Shared Decision-Making With Physicians Helps Assess, Improve Pain

Shared decision-making with health care providers can help to implement a comprehensive pain assessment at baseline and improve outcomes among patients with metastatic cancer, according to study results presented at the ONS 44th Annual Congress.

“Shared decision making can foster earlier identification and improved pain management, where patient preferences, goals, and concerns are discussed,” Jeannine Brant Ph. D., APRN, AOCN, FAAN, Billings Clinic, said during her presentation.

The prevalence of cancer pain ranges from 52% to 77%, which contributes to suffering and increased health care utilization, she added.

Therefore, in one of the first studies to examine shared decision-making as part of the pain management plan of care, 52 patients with metastatic cancer experiencing pain or were taking opioids to manage chronic cancer pain completed a tablet-based survey at enrollment to record baseline pain and activity levels, pain flare severity and length, end of dose pain and shared decision-making preferences.

In turn, results from the survey were then presented on an electronic dashboard and the healthcare provider and patient collaboratively established a pain care plan. The tailored care plans defined the breakthrough agent for treatment, reinforced the patient taking a long-acting opioid and provided specific medication instructions, Brant explained. Next, in visits two through four, the health care providers tracked symptoms over time to determine if they were making any progress with patient pain.

The effectiveness of shared decision-making on pain outcomes was then measured with the Pain Care Quality Survey. “This really addresses who well we take care of their pain needs as well as involving them in decision making in the pain care plan,” Brant said.

The majority of patients were female (63%) and white (61%), at a mean age of 56. Diagnoses included breast (nine patients), hematologic (seven patients), gastrointestinal (seven patients), gynecologic (six patients), head and neck (six patients), endocrine (six patients), thoracic (five patients), colorectal (three patients) and other types of cancer (six patients).

At baseline, the average pain scores was 6.0 on a scale from zero to 10, which improved to 5.0 at the second visit. In total, 88% reported to have experienced pain flare, with a mean severity score of 8.0, of which 74% said their flares last longer than 30 minutes. In addition, 70% reported experiencing unexpected pain and 25% had end-of-dose pain.

Overall, 23 patients (44%) reported a desire for shared decision-making with their provider, while 22 (42%) preferred to make their final decision after they consider their health care provider’s input and five patients (10%) wanted to leave the decision up to their physician.

“Patients were pretty satisfied with the platform and we’ve been doing these for quite some time now,” Brant said.