Improving cancer pain in adult oncology patients through evidence-based structured program

SSN Jeraine J.N, Tien, Singapore National University Hospital (NUH) Centre for Evidence-Based Nursing: A JBI Centre of Excellence

Cancer-related pain is prevalent across the cancer trajectory. Despite having guidelines and frameworks on managing cancer pain, pain control among patients is suboptimal, with many cancer patients experiencing moderate to severe pain during their course of illness. Cancer pain negatively impacts patients’ psychosocial health and research has identified a correlation between uncontrolled pain and poorer quality of life arising primarily from the pain or experience itself. Uncontrolled pain is also associated with extensive utilisation of healthcare resources.

Jeraine Tien is an oncology nurse at the National University Cancer Institute at Singapore National University Hospital (NCIS) is a national specialist centre and the only public cancer centre in Singapore treating both paediatric and adult cancers in one facility.

When undergoing a Graduate Nurse Residency Program in 2018, Jeraine and a fellow residency nurse witnessed how cancer pain took a toll on patients’ quality of life. They also realised that some patients were refusing analgesia even when they were experiencing pain. These observations prompted them to undertake an EBP approach to address the issue.

Nurses play a pivotal role in cancer-related pain management. The role of a nurse includes pain assessment, management, evaluation effectiveness of management and pain education. Patient and care-giver knowledge about pain is also a critical component to achieve good control of cancer pain. Hence, the aim of my project is to improve patients’ perception of cancer pain management and pain control through implementing structured patient and family education on managing cancer pain.

The evidence implementation project utilised JBI PACES. The results of the baseline audit revealed that patients did not receive any patient and family education or a patient information leaflet on cancer-related pain management. The pre-implementation survey also indicated that the majority of patients had poorly controlled pain due to non-compliance with their analgesia regime due to fear of opioid addiction and not understanding the difference between strict doses and breakthrough doses.

Utilising the GRiP audit and feedback tool in JBI PACES, Jeraine and her project team identified barriers to achieving compliance on the best practice recommendations of cancer-related pain management and, in due course, executed several strategies to overcome the barriers. One of the most critical barriers that surfaced was the issue of time, leading the team to revise the contents of the pamphlets to further condense the information addressing patients’ fears and knowledge gaps. In addition, nurses received education on the importance of pain education.

The results from the post-implementation survey demonstrated that the delivery of a structured education program had successfully help improve patients’ knowledge on cancer-related pain management and pain control. At post-implementation, the number of patients who received verbal education increased from 0% to 69% at the post-implementation audit; the patients who received the patient information leaflet increased from 0% to 100%.

Patients’ compliance with the analgesic regime increased from 0% to 100%. The majority of the patients rated their pain level from none to mild pain (P<0.001) at the post-implementation audit.

The project was successful in promoting the delivery of patient and family education as well as the patient information leaflet on managing cancer pain to patients. The improvement in pain management was also attributed to better understanding of pain characteristics and analgesia regimes, which raised patients’ self-efficacy with pain management. This additional information from patients permitted a deeper understanding of the pros of a structured education.

The project would not be successful without access to JBI evidence-based tools and resources provided by the hospital. The JBI EBP Database provides a wide range of tools, such as JBI PACES and resources, including evidence summaries and Best Practice Information Sheets, designed to deliver practical implementation of EBP into the clinical settings.

Links to additional resources

Tien JN, Tan HC, Chua CT, Lee YM, Tho PC. Implementing an evidence-based structured education and management program in an inpatient adult oncology setting to improve patients’ pain control. JBI Evid Implement 2022;20(4):326-33. | DOI: 10.1097/XEB.0000000000000309