Background: Pain is under-managed in adults with cancer despite internationally available guidelines. Adherence is poor which detracts from outcomes. Audit and feedback improves guideline translation and pain outcomes. A set of palliative care indicators for pain has been developed using systematic review and modified RAND process, and implemented in July 2014 using an audit tool in 22 sites in Victoria, Australia. The indicators are: use of validated pain scale (Indicator 1); assessment of pain at first presentation (Indicator 2); regular pain assessment (Indicator 3); bowel regime plan (Indicator 4); routine prescription of opioid analgesia for breakthrough cancer pain (Indicator 5); and the scheduling of pain medication for severe pain (Indicator 6).
Aim:pilot the audit tool in New South Wales (NSW) as part of complex systems intervention to improve cancer pain guideline uptake to be evaluated in a planned multisite randomised controlled trial.
Methods: Medical records of 35 patients with advanced cancer and pain from public palliative care (n=20) and private oncology (n=15) health services in NSW were audited. NSW data was compared with the data from Victoria (n= 278) and shown in brackets (%V) for each indicator.
Results: Compliance for: Indicator 1 was 90.6% across both services (96%V), Indicator 2 was 95% of public palliative care of and 73% of private oncology patients, (87%V)). A pain chart greatly increased comprehensiveness of pain assessment. Indicator 3: 83% (96%V) Indicator 4: 100% of public and 66% of private patients. (87%V) Indicator 5 and 6 were similar between services: overall 71.4% (87%V) and 94.3% (85%V).
Conclusions:The audit tool was found to be a feasible component of a complex intervention for improving translation of cancer pain management guidelines into practice.