Diagnosis and management of breakthrough cancer pain: Have all the questions been resolved? A Delphi-based consensus assessment (DOIRON)

Porta-Sales, Josep; Pérez, Concepción; Escobar, Yolanda; Martı́nez, Vicente

doi:10.1007/s12094-015-1468-7

Cited by 21 publications

(14 citation statements)

References 50 publications

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“…Nevertheless, most contemporary guidelines exclude end-of-dose pain/end-of-dose failure as a subtype of breakthrough pain, since this phenomenon represents a ‘failure’ of the around-the-clock/background medication 5–8. Moreover, there appears to be high agreement with this position among relevant healthcare professionals within Europe 9 10. In this study, 28% patients with breakthrough pain identified that ‘scheduled pain medication wearing off’ was a precipitant of their breakthrough cancer pain, which again suggests that many of these patients did not have adequately controlled background pain.…”

mentioning

confidence: 64%

Letter to the Editor re ‘Characteristics of breakthrough cancer pain and its influence on quality of life in an international cohort of patients with cancer (BMJ Support Palliat Care2016;6:344–52)’

Davies

Dickman

Farquhar-Smith

et al. 2016

BMJ Support Palliat Care

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mentioning

confidence: 64%

Letter to the Editor re ‘Characteristics of breakthrough cancer pain and its influence on quality of life in an international cohort of patients with cancer (BMJ Support Palliat Care2016;6:344–52)’

Davies

Dickman

Farquhar-Smith

et al. 2016

BMJ Support Palliat Care

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“…Constructs were rated on a 7-point Likert scale (i.e., 1-not at all important, 2-extremely low importance, 3-low importance, 4-slightly important, 5-moderately important, 6-very important, 7-extremely important/essential for all ACP studies). (32, 33) The panel was encouraged to use the full 7-point scale to prevent ceiling effects. Open-ended text boxes were provided for panelists to comment on the Organizing Framework domains, subdomains, and outcome constructs; to suggest new constructs; or to suggest whether constructs should be consolidated or deleted.…”

Section: Methodsmentioning

confidence: 99%

Outcomes That Define Successful Advance Care Planning: A Delphi Panel Consensus

Sudore

Heyland

Lum

et al. 2018

Journal of Pain and Symptom Management

259

277

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Context Standardized outcomes that define successful advance care planning (ACP) are lacking. Objective To create an Organizing Framework of ACP outcome constructs and rate the importance of these outcomes. Methods This study convened a Delphi panel consisting of 52 multidisciplinary, international ACP experts including clinicians, researchers, and policy leaders from four countries. We conducted literature reviews and solicited attendee input from 5 international ACP conferences to identify initial ACP outcome constructs. In 5 Delphi rounds, we asked panelists to rate patient-centered outcomes on a 7-point “not-at-all” to “extremely important” scale. We calculated means and analyzed panelists’ input to finalize an Organizing Framework and outcome rankings. Results Organizing Framework outcome domains included process (e.g., attitudes), actions (e.g., discussions), quality of care (e.g., satisfaction), and healthcare (e.g., utilization). The top 5 outcomes included (1) care consistent with goals, mean 6.71 (±SD 0.04); (2) surrogate designation, 6.55 (0.45); (3) surrogate documentation, 6.50 (0.11); (4) discussions with surrogates, 6.40 (0.19); and (5) documents and recorded wishes are accessible when needed 6.27 (0.11). Advance directive documentation was ranked 10th, 6.01 (0.21). Panelists raised caution about whether “care consistent with goals” 6.01 (0.21). Panelists raised can be reliably measured. Conclusion A large, multidisciplinary Delphi panel developed an Organizing Framework and rated the importance of ACP outcome constructs. Top rated outcomes should be used to evaluate the success of ACP initiatives. More research is needed to create reliable and valid measurement tools for the highest rated outcomes, particularly “care consistent with goals.”

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“…largely uniform, as suggested by the high degree of consensus reached in more than 80% of the items proposed. Two previous Spanish Delphi consensus ascertain the level of agreement among cancer pain specialists with the optimal definition, diagnosis, and management of BTcP, including a little section about BTcP follow-up [16,17]. The experts surveyed agreed that patients and adverse events should be assessed after starting BTcP medication within 48-72 h [17].…”

Section: Discussionmentioning

confidence: 99%

Delphi Consensus on the Follow-up of Cancer Patients with Breakthrough Pain Under Opioid Treatment

González

López

Calvo

et al. 2019

SN Compr. Clin. Med.

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Background Breakthrough cancer pain (BTcP) is one of the most common symptoms related to the disease and its treatment. Its management differs from that of chronic pain but there is not a wide consensus about fundamental aspects of BTcP definition, diagnosis, follow-up, and management. The objective of this study is to reach a consensus on the follow-up of patients with BTcP under opioid treatment. Background This work was conducted using a modified Delphi method organized in two rounds and involving a panel of 84 medical oncologists. A questionnaire of 66 items was developed with the following topics: (1) When to perform the first and subsequent BTcP treatment evaluations; (2) What to assess at the first follow-up visit and how; and (3) What to assess in the following visits and how. Results After two rounds, a consensus was reached in 53 of 66 items proposed (80.3%). The main agreements reached include: The first follow-up visit should preferably be face-to-face; increase the number of visits after detecting poor control of BTcP; assess pain control episodes of BTcP in the first and following visits; adjust treatment dose of opioids due to poor control of BTcP; and adopt measures to prevent aberrant opioid-induced behaviors when treating BTcP in patients with cancer. Conclusion This Delphi consensus highlights the different points of view of medical oncologists regarding the follow-up of patients with BTcP under opioids treatment. Nonetheless, the conclusions reached can facilitate optimizing monitoring of these patients and promote long-term effectiveness of BTcP control.

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Diagnosis and management of breakthrough cancer pain: Have all the questions been resolved? A Delphi-based consensus assessment (DOIRON)

Cited by 21 publications

References 50 publications

Letter to the Editor re ‘Characteristics of breakthrough cancer pain and its influence on quality of life in an international cohort of patients with cancer (BMJ Support Palliat Care2016;6:344–52)’

Letter to the Editor re ‘Characteristics of breakthrough cancer pain and its influence on quality of life in an international cohort of patients with cancer (BMJ Support Palliat Care2016;6:344–52)’

Outcomes That Define Successful Advance Care Planning: A Delphi Panel Consensus

Delphi Consensus on the Follow-up of Cancer Patients with Breakthrough Pain Under Opioid Treatment

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