Breakthrough cancer pain: A delphi consensus study on expert recommendations for barriers that prevent the proper management of BTcP in Spain

Abstract

Background: The management of Breakthrough cancer Pain (BTcP) remains unsatisfactory. Although many barriers to BTcP management have been identifi ed, oncologists have not been able to overcome them. The aim of this study is to identify the barriers preventing proper BTcP management that Spanish medical oncologists have found, and to reach a consensus in order to draft the appropriate recommendations to overcome them. Methods: This study is based on two surveys conducted by oncologists. The fi rst survey was designed to reach a consensus on the main barriers (related to patients, physicians and healthcare organizations) that stand in the way of BTcP control. The second survey (a Delphi questionnaire) was based on the barriers evaluated in the fi rst survey, including recommendations assessed using the two-round Delphi methodology. Results: The identifi cation of the main barriers to BTcP management to be assessed showed a high consensus regarding the need for greater involvement from health organizations. Eighty-eight experienced oncologists evaluated the proposed recommendations. A consensus was reached on 93% of these recommendations, always in terms of agreement. Only three recommendations did not reach a consensus, one in each block of barriers (patients, physicians and healthcare organizations). Conclusion: Showing a high degree of consensus, the results of this study refl ect that there are overworked medical oncologists, which results in more time and training being taken away from proper BTcP management. Although oncologists considered cancer pain management to be suitable in oncologist consultations, they also revealed that more support and resources are necessary in order to improve BTcP control.