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Background: The provision of pain management programmes (PMPs) changed substantially in response to the COVID-19 pandemic with virtual delivery implemented in many services. Little is known about patient selection processes for virtual PMPs and how this might differ from in-person programmes. The aim of this audit was to document the patient selection process for PMPs at a speciality pain service prior to and during the pandemic. Methods: This retrospective audit used data from consecutive patients attending a multidisciplinary assessment to determine the suitability of a PMP. Anonymized data were extracted from assessment letters and hospital records in the months prior to the pandemic (n =168) and during the start of the pandemic once the service began delivering virtual PMPs (n =171). Results: For the standard pain management pathway, most patients were offered a PMP option within the service before and during the pandemic, although a greater proportion of patients were offered treatment during the pandemic. For the neuromodulation pathway, most patients were offered a pre-neuromodulation PMP option, and this was similar before and during the pandemic. Psychosocial complexities and unwillingness to engage in a pain management approach that does not principally focus on pain reduction were the most common reasons that patients were not offered a programme. Discussion: This audit points to a pattern of more inclusive assessment outcomes within our service over time and particularly during the pandemic. Offering a range of in-person and virtual PMPs can meet a wider range of patient need. Research is needed to understand how to best assess and match patients with the breadth of treatment delivery formats now available.
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INTRODUCTION: The present study audited the process of assessing and selecting patients for a pain management programme with the aim of reviewing best practice in the light of the latest British Pain Society guidelines for pain management programmes for adults. The guidelines include defined inclusion/exclusion criteria and it was explored how they are used by clinicians providing a pain management service. METHOD: The records of 200 consecutive patients who attended a multidisciplinary assessment for a central London specialist Pain Management Service from September 2014 to December 2014 were audited. The proportions of patients who were offered a programme, were discharged or referred for a different service were calculated. Clinic letters were reviewed to collect information on assessment outcomes, recommendations and inclusion/exclusion criteria used. RESULTS: About half the patients (53%) seen for assessment were offered treatment within the service, most frequently the intensive residential programme (30.5%, with an additional 11.6% offered case management first), followed by the five session outpatient programme (8.1%) and a minority was offered individual treatment (2.5%); 44.7% of the patients were discharged following the assessment. The three most frequently used reasons for exclusion were: not ready to engage with the pain management approach (35%), complex psychological or other needs needing to be prioritised (29.5%) and the patient declining a programme (19.3%). CONCLUSION: Reviewing the use of inclusion/exclusion criteria revealed some challenges regarding patient selection. For example, a sizable proportion of patients were still seeking pain reduction and were not open to a self-management approach when this was the recommended treatment for them. Complex patients might need other treatment approaches before they can be considered for a programme. Having a range of pain management options of varying intensities available seems helpful in meeting individual patient need.
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OBJECTIVE: Observational studies using routinely collected data indicate that pain management programmes (PMPs) based on cognitive-behavioural principles are associated with clinically meaningful improvements for individuals with chronic pain. This study evaluated change across functional measures in a sample of chronic pain patients attending a 4-week residential PMP between 2006 and 2010. The findings were directly compared with published outcomes from an earlier period (1989-1998) at the same service. METHODS: Participants included 760 consecutive completers of a multidisciplinary PMP. Data were collected at pre-PMP, post-PMP (1-month post-discharge) and at a 9-month follow-up session. Group-based treatment effects and the reliability and clinical significance of change across functional measures were calculated and compared across cohorts. RESULTS: Effect sizes for the recent cohort ranged from small to medium (.43-.67) for pain and physical functioning outcomes to large (.90-1.12) for psychological outcomes at post-treatment (n = 654), and from small (.30-.51) to medium (.58-.71) at 9-month follow-up (n = 493). Clinically significant gains on pain and psychological measures were achieved by 19-55% of patients at post-treatment and 17-44% at follow-up. Comparisons with the earlier cohort showed significantly stronger post-treatment outcomes but differences at follow-up were less marked. DISCUSSION: These results add to the evidence base supporting the effectiveness of cognitive-behavioural therapy (CBT)-based pain management interventions. There were significantly larger gains in patient functioning in the recent dataset, suggesting improved programme delivery. But effects were less marked in the longer term, indicating a need for improvements in therapeutic models and related methods to promote meaningful and lasting changes.
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OBJECTIVE: This study describes the development and psychometric evaluation of the Basic Documentation for Psycho-Oncology (PO-Bado), an expert rating scale designed for the comprehensive assessment of psychosocial and physical distress in cancer patients. While there are many self-report measures (usually used for screening purposes), the PO-Bado is the first standardized clinician-administered instrument to guide professionals in a focused and structured psycho-oncological assessment. METHODS: The validation procedure was performed in 596 patients from different settings of cancer care, including all cancer sites and stages of the disease. The psychometric evaluation included (a) determination of the factorial structure, (b) homogeneity of scales and interrater reliability, (c) convergent and discriminant validities, and (d) examination of sensitivity to change. RESULTS: The final version of the PO-Bado includes two scales: the physical distress scale (four items) and the psychological distress scale (eight items). A manual and an interview guideline were developed alongside. The psychometric properties suggest that the PO-Bado is a reliable and valid tool used to assess and to differentiate the distress of patients with cancer, as well as treatment-related changes in distress. CONCLUSION: We suggest that the PO-Bado is a useful tool that is applicable in different oncology settings. It complements self-report measures and provides a structured format for focused psycho-oncological assessment and intervention. The two-dimensional structure allows differentiation between physical and psychological problems, assisting professionals in their diagnostic efforts and in providing appropriate support or treatment. When used consistently across professions and settings, the PO-Bado can form the basis for audit and interdisciplinary communication.