Dutch Pain Specialists' Adherence to the Multidisciplinary Guideline on Treating Pain in Patients with Cancer: A Case Vignette Study.
Many patients with cancer suffer from pain, which is often not optimally treated. In 2008, the evidence-based, multidisciplinary Dutch guideline on the diagnosis and treatment of pain in this patient group was published. We assessed knowledge about and adherence to the guideline by pain specialists.



A cross-sectional case vignette survey describing a palliative patient with intractable pancreatic cancer and pain was sent to all 350 Dutch anesthesiologists registered as pain specialists at the Netherlands Association of Anesthesiology. Descriptive statistics were conducted.



Ninety-three pain specialists completed the questionnaire (27%). The majority appeared to follow the guideline recommendations on pharmacological (99%) and invasive treatment (95%) in the diverse stages of the disease. However, the recommendation to use a one-dimensional pain scale to evaluate the effect of pain treatment and the recommendation to perform a multidimensional pain assessment if the patient in pain is in a deteriorating stage were only followed by a minority of the respondents (23% and 15%, respectively).



Regarding most recommendations, Dutch pain specialists know and intend to follow the national multidisciplinary cancer pain guideline. Yet, only a minority of them perform structural pain assessment of the patient with cancer pain. However, as the response rate was low (27%), the results should be interpreted with caution and cannot be generalized to the entire population of pain specialists in the Netherlands. We recommend that, in the guideline update and implementation programs, more attention be given to thorough assessment of the patient with pain and cancer.
Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
Kees
K
Besse
Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
Monique
M
Steegers
Department of IQ-Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.|Kalorama Foundation, Beek-Ubbergen, the Netherlands.
Myrra
M
Vernooij-Dassen
Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
Kris
K
Vissers
Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
Yvonne
Y
Engels
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008511:Medicine / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D059408:Pain Management / Q000379:methods / Q000592:standards*; D010147:Pain Measurement / Q000379:methods / Q000592:standards; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D010820:Physicians / Q000592:standards*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
Dutch; adherence; cancer; case vignette study; clinical practice guideline; multidisciplinary treatment; pain management