title: Establishment of Personalized Pain Goals in Oncology Patients to Improve Care and Decrease Costs.
abstract: Cancer-related pain is common, negatively affects quality of life and survival, and often requires treatment with opioid analgesics. Patient-reported data that describe the incidence and severity of pain, medication use, and patient satisfaction with care are lacking.
  
  
  
  We analyzed 18 months of outpatient oncology clinic encounters from the electronic medical record to obtain data on pain levels and opioid and nonopioid treatments. In June 2014, we instituted a pain intervention by creating a pain management information handout for patients, educating clinicians on opioid cost-effectiveness, and implementing a nursing protocol to document personalized pain goals (PPGs).
  
  
  
  Moderate to severe pain was reported in nearly 15% of patient encounters. We observed an increase in the percentage of encounters with a documented PPG of 16% to 71% ( P < .001). On average, PPG was achieved in 84% of patients. Rates of high-cost long-acting opioid prescriptions (oxycodone controlled release and fentanyl patches), as a total of all long-acting opioids, declined from 45% preintervention to 33% postintervention ( P = .005).
  
  
  
  Our intervention improved rates of PPG documentation and decreased the number of prescriptions for high-cost long-acting opioids. Oncology clinics can implement simple quality improvement methods, such as asking patients about their PPG and educating clinicians about opioid costs, to improve outcomes and lower treatment costs.
authors.affiliation: Park Nicollet Oncology Research and HealthPartners Institute, Minneapolis, MN.
authors.forename: Dylan
authors.initials: D
authors.lastname: Zylla
authors.affiliation: Park Nicollet Oncology Research and HealthPartners Institute, Minneapolis, MN.
authors.forename: Amber
authors.initials: A
authors.lastname: Larson
authors.affiliation: Park Nicollet Oncology Research and HealthPartners Institute, Minneapolis, MN.
authors.forename: Gladys
authors.initials: G
authors.lastname: Chuy
authors.affiliation: Park Nicollet Oncology Research and HealthPartners Institute, Minneapolis, MN.
authors.forename: Lisa
authors.initials: L
authors.lastname: Illig
authors.affiliation: Park Nicollet Oncology Research and HealthPartners Institute, Minneapolis, MN.
authors.forename: Adina
authors.initials: A
authors.lastname: Peck
authors.affiliation: Park Nicollet Oncology Research and HealthPartners Institute, Minneapolis, MN.
authors.forename: Sarah
authors.initials: S
authors.lastname: Van Peursem
authors.affiliation: Park Nicollet Oncology Research and HealthPartners Institute, Minneapolis, MN.
authors.forename: James W
authors.initials: JW
authors.lastname: Fulbright
authors.affiliation: Park Nicollet Oncology Research and HealthPartners Institute, Minneapolis, MN.
authors.forename: Pamala A
authors.initials: PA
authors.lastname: Pawloski
authors.affiliation: Park Nicollet Oncology Research and HealthPartners Institute, Minneapolis, MN.
authors.forename: Sara
authors.initials: S
authors.lastname: Richter
authors.affiliation: Park Nicollet Oncology Research and HealthPartners Institute, Minneapolis, MN.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Mettner
mesh_terms: D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000191:economics* / Q000628:therapy*; D010146:Pain / Q000209:etiology*; D059408:Pain Management / Q000191:economics* / Q000379:methods; D017060:Patient Satisfaction; D011788:Quality of Life / Q000523:psychology*