title: The impact of a simplified documentation method for the Edmonton classification system for cancer pain (ECS-CP) on clinician utilization.
abstract: The use of standardized pain classification systems such as the ECS-CP can assist in the assessment and management of cancer pain. However, its completion has been limited due to its perceived complexity of decoding each feature. The objectives of this study were to determine the rate of clinician documentation and completion of the ECS-CP features after revision and simplification of the response for each feature.
  
  
  
  Electronic records of consecutive patient visits at the outpatient supportive care center seen by 12 palliative medicine specialists were collected at 6 months before (pre-interventional period), 6 and 24 months after (post-interventional period) the implementation of the simplified ECS-CP tool. Rate of ECS-CP documentation, completion, and analysis of patient and physician predictors were completed.
  
  
  
  One thousand and twelve patients' documentation was analyzed: 343 patients, before; 341 patients, 6 months after, and 328 patients, 24 months after the intervention. ≥2/5 items were completed before the intervention, 6 months after the intervention and 24 months after intervention in 0/343 (0 %), 136/341 (40 %), and 238/328 (73 %), respectively (p < 0.001). 5/5 items were completed before the intervention, 6 months after the intervention and 24 months after intervention in 0/343 (0 %), 131/341 (38 %), and 222/328 (68 %), respectively, (p < 0.001). There were no patient or physician predictors found significant for successful documentation of ECS-CP.
  
  
  
  Our findings suggest that significant simplification and intensive education is necessary for successful adoption of a scoring system. More research is needed in order to identify how to adopt tools for daily clinical practice in palliative care.
authors.affiliation: Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1414, Houston, TX, 77030, USA. kctanco@mdanderson.org.
authors.forename: Kimberson
authors.initials: K
authors.lastname: Tanco
authors.affiliation: Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1414, Houston, TX, 77030, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Arthur
authors.affiliation: Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1414, Houston, TX, 77030, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Haider
authors.affiliation: Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1414, Houston, TX, 77030, USA.
authors.forename: Saneese
authors.initials: S
authors.lastname: Stephen
authors.affiliation: Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1414, Houston, TX, 77030, USA.
authors.forename: Sriram
authors.initials: S
authors.lastname: Yennu
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1414, Houston, TX, 77030, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000328:Adult; D000072716:Cancer Pain / Q000145:classification*; D004282:Documentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010147:Pain Measurement / Q000379:methods*
keywords: Cancer pain; ECS-CP; Edmonton classification system for cancer pain; Standardized pain classification system; Standardized pain score