Authors (including presenting author) :
Tang PL(1), Chan PC(2)
Affiliation :
(1) Department of Pharmacy, Tuen Mun Hospital, (2) Department of Clinical Oncology,
Tuen Mun Hospital
Introduction :
Pain relief is one of the targeted management plans in cancer patients
under palliative care. Multidisciplinary collaborations among health care professionals are essential in providing integrated pain management. Pharmacist-led pain clinic has been shown to significantly improve pain score and reduce adverse effects by opioids in cancer patients recently. This study aimed to investigate the impact of pharmacist’s intervention in pain control of cancer patients under local palliative unit.
Objectives :
To evaluate the effect of pharmacist's interventions on cancer pain management as assessed by Numerical Rating Scale (NRS).
To assess barriers for patient's cancer pain management based on the Barrier Questionnaire.
To assess the re-admission and early follow-up rate due to pain during study period
To evaluate the effect of pain medication counseling on patients' medication adherence and their satisfaction rate of pharmacist's intervention
Methodology :
This study is a prospective, randomized controlled study conducted from
December 2021 to June 2022. Patients were randomized into either control group or
intervention group. All patients were assessed of baseline pain level, pain management barrier and quality of life (QOL) by Numerical Rating Scale (NRS), validated Taiwan Barrier Questionnaire and McGill Quality of Life Questionnaire respectively. Adherence to pain medications was also recorded using 8-item Morisky instrument (MMAS-8). Patients would receive face-to-face or phone assessment with pharmacist before the three physician appointments. Education was provided to intervention group and recommendations would be made to physicians when necessary.
Result & Outcome :
At the interim analysis in June 2022, 30 patients were recruited; in which 15
patients completed the the study. The pain score in terms of NRS was significantly
reduced from 5.62±2.18 to 3.67±2.57 out of 10 in intervention group (P=0.03) after
three pharmacist’s consultations, but not in control group (P=0.791). Significant
increase was observed in medication adherence from 6.47±1.00 to 7.06±0.81 in the
intervention group (P=0.043). Scores for two third of the domains in barrier
questionnaire were also significantly reduced in intervention group. No significant
changes were observed in terms of QOL for both control and intervention group. The
intervention acceptance rate by physicians, including partially accepted, was 58.3%; and the mean patient’s satisfaction score was 3.875 out of 5.
Pharmacist’s interventions could significantly reduce pain intensity in
cancer patients under palliative care. The negative belief on opioids was also reduced and drug adherence to pain medications was increased significantly. Further studies with larger sample size are required to fully ascertain the impact of pharmacist-led pain clinic.
