The Impact of a National Guideline on the Management of Cancer Pain on the Practice of Pain Assessment and Registration

Abstract

The Dutch clinical practice guideline on the diagnosis and management of pain in patients with cancer was published in 2008 and intensively promoted to healthcare professionals who see patients with cancer. One of the most important recommendations is the systematic registering of the pain and its intensity. To evaluate in which degree this part of the practice guideline is implemented, we analyzed the medical records of patients attending the outpatient oncological clinic in an academic hospital, a large teaching hospital, and 4 smaller peripheral hospitals. None of the participating hospitals assessed pain by a standardized scale. Reference to pain in the medical record happened more frequently in the academic hospital than in the other hospitals. The frequency of recording pain in the medical record in the academic hospital was much higher in this study than the one previously reported, whereas the findings in the other hospitals were comparable. There may be several reasons for the difference in reporting rate of pain in patients with cancer. Our findings indicate that the clinical practice guideline with regard to pain registration is poorly implemented in oncology outpatient clinics. More efforts should be made to generate the awareness for the need of pain registration.

Treatment of Pain in Cancer: Towards Personalised Medicine

“…In a recent study in the Netherlands, in only 0.1% of almost a thousand patients visiting an oncology outpatient clinic was an NRS score of pain intensity recorded [15]. A year later, after introducing the new nationwide cancer pain guidelines in the Netherlands, there was still no mention of pain in the vast majority of patients, and an NRS was found only once in the patient records [16]. A reference to pain in the medical record of patients was found in 50%, 28%, and 21% in respectively academic, large peripheral, and small peripheral hospitals.…”