Implementing national standards for cancer pain management: program model and evaluation.

The purpose of this quasi-experimental (pre and posttest) study was to test a model pain management program (PMP) to implement the American Pain Society (APS) quality assurance standards for the management of acute and chronic cancer pain using a continuous quality improvement (CQI) approach to improve professionals' knowledge and skills, patient satisfaction, and to identify areas needing improvement. The sample consisted of 1210 nurse responses and 698 interviews of patients with pain during hospitalization at a major urban cancer center. The PMP provided a structure (standards), educational opportunities, and training in CQI methods. Outcome measures included a patient evaluation questionnaire and concerns checklist; nurse knowledge, attitude and barriers questionnaire; and focus groups to identify areas needing improvement. Significant improvements were found in patients' satisfaction, nurses' knowledge and attitude scores, and reductions in nurses' perceptions of barriers. Focus groups revealed the need for improved communication among disciplines about pain and better assessment of patients unable to self-report. The program met its goal of implementing the APS standards, educating nurses, and identifying "system" problems, and improving overall patient satisfaction.

Implementation of an anesthesia pain management service program.

Pain management has emerged as a priority patient care issue, especially in the oncology setting. For most patients with advanced cancer, pain is a major symptom. Cancer pain can be acute, chronic, or a combination. Patient-controlled analgesia (PCA) and epidural analgesia have been shown to be safe and effective techniques for the management of pain in the acute and chronic pain populations. Little information is available concerning the use of these modalities in patients with cancer. The authors describe the experience of instituting a pain management program at Memorial Sloan-Kettering Cancer Center. The objectives of the program, the components necessary to institute the pain management program, and the roles of PCA and epidural analgesia are noted. Recommendations are offered for organization of services, reliance on primary nurses, and involvement of the multidisciplinary team. Safety concerns and other patient-related issues are highlighted. Based on Memorial Hospital experience, the authors conclude that an acute pain service has an important role in meeting the needs of patients with cancer.