Yang, Y.P., Ma, Y.X., Huang, Y., Zhao, Y.Y., Xu, F., Tian, Y., . . . Zhang, L. (2014). The good pain management (GPM) ward program in China and its impact on Chinese cancer patients: The SYSUCC experience. Chinese Journal of Cancer, 33, 323–329. 

To evaluate improvementcancer-related pain management after the implementation of a program to improve this aspect of cancer care

The pain initiative involved the training and education of medical and nursing staff, training in standardized cancer pain management according to National Comprehensive Cancer Network (NCCN) and World Health Organization (WHO) guidelines conducted monthly, patient education in person and via booklets, and the use of a pain assessment scale posted at each bedside. Participating hospitals established cancer pain treatment teams including multiple disciplines. Patients who had multiple bone metastases were included. Patients who were cared for after the program was initiated were compared to historical controls. Pain levels were recorded on admission and after pain management.

• N = 475
• AGE = Not reported
• MALES: 57.7%, FEMALES: 42.3%
• KEY DISEASE CHARACTERISTICS: Lung, breast, head and neck, and other cancer types
• OTHER KEY SAMPLE CHARACTERISTICS: The majority of patients had multiple metastatic bone lesions.

• SITE: Multi-site  
• SETTING TYPE: Inpatient    
• LOCATION: China

• APPLICATIONS: Palliative care 

Multisite cohort comparison with historical controls

• Pain reporting rate on admission
• Rate of analgesic administration
• Numeric Rating Scale (NRS) for pain 
• Rate of complete pain remission (pain level decreased to none)

The proportion of patients with pain on admission was higher after the intervention. The complete pain remission rate was higher in the intervention group (54.5% versus 33.7%, p = 0.0002). The uncontrolled pain rate was lower with the intervention group (13.8% versus 31.5%, p = 0.0001). There was greater use of strong opioids after the intervention (p = 0.01). There were no differences between groups in use of bone modifying agents, radiotherapy, or nonsteroidal anti-inflammatory agents.

The organizational intervention used here, including staff education, patient education, and ongoing visual reminders at the point of care, appeared to have a positive effect on pain management practices and outcomes.

• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Risk of bias (sample characteristics)
• Measurement/methods not well described
• Questionable protocol fidelity
• Other limitations/explanation: The timing of various pain measurements used in the comparison was not stated. The use of historical controls had some inherent potential bias because of the possibility of other confounding variables although the timeframe between groups was only about six months. The duration of management for individual patients was not stated. The medications used and dosages were not provided.

There is some evidence that cancer-related pain continues to be under-reported and undertreated. The program initiated and reported here was associated with some improvements in practices related to pain management and pain outcomes predominantly associated with the increased use of strong opioids. This program provided an approach to encourage clinicians to pay more attention to pain and increase skills for appropriate analgesic use. It appeared to lead them to use strong opioids more. This evaluation could provide ideas for institutional efforts to improve cancer pain management.