Barriers to Effective Cancer Pain Management, Comparing the Perspectives of Physicians, Nurses, and Patients.

BACKGROUND: Pain associated with cancer is one of the most significant concerns for patients, families, and health care providers. Various barriers may hinder optimal pain management. AIM: The study was conducted in specialized cancer center in Jordan and aimed to explore the barriers to effective cancer pain management from the perspectives of physicians, nurses, and patients. METHODS: A quantitative descriptive cross-sectional design was used, with a total sample of 185 participants (55 Physicians, 70 Nurses, and 60 Patients) who completed a demographic datasheet and the Arabic-Barrier Questionnaire II (BQII). RESULTS: The overall BQII of patient score was 2.4 (standard deviation [SD] = 0.7). The harmful effects of pain medications were the highest barrier 2.7 (SD = 1.0), followed by the physiologic effect 2.4 (SD = 0.9), and the communication 2.4 (SD = 1.1) subscales. Nurses and physicians reported an overall BQII of 1.9 (SD = 1.1) and 1.8 (SD = 0.9), respectively. One-way analysis of variance showed that the perspectives of patients, physicians, and nurses differed significantly in the overall BQII F(2, 182) = 6.81, p < .01, communication F(2, 182) = 10.55, p < .01, and harmful effects F(2, 182) = 7.26, p < .01. Multiple pairwise comparisons also showed that the patients significantly perceived higher communication barriers, more concerns of analgesic harmful effects, and higher overall barriers than nurses and physicians. CONCLUSIONS: Significant differences were found in the perspectives of patients, physicians, and nurses toward pain management barriers in the overall barriers, communication, and harmful effect. It is recommended to develop awareness programs for patients about pain management, barriers, use of analgesia, and communication. Nurses and physicians are advised to discuss mutual concerns and pay more attention to overcoming patient concerns.

The Effect of Remote-Based Monitoring and Education Program on Cancer Pain Management in an Outpatient Pain Clinic.

BACKGROUND: Pain is one of the most feared consequences of cancer for patients and their families. Many barriers may hinder optimal pain management. AIM: Examine the effect of remote-based monitoring and education program on cancer pain management, patient-related barriers, and level of adherence to pain medication. METHODS: A sample of 134 patients was assigned to two groups; 68 in the intervention group and 66 in the control. The intervention group received three educational sessions by telephone. Both groups completed questionnaires at baseline and one month after the initial visit. RESULTS: Significant differences were found between the groups in the levels of pain right now (p = .030), pain at its least (p = .016), and in the percentage of achieved pain relief (p = .048). Moreover, the intervention group experienced lower levels of interference with their general activity (p = < .001), mood (p = .011), and normal work (p = .004) post-intervention. The Attitudinal Barriers differences were statistically significant in the total mean (p = < .001), and the subscales of physiological effects (p = < .001), fatalism (p = < .001), communication (p = < .001), harmful effects (p = < .001). Participants in the intervention group exhibited higher adherence levels (p = .001). CONCLUSIONS: Patients suffering from cancer-related pain can benefit from remote-based monitoring and education programs to improve pain management outcomes, overcome barriers, and increase adherence. Further research is needed to investigate the different available educational methods and long-term effects.

Effectiveness of Education Program on Nursing Knowledge and Attitude toward Pain Management.

OBJECTIVE: Nurses have an integral role in pain assessment and management. Adequate knowledge and positive attitudes toward pain management are essential to provide high-quality nursing care for cancer pain. The purposes of this study are to evaluate nurses' knowledge and attitude toward cancer-related pain and to assess the effectiveness of a pain management education program on nurses' knowledge and attitude toward pain. METHODS: A quantitative, experimental design was used. RESULTS: The total number of participants who were surveyed at three measurement points was 131, with a completion rate of 87.3%. Findings revealed that the score of knowledge and attitude toward cancer-related pain ranged from 14 to 35, with a mean of 23.6 (standard deviation [SD] = 4.38). The mean scores of the intervention group and the control group at two measurement points regarding knowledge and attitude toward cancer-related pain were 32.7 (SD = 2.8) and 32.8 (SD = 4.3) and 23 (SD = 5.5) and 22.2 (SD = 3.8), respectively. There were significant differences at three measurement points among the intervention group (F = 114.3, P < 0.0005). There were no differences in the three measurement points among the control group (F = 3.4, P = 0.055). CONCLUSIONS: Nurses have essential roles in cancer pain. A pain management education program can improve nurses' knowledge and attitude toward cancer-related pain.

Improving the Workflow Efficiency of An Outpatient Pain Clinic at A Specialized Oncology Center by Implementing Lean Principles.

OBJECTIVE: Adult outpatient oncology pain clinics face many challenges due to the increased number of patients, the restriction of electronic appointment systems, overcrowding, waiting time, and patient dissatisfaction. This project aimed to improve clinic time efficiency, decrease clinic waiting time, and improve patient satisfaction. METHODS: Lean thinking concepts and their tools, for example, value-stream mapping and value added (VA)/non-VA (NVA) analysis were used. Electronic appointment system slots were stratified based on patient visit type. A total of 187 patients were included in a time-motion survey at three different occasions: preintervention (n = 67) and two consecutive quarter postintervention time points (n = 64, n = 56). Simultaneously, patient satisfaction was reported quarterly by a quality management office. RESULTS: The pain clinic workflow became more efficient; the mean clinic waiting time decreased from 72.5 min at preintervention to 19.5 and 21 min at the two postintervention quarters, respectively. Moreover, patient satisfaction improved from 75% at the preintervention to 100% and 96.7% at the two postintervention quarters. CONCLUSIONS: Redesigning the process of an electronic appointment system using lean thinking considerably decreases patients' waiting time, improves patient satisfaction, improves resource utilization, allows proper scheduling based on patient visit types, eliminates unnecessary waste processes, and reallocates health-care providers' time toward direct, individualized patient care.

The role of electronic medical records in improving the quality of health care services: Comparative study.

PURPOSE: The purpose of this study is to identify the quality of health care services' differences between adopted Electronic Medical Record (EMR) and paper-based record hospitals. Moreover, to identify how the quality of electronic medical records affect the quality of health care services. METHODS: A cross-sectional, descriptive, and comparative design was utilized between two groups in this study. The study was conducted in two public hospitals in Jordan. One hospital which had adopted the EMR system in their works and another hospital that had paper-based record. A convenience sampling technique was used to select 410 health professionals from the selected hospitals (205 participants from each hospital). SERVQUAL and E-S-QUAL questionnaires were adopted to collect the data about the quality of EMR and quality of health care service. Statistical Package for the Social Sciences (SPSS) Version 21 was deployed to analyze the collected data. RESULT: The results indicate that the quality of health care services (expectation and perception) in EMRs adopted hospital is higher than the quality of health care services in the hospital using paper-based record. Quality of EMRs and its domains (efficiency, availability, fulfilment, and privacy) are high in both perception and expectation of health care professionals in EMR-adopted hospitals. Moreover, there is a significant relationship between the whole perception of the quality of electronic medical records and the quality of services, and between each domain of quality of EMRs and total perception of quality of services. CONCLUSION: Adoption of a high quality of EMR has a significant impact on improving the quality of health care services.

Knowledge of thromboprophylaxis guidelines pre- and post-didactic lectures during a venous thromboembolism awareness day at a tertiary-care hospital.

BACKGROUND: Didactic lectures are frequently used to improve compliance with practice guidelines. This study assessed the knowledge of health-care providers (HCPs) at a tertiary-care hospital of its evidence-based thromboprophylaxis guidelines and the impact of didactic lectures on their knowledge. METHODS: The hospital launched a multifaceted approach to improve thromboprophylaxis practices, which included posters, a pocket-size guidelines summary and didactic lectures during the annual thromboprophylaxis awareness days. A self-administered questionnaire was distributed to HCPs before and after lectures on thromboprophylaxis guidelines (June 2010). The questionnaire, formulated and validated by two physicians, two nurses and a clinical pharmacist, covered various subjects such as risk stratification, anticoagulant dosing and the choice of anticoagulants in specific clinical situations. RESULTS: Seventy-two and 63 HCPs submitted the pre- and post-test, respectively (62% physicians, 28% nurses, from different clinical disciplines). The mean scores were 7.8 ± 2.1 (median = 8.0, range = 2-12, maximum possible score = 15) for the pre-test and 8.4 ± 1.8 for the post-test, P = 0.053. There was no significant difference in the pre-test scores of nurses and physicians (7.9 ± 1.7 and 8.2 ± 2.4, respectively, P = 0.67). For the 35 HCPs who completed the pre- and post-tests, their scores were 7.7 ± 1.7 and 8.8 ± 1.6, respectively, P = 0.003. Knowledge of appropriate anticoagulant administration in specific clinical situations was frequently inadequate, with approximately two-thirds of participants failing to adjust low-molecular-weight heparin doses in patients with renal failure. CONCLUSIONS: Education via didactic lectures resulted in a modest improvement of HCPs' knowledge of thromboprophylaxis guidelines. This supports the need for a multifaceted approach to improve the awareness and implementation of thromboprophylaxis guidelines.