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Improving Palliative Care for Cancer
from the outpatient clinics of 26 medical oncologists in western Washington State. A multilevel treatment algorithm, based on the AHCPR Guideline for Cancer Pain Management was compared with “standard practice” (control) therapies for pain and symptom management used by community oncologists. The primary outcome of interest was pain. Patients randomized to the guideline group achieved a statistically significant reduction in usual pain intensity when compared with standard community practice.
A second randomized trial, evaluating the effects of an education program for cancer patients with chronic pain (de Wit et al., 1997), also used pain as an outcome variable. Information about pain and pain management was given to patients in the intervention group by several media: verbal instruction, written material, an audio cassette tape, and the use of a pain diary. The pain education program consisted of three elements: (1) educating patients about the basic principles of pain and pain management, (2) instructing patients how to report their pain in a pain diary, and (3) instructing patients how to communicate about pain and how to contact health care providers. Patients in the intervention group participated in the pain education program in the hospital and three and seven days post-discharge by telephone. Results showed a significant increase in pain knowledge and a significant decrease in pain intensity in patients who received the pain education program.
Studies of the prevalence, severity, and treatment of pain present a model of the descriptive research that has to be done in other areas of symptom management and end-of-life care. First, we need to determine the prevalence and severity of various symptoms in patients throughout the course of their disease: at diagnosis, during treatment, when cancer is in remission, and near the end of life. This includes the behavioral, economic, and social impact of these symptoms. There is an urgent need to learn more about how care for advanced disease is reimbursed. It is important to include longitudinal designs in this research so that we can determine changes in symptom patterns over time. We also need to identify the adequacy of care for these symptoms, including identifying what factors (e.g., patient related, clinician related, system related) are predictive of poor symptom management and poor end-of-life care.
Current projects were identified in areas related to end of life, palliative care, and symptom control by searching CRISP, the NIH engine for indexing currently funded research. Key words for the major areas of such research were combined with “cancer.” Individual funding abstracts were inspected to see if they were research projects, defined as “matches.” Excluded were training grants, fellowships without a specific research topic,