title: Pain assessment and management in paediatric oncology: a cross-sectional audit.
abstract: OBJECTIVE
  To describe the pain assessment and management practices documented by health professionals within a tertiary-level Children's Cancer Centre and to evaluate how these practices were compared with international recommendations.
  
  
  BACKGROUND
  Children with cancer are vulnerable to pain due to the intensity of antineoplastic therapy. Therefore, it is imperative to ensure that current pain management practices provided to paediatric oncology inpatients are of a high quality.
  
  
  METHODS
  A single-site cross-sectional audit.
  
  
  METHODS
  A 24-hour period of documented pain-related care in randomly selected inpatients of an Australian tertiary-level Children's Cancer Centre was examined. The current pain management practices were audited over a two-month period resulting in 258 episodes of pain-related care being reviewed.
  
  
  RESULTS
  Pain related to medical treatment for cancer was common (n = 146/258, 57%) and persistent. The presence of pain was not consistently recorded by health professionals (n = 75/146, 51%). Pain was mild (n = 26/75, 35%) and opioids were the mainstay of pain management interventions (n = 63/112, 56%). Adjuvants were an important component of pain management (n = 47/112, 42%), and nonpharmacological methods of managing pain were under-represented in this audit (n = 38/146, 26%). According to the Pain Management Index, pain was appropriately managed for the majority of children (n = 65/76, 87%).
  
  
  CONCLUSIONS
  Pain management practices did not fully reflect the recommendations of contemporary paediatric pain management. Due to limitations in the documentation of children's pain, it was difficult to determine the effectiveness of pain management interventions.
  
  
  CONCLUSIONS
  This study highlights the ongoing problem of pain for children receiving antineoplastic therapy. It is recommended that health professionals routinely screen for the presence of pain during hospitalisation and assess the efficacy of pain-related care.
authors.affiliation: Children's Cancer Centre, Royal Children's Hospital, Parkville, Melbourne, Vic., Australia.|Social and Mental Health Aspects of Serious Illness, Critical Care and Neurosciences, Murdoch Children's Research Institute, Parkville, Melbourne, Vic., Australia.|Department of Nursing, University of Melbourne, Parkville, Melbourne, Vic., Australia.|Department of Anaesthesia and Pain Management, Royal Children's Hospital, Parkville, Melbourne, Vic., Australia.
authors.forename: Karin
authors.initials: K
authors.lastname: Plummer
authors.affiliation: Children's Cancer Centre, Royal Children's Hospital, Parkville, Melbourne, Vic., Australia.|Social and Mental Health Aspects of Serious Illness, Critical Care and Neurosciences, Murdoch Children's Research Institute, Parkville, Melbourne, Vic., Australia.
authors.forename: Maria
authors.initials: M
authors.lastname: McCarthy
authors.affiliation: Department of Anaesthesia and Pain Management, Royal Children's Hospital, Parkville, Melbourne, Vic., Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: McKenzie
authors.affiliation: Department of Nursing, University of Melbourne, Parkville, Melbourne, Vic., Australia.|Critical Care and Neurosciences, Murdoch Children's Research Institute, Parkville, Melbourne, Vic., Australia.|Department of Pediatrics, University of Melbourne, Parkville, Melbourne, Vic., Australia.|Department of Nursing Research, Royal Children's Hospital, Parkville, Melbourne, Vic., Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Newall
authors.affiliation: Departments of Nursing, Deakin University, Burwood, Melbourne, Vic., Australia.|Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Melbourne, Vic., Australia.|Melbourne School of Health Sciences, University of Melbourne, Parkville, Melbourne, Vic., Australia.|Faculty of Health, School of Nursing and Midwifery, Deakin University, Burwood, Melbourne, Vic., Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Manias
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use; D001315:Australia; D002173:Cancer Care Facilities; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000451:nursing; D009741:Nursing Staff, Hospital / Q000592:standards; D010146:Pain / Q000188:drug therapy* / Q000451:nursing; D059408:Pain Management / Q000592:standards*; D010147:Pain Measurement / Q000451:nursing*
chemical_list: D000700:Analgesics
keywords: cancer; children; pain; pain assessment; pain management; quality of care