses on the perceptions of responding palliative care physicians.
  
  
  METHODS
  A cross-sectional survey was administered online.
  
  
  METHODS
  Invitations were circulated via peak bodies and clinical leaders. Comments were coded independently by two researchers.
  
  
  RESULTS
  Ninety-two palliative care physicians responded to the survey; 39% of the national total. The majority reported barriers to pain management, including insufficient access to nonpharmacologic interventions, poor coordination between services, and management challenges posed by comorbidities. Forty-five percent reported using pain guidelines, most commonly the Australian Therapeutic Guidelines-Palliative Care. Respondents were largely supportive of the development of new Australian guidelines and implementation strategies, in particular any offering advice on specific cases of cancer pain (e.g., neuropathic), patient self-management resources, assessment of patient priorities, and disciplinary roles.
  
  
  CONCLUSIONS
  Barriers to evidence-based practice identified by our survey might be addressed via strategies to support decision making and coordination of care (e.g., a clinical pathway). Particular attention should be paid to promoting access to nonpharmacologic interventions and patient education, and improving referral and care coordination.
authors.affiliation: 1 Department of Palliative Care , HammondCare, Sydney, New South Wales, Australia .
authors.forename: Melanie
authors.initials: M
authors.lastname: Lovell
authors.forename: Meera
authors.initials: M
authors.lastname: Agar
authors.forename: Tim
authors.initials: T
authors.lastname: Luckett
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
authors.forename: Anna
authors.initials: A
authors.lastname: Green
authors.forename: Josephine
authors.initials: J
authors.lastname: Clayton
mesh_terms: D000328:Adult; D001315:Australia; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications*; D059408:Pain Management; D010147:Pain Measurement; D010148:Intractable Pain / Q000628:therapy*; D010166:Palliative Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*