E-poster Presentation 2014 World Cancer Congress

Prospective Audit for Pain Control. (#585)

Sanghamitra Bora 1
  1. B.P.Poddar Hospital & Medical Research Ltd., Kolkata, WB, India

Background: For a country like India where 80% of cancer patients report to the cancer hospital at an advanced stage and the concept of Palliative Care is synonymous with terminal care, it is necessary to propagate the right concept of pain management and palliative care among patients and doctors.

Aim: To stress the importance of treating pain at the onset, improve the knowledge about pain, its management and impart scientific skills of measuring pain and its intensity which is limited among doctors and nurses. 

Methods: A standard of 100% was set. A Pain Screening Questionnaire was designed to be filled up by the attending Physicians/Oncologists at the Outpatient clinics. The responses were compared with the OPD record list in the PCU on a day to day basis. The number of patients referred for pain management was then compared against the standard. Conscious patients of all ages with a sound state of mind were included.

Results: 66.37% of patients (231/348) were referred to the pain clinic in the first round of the audit as compared to 90.93% (231/311) in the second round. The most frequently identified barriers in adequate pain management are found to be physician's underestimation and patient's reluctance to report pain.1

Conclusions: The audit reflected scope of improving practice in many areas for getting referral for pain management early on presentation. In this audit, patients from the outpatient department were included. It is now anticipated that if those in the inpatient and home care were also taken, the results may have further declined.

There is no auditing of Palliative Care services in India2. Improvement in patient care have been demonstrated with the help of audit in many places like Australia, Europe and Canada3. It is important to conduct audit in resource poor countries like India to improve palliative care services.

  1. Salminen E, Clemens KE, Syrjanen K, Salmenoja H. Needs of developing the skills of palliative care at the oncology ward: An audit of symptoms among 203 consecutive cancer patients in Finland. Support Cancer Care. 2008;16:3–8.
  2. Rajagopal, M.R. and Venkiteswaran, C. 2003. Palliative care in India: successes and limitations. In: Rajagopal, M.R. et al. eds. Pain and palliative Care in the Developing World and Marginalised Populations: A Global Challenge. Binghamton: The Haworth Medical Press, pp. 121-128.
  3. Higginson, I.J. and Bruera, E. 2002. Do we need Palliative Care auditing in developing countries? Palliative Medicine 16, pp.546-547.