Evidence Based Practice in Management of Cancer Pain

Topics: Pain, Pain scale, Psychometrics Pages: 13 (4150 words) Published: November 10, 2008
Evidence Based –Health Care and Social Care 2

Critical appraisal of Outcome Measure (BPI) for Cancer related pain and the use of this outcome measure (BPI) in the effective management of Cancer Pain



- Introduction

- Brief Pain Inventory.

- Psychometric Properties of the BPI

- Is BPI user centered?

- Conclusions


- Appendices

Outcome measure is one of the three components of clinical evaluation. The use of outcome measures provides objectivity to anyone interested in the evidence of effectiveness of intervention (Corr and Siddons. 2005). Indeed, it has been said that quality health care can only be provided if evidence on best practice is proffered, and this helps practitioners identify the unambiguous outcome of effective occupational therapy services (Law et al. 2001). Measurement enables practitioners and healthcare professionals in particular, to make informed choices and ensure that their services are put to their most appropriate use. This paper will deal with one of the types of outcome measures, namely symptom, and particular, pain among cancer patients as well as a method of measuring the effectiveness of intervention (or lack of it) will be examined in detail.

Pain is a symptom frequently experienced by patients with cancer, which can impact significantly on the patient’s quality of life (Oncology Nursing Society 2006). Effective pain management requires an integrated approach, combining regular pain assessments with pharmacological (e.g. the use of analgesics and pain modifiers) and non-pharmacological measures (e.g. massage or other complementary therapies) (Davis and Walsh 2004). Because of their close contact with patients during their entire period of care, nurses play a key role in the management of pain in patients with cancer (Oncology Nursing Society 2006). Improvement in pain assessment and documentation can lead to effective pain management (Erdek and Pronovost, 2004). It is therefore essential that they have the knowledge to evaluate and select appropriate measures which can be used to provide an accurate assessment of a patient’s pain.

A large number of instruments have been developed to assess various aspects of cancer pain. Simple, one-dimensional tools include the Numeric Rating Scale (NRS), Visual Analog Scale (VAS), Verbal Rating Scale (VRS), Faces Scale and the Finger Dynamometer. Among the multi-dimensional instruments are the Brief Pain Inventory (BPI), Memorial Pain Assessment Card, McGill Pain Questionnaire and the Pain-o-Meter (Scottish Intercollegiate Guidelines Network 2000). This paper will examine published research supporting the clinical utility and psychometric properties of the BPI, and discuss the use of this instrument in the effective management of cancer pain.

The Brief Pain Inventory (BPI)
Clinical utility
The Brief Pain Inventory (BPI) was originally developed for use by nurses and other healthcare practitioners to assess pain in patients with cancer (Cleeland, Ryan 1994). Whereas the attention and research on the BPI has been directed at the pain of that etiology, the tool is increasingly being used in relation with patients suffering from non-cancer pain (Keller et al. 2007.). It has two dimensions, namely the pain intensity, and the pains interference with functions (Holen et al. 2008). The BPI takes an average of fifteen minutes to complete and consists of a total of 23 items designed to gather information from the patient on pain intensity, pain relief, pain quality, and the patent’s perceptions of the cause of their pain (Tittle et al. 2003). The patient’s experience of pain is recorded by the answer to a simple ‘yes’ or ‘no’ type question and a body drawing is used to measure pain location. There can be considerable variations in pain in any given day, and to take care of...

References: Validity
Validity relates to whether an instrument measures what it intends to measure, and the degree of confidence that the user can have in the results obtained when using the instrument (Corr and Siddons 2005)
The responsiveness of an instrument relates to how sensitive the instrument is at detecting meaningful and clinically important changes over time, which forms an important part of an instrument’s validity (Portney and Watkins 2000)
Cheung, J.W.Y. Wong, T.K.S. Yang, J.C.S. 2000. "The Lens Model Assessment of Cancer Pain" Cancer Nursing 23 ;6: 454-461
Cleeland, C
Corr, S. & Siddons, L. 2005, ‘An introduction to the selection of outcome measures’, British Journal of Occupational Therapy, vol. 68, no. 5, pp. 202–6.
Davis, M. P. and Walsh, D. 2004, ‘Cancer pain: how to measure the fifth vital sign’, Cleveland Clinic Journal of Medicine, vol. 71, no. 8, pp. 625–32.
Daut, R. L., Cleeland, C. S., Flanery, R. C. 1983, ‘Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases’, Pain, vol. 17, pp. 197–210.
De Conno, F. Caraceni, A. 1996. “Manuals of Cancer Pain.” New York, Springer.
Erdek, M.A. Pronovost, P.J. 2004. "Improving Assessment and Treatment of Pain in the Critically Ill". International Journal for Quality in Health Care 16 ;1: 59-64
Fortner, B
Iersal, T. Timmerman, D. Mullie, A. 2006. "Introduction of a pain scale for Palliative care patients with cognitive impairment". International Journal of Palliative Nursing 12;2:54-59
Jensen, M
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