Congress Abstracts 2004

38

EXAMINING THE EFFECTIVENESS OF OPIATE USE IN CANCER PAIN MANAGEMENT: VARIATION ACROSS OUTPATIENT ONCOLOGY CLINIC SETTINGS. Mary Thomas, RN, MS, AOCN^®, VA Palo Alto Health Care System, Palo Alto, CA; Shirley Hwang, RN, MS, AOCN^®, VA Health Care System of New Jersey, East Orange, NJ; Doretta Annis, RN, BSN, OCN^®, VA Central California Health Care System, Fresno, CA; and Kathleen Fahey, RN, MS, Jan Elliott, RN, MS, AOCN^®, and Marty Douglas, RN, DNSc, FAAN, VA Palo Alto Health Care System, Palo Alto, CA.

Despite continued emphasis, effective pain management (PM) remains difficult to achieve. One potential barrier may be inadequate individualization of PM (i.e., approaches to PM may be setting-specific, rather than patient-specific).

The purpose of this pilot study was to compare the amount of pain medication prescribed at three VA oncology clinics and to assess its impact on patients’ pain intensity ratings, satisfaction with PM, and specific quality-of-life parameters.

Ahles’ multidimensional nature of cancer pain served as the conceptual framework for this study.

The Brief Pain Inventory was used to measure the dependent variables of pain severity, pain relief, and impact of pain on various dimensions of quality of life (e.g., general activity, sleep, enjoyment of life). This instrument has established reliability and validity. Medications prescribed and taken were recorded and converted into morphine equivalents (MEQ) using AHCPR guidelines.

The dependent variables were examined using a one-way ANOVA. For those variables demonstrating a statistically significant difference in mean scores, a pair-wise contrast analysis was performed using the Bonferroni or Dunnett T3 method as appropriate.

141 adults (96% male) with a variety of cancer types who reported having cancer pain participated in this study. The mean amount of medication prescribed for patients at Clinic A (188 mg, MEQ, SD = 187 mg) was significantly greater (p < .001) than that at Clinics B or C (80 mg MEQ, SD = 102 mg; 58 mg MEQ, SD = 78 mg, respectively). Similar findings were realized when comparing the amount of opiates reported as actually taken by the patients, albeit less than was prescribed. Despite the great difference in amount of opiates used by those at Clinic A, there was no significant difference in patients’ pain intensity ratings, amount of pain relief achieved, or in ratings of impact of pain on specific quality-of-life parameters across the three clinic settings. While liberal use of opiates is often considered an integral component of effective PM, data from this study suggest that cancer pain can persist despite liberal opiate use. Additional approaches may be necessary in conjunction with opiate use if PM is to be truly effective.