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An in-hospital clinical care pathway with integrated decision support for cancer pain management reduced pain intensity and needs for hospital stay

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Abstract

Purpose

A clinical care pathway for pain management in a palliative care unit was studied with outcomes related to patients, physicians, and health care service. Mandatory use of patient-reported outcome measures (PROMs) and physician-directed decision support (DS) were integrated parts of the pathway.

Methods

Adult cancer patients with pain intensity (PI) ≥ 5 (NRS 0–10) at admission were eligible. The patients reported average and worst PI at admission, day four, and discharge. The physicians completed the DS at admission and day four. The DS presented potential needs for treatment changes based on pain severity and pathophysiology. The physicians reported treatment changes due to input from the DS system. The two primary outcomes were average and worst PI changes from admission to discharge. Hospital length of stay (LOS) was registered.

Results

Of 52 included patients, 41 were discharged alive. For those, the mean average PI at admission and at discharge was 5.8 and 2.4, respectively, a reduction of 3.4 points (CI 95% 2.7–4.1). The corresponding worst pain intensities were 7.9 and 3.8, a reduction of 4.1 points (CI 95% 3.4–4.8). The physicians completed DS forms for all patients. Fifty-five percent (CI 95% 41–69) of the patients had pain intervention changes based on the DS. A significant reduction in LOS (4.4 days, CI 95% 0.5–8.3) was observed during the study period.

Conclusions

The interventions were implemented according to the intentions and PI was reduced as hypothesized. For evaluation of generalizability, the interventions should be studied in other settings and with a controlled design.

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Acknowledgments

The Norwegian Cancer Society supported this study. All authors had full access to all of the data in the study and take complete responsibility for the integrity of the data and accuracy of the data analysis. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

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Authors and Affiliations

  1. Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology , N-7491, Trondheim, Norway

    Erik Torbjørn Løhre, Morten Thronæs & Stein Kaasa

  2. Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

    Erik Torbjørn Løhre & Morten Thronæs

  3. Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Cinzia Brunelli

  4. European Palliative Care Research Centre (PRC), Department of Oncology and Institute of Clinical Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway

    Cinzia Brunelli & Stein Kaasa

  5. Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway

    Pål Klepstad

  6. Department of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

    Pål Klepstad

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  1. Erik Torbjørn Løhre
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Correspondence to Erik Torbjørn Løhre.

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Løhre, E.T., Thronæs, M., Brunelli, C. et al. An in-hospital clinical care pathway with integrated decision support for cancer pain management reduced pain intensity and needs for hospital stay. Support Care Cancer 28, 671–682 (2020). https://doi.org/10.1007/s00520-019-04836-8

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