Chen, J., Lu, X.Y., Wang, W.J., Shen, B., Ye, Y., Jiang, H., . . . Cheng, B. (2014). Impact of a clinical pharmacist-led guidance team on cancer pain therapy in China: A prospective multicenter cohort study. Journal of Pain and Symptom Management, 48, 500–509. 

DOI Link

Study Purpose

To assess the value of pharmacist-led teams as a model for improving drug delivery and implementing the role of the clinical pharmacist in direct patient care using cancer pain management as a focus area

Intervention Characteristics/Basic Study Process

Clinical guidance teams included clinical pharmacists, nurses registered in oncology, oncologists, and administrators. Pharmacists had at least two years' residency in the oncology department and underwent training in opioid pharmacotherapeutics, National Comprehensive Cancer Network guidelines, and Chinese practice guidelines, and they had to pass an examination. The pharmacist was responsible for patient and physician education, consulting in complex cases, and monitoring for drug efficacy and side effects. Patients with a history of cancer-related pain were enrolled. Patients were assigned consecutively to the intervention group, in which the guidance team was involved, or the control group, in which no guidance from the cancer pain therapy team was given. Outcomes were evaluated after six months. Patients in the experimental group had follow-up appointments via face to face or telephonic interviews twice a month. Study data were obtained from medical records and follow-ups.

Sample Characteristics

  • N = 542  
  • AGE = 63.7% aged greater than 60 years
  • MALES: 49.3%, FEMALES: 50.7%
  • KEY DISEASE CHARACTERISTICS: Disease types were not provided.

Setting

  • SITE: Multi-site  
  • SETTING TYPE: Inpatient    
  • LOCATION: China

Study Design

Cohort design

Measurement Instruments/Methods

  • Numeric or visual scale for pain (mean value from follow-up scores used in analysis)
  • Documentation of adverse effects (yes/no evaluation)
  • Quality of life questionnaire (not described)

Results

Compared to the control group, there were more frequent pain severity evaluations before opioid administration, more standardized dose titrations, more sustained-release formulations (p < 0.001), and fewer errors in dose conversion to other opioids (p = 0.017) in the experimental group. Pain scores were lower in the experimental group (p < 0.05), and the incidence of constipation, nausea, and vomiting was lower in the experimental group (p < 0.05).

Conclusions

The implementation of the clinical pharmacist role in guidance teams for cancer-related pain was associated with improvements in the process of medication management and pain scores.

Limitations

  • Key sample group differences that could influence results 
  • Measurement/methods not well described 
  • Risk of bias (no blinding) 
  • Risk of bias (no random assignment) 
  • Risk of bias (no appropriate attentional control condition)  
  • Unintended interventions or applicable interventions not described that would influence results 
  • Other limitations/explanation: No information regarding baseline pain levels was provided, so changes between groups are not known. Patient assignment was consecutive rather than true random assignment. Whether patient assignments to study groups took place within the same institution was not stated, and contamination could have occurred if patients in different groups were in the same location.

 

Nursing Implications

The findings of this study suggested that the intervention of a multidisciplinary team to guide pain management can improve medication management, monitoring, and chronic pain outcomes.