Cancer Pain Education: A Structured Clinical Instruction Module for Hospice Nurses

Abstract

The learning experience with the Cancer Pain Structured Clinical Instruction Module (SCIM), a highly structured skills training course for medical students, has been reported favorably. The purpose of this study was to present the Cancer Pain SCIM to registered nurses employed in a hospice setting. The goal of the study was to pilot test a structured cancer pain educational program for hospice nurses and to determine the perceived effectiveness of this course on the participants' cancer pain assessment and management skills. A multidisciplinary Cancer Pain SCIM was presented to 25 hospice nurses to improve their understanding of the management of cancer pain. The development group identified essential aspects of cancer pain management and then developed checklists defining specific station content. During the 2-hour Cancer Pain SCIM, nurses rotated through 8 stations in groups of 3, spending 15 minutes at each station. Eight instructors and 6 standardized patients, 5 of whom were survivors of cancer, participated in the course. All participants (students, instructors, and patients) evaluated the course, using a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). Nurses provided self-assessments of their perceived competence on important aspects of cancer pain management both before and after the SCIM. The self-assessment items used a 5-point scale ranging from 1 (not competent) to 5 (very competent). Twenty-five hospice nurses, averaging 4.1 years (range 1-30 years) postgraduation, participated in the Cancer Pain SCIM. Overall, nurses agreed that they improved on each of the 8 teaching items (P < 0.001). The average (SD) pretest score of 2.8 (0.72) improved to 3.8 (0.58) on the post-test (P < 0.001). Nurses believed that their mastery of specific clinical skills, taught in all 8 stations, improved as a result of participation in the course. Nurses strongly agreed (mean +/- SD) that it was beneficial to use patients with cancer in the course (4.6 +/- 0.82). Faculty members enjoyed participating in the course (4.9 +/- 0.35) and indicated a willingness to participate in future courses (4.7 +/- 0.49). Significant perceived learning among hospice nurses took place in all aspects of the Cancer Pain SCIM. Participating nurses, instructors, and patients with cancer appreciated the SCIM format. Nurses and faculty considered the participation of actual patients with cancer highly beneficial. The SCIM format has great potential to improve the quality of cancer pain education.

Preparation for cancer care: Perceptions of newly qualified health care professionals

“…For instance, positive outcomes have been reported from nurses who participated in a highly structured clinical training course providing education in cancer pain (Plymale et al, 2001). There is some evidence from small-scale studies to suggest that interprofessional education across primary and secondary care may assist in improving the delivery of symptom control for cancer patients (Leslie et al, 2003).…”

Using Structured Clinical Instruction Modules (SCIM) in Teaching Palliative Care to Undergraduate Medical Students

“…We have delivered the SCIM workshop with less facilitators than described in other studies, 8,12,14 and utilized nonspecialist staff in the successful delivery of the program. We now have a core of involved teachers that enjoy the experience and offer to be involved with each new group.…”

“…8 They have been used in the teaching of pain management, cancer care, and surgical techniques and have been evaluated as an effective, sustainable tool delivering durable skills and knowledge improvements. [9][10][11][12] To date, this literature has focused on the use of SCIMs to teach various aspects of a single topic. The SCIM program developed for the palliative care attachment is novel, as it covered numerous aspects of knowledge and skills essential for end-of-life care.…”

Medical residents beliefs and concerns about using opioids to treat chronic cancer and noncancer pain: A pilot study

“…Educational programs for students and residents have shown improved knowledge and attitudes toward the management of pain, including the proper use of opioids [20,29,[32][33][34]. Postworkshop surveys from residents in this study showed that their beliefs and concerns about using opioids for chronic low back pain were changed by participating in a 4-hour interactive session using short didactics, observation exercises with reflection, and practice with feedback using patient actors [35].…”