Multidisciplinary pain management based on a computerized clinical decision support system in cancer pain patients

Bertsche, Thilo; Askoxylakis, Vasileios; Habl, Gregor; Laidig, Friederike; Kaltschmidt, Jens; Schmitt, Simon P.W.; Ghaderi, Hamid; Bois, Angelika Zabel-du; Milker-Zabel, Stefanie; Debus, Jürgen; Bardenheuer, Hubert J.; Haefeli, Walter E.

doi:10.1016/j.pain.2009.07.009

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Volume 147, Issue 1 , Pages 20-28, 15 December 2009

Multidisciplinary pain management based on a computerized clinical decision support system in cancer pain patients

Thilo Bertsche
- Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- Cooperation Unit Clinical Pharmacy, University of Heidelberg, Germany
Vasileios Askoxylakis
- Department of Radiation Oncology, University of Heidelberg, Germany
Gregor Habl
- Department of Radiation Oncology, University of Heidelberg, Germany
Friederike Laidig
- Cooperation Unit Clinical Pharmacy, University of Heidelberg, Germany
Jens Kaltschmidt
- Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
Simon P.W. Schmitt
- Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
Hamid Ghaderi
- Department of Anaesthesiology, University of Heidelberg, Germany
Angelika Zabel-du Bois
- Department of Radiation Oncology, University of Heidelberg, Germany
Stefanie Milker-Zabel
- Department of Radiation Oncology, University of Heidelberg, Germany
Jürgen Debus
- Department of Radiation Oncology, University of Heidelberg, Germany
Hubert J. Bardenheuer
- Department of Anaesthesiology, University of Heidelberg, Germany
Walter E. Haefeli
- Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- Corresponding author. Tel.: +49 6221 56 8740; fax: +49 6221 56 4642.

Received 15 December 2008; received in revised form 6 July 2009; accepted 13 July 2009. published online 20 August 2009.

Abstract

A prospective controlled intervention cohort study in cancer pain patients (n=50 per group) admitted to radiation oncology wards (62 beds, 3 wards) was conducted in a 1621-bed university hospital. We investigated the effect of an intervention consisting of daily pain assessment using the numeric visual analog scale (NVAS) and pain therapy counseling to clinicians based on a computerized clinical decision support system (CDSS) to correct deviations from pain therapy guidelines. Effects on guideline adherence (primary outcome), pain relief (NVAS) at rest and during physical activity (both groups: cross-sectional assessment on day 5; intervention group: every day assessment), co-analgesic prescription, and acceptance rates of recommendations (secondary outcomes) were assessed. The number of patients with at least one deviation from guidelines at discharge was decreased by the intervention from 37 (74%) in controls to 7 (14%, p<0.001). In the intervention group, pain (NVAS) decreased during hospital stay at rest from 3.0 (Δ_0.5 (Q_75%−Q_25%)=3.0) on admission to 1.5 (Δ_0.5=1.0) at discharge (p<0.01) and during physical activity from 7.0 (Δ_0.5=4.0) on admission to 2.5 (Δ_0.5=3.8) at discharge (p<0.001). At discharge, the number of patients treated with co-analgesics increased from 23 (46%) in controls to 33 (66%) in the intervention group (p=0.04). From 279 recommendations issued in the intervention 85% were fully accepted by the physicians. Deviations from well-established guidelines are frequent in pain therapy. A multidisciplinary pain management increased adherence to pain management guidelines.