title: Adaptation of an evidence-based clinical practice guideline in cancer pain management by medical oncologists: a case vignette study.
abstract: OBJECTIVE
  Pain is a major problem in all cancer stages. Cancer pain guidelines are developed to improve management of pain. It is unclear whether these recommendations are applied in daily practice. Therefore, the objective of this study was to assess medical oncologists' adherence to an evidence-based clinical practice guideline in cancer pain management and their confidence in treatment choices.
  
  
  METHODS
  A cross-sectional case vignette survey describing a patient with intractable pancreatic cancer and pain was sent to all 268 medical oncologists registered at the Netherlands Association of Internal Medicine. Descriptive statistics were conducted.
  
  
  RESULTS
  Sixty-three of 268 medical oncologists (24 %) completed the survey. Adherence to the different recommendations of the guideline ranged from 18 to 100 %. Confidence for treatment choice ranged from 5.6 to 9.5 on a Numeric Rating Scale (0-10). Most of the responding oncologists (94 %) adhered to prescribing paracetamol as first-line pain treatment, and all prescribed a laxative in combination with opioids to prevent constipation. However, only 24 % of the respondents adhered to the guideline when first-line treatment had insufficient effect. Additionally, only 35 % adhered to the recommendation for insomnia treatment providing psychosocial support or using a multidimensional pain questionnaire besides pharmacological treatment. Finally, only 18 % adhered to the recommendation to perform a multidimensional pain assessment when disease worsens and pain increases.
  
  
  CONCLUSIONS
  The recommendations of the guideline have been partly adopted in cancer pain practice by medical oncologists. Particularly, pain assessment is not applied in the recommended manner. Therefore, implementation strategies should focus on adequate pain assessment in patients with cancer.
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center (Radboudumc), PO Box 9101, 6500 HB, Nijmegen, The Netherlands, nienke.faber-teboveldt@radboudumc.nl.
authors.forename: Nienke
authors.initials: N
authors.lastname: te Boveldt
authors.forename: Myrra
authors.initials: M
authors.lastname: Vernooij-Dassen
authors.forename: Kees
authors.initials: K
authors.lastname: Besse
authors.forename: Kris
authors.initials: K
authors.lastname: Vissers
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Engels
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D003248:Constipation / Q000139:chemically induced / Q000517:prevention & control; D003430:Cross-Sectional Studies; D055317:Evidence-Based Practice / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008297:Male; D008495:Medical Oncology / Q000592:standards*; D008875:Middle Aged; D009426:Netherlands; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management / Q000592:standards*; D010147:Pain Measurement / Q000592:standards; D010190:Pancreatic Neoplasms / Q000150:complications / Q000188:drug therapy; D010820:Physicians; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
chemical_list: D000701:Analgesics, Opioid; D054368:Laxatives; D000082:Acetaminophen