Journal of pain and symptom management
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J Pain Symptom Manage · Feb 2010
Retrospective assessment of cancer pain management in an outpatient palliative radiotherapy clinic using the Pain Management Index.
The Pain Management Index (PMI) is a simple index linking the usual severity of cancer pain with the category of medication prescribed to treat it. Medication categories are derived from the World Health Organization's "analgesic ladder" approach to cancer pain, and the PMI is an indicator of the extent to which the medication prescribed corresponds to the recommended categories for mild, moderate, and severe pain. ⋯ Despite publication of numerous cancer pain management guidelines, undermedication appears to be a persistent problem for patients with painful bone metastases referred for radiotherapy.
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J Pain Symptom Manage · Feb 2010
Comparative StudyEvaluating correlation and interrater reliability for four performance scales in the palliative care setting.
Performance scales are used by clinicians to objectively represent a patient's level of function and have been shown to be important predictors of response to therapy and survival. Four different scales are commonly used in the palliative care setting, two of which were specifically developed to more accurately represent this population. It remains unclear which scale is best suited for this setting. ⋯ Whether using a reliability measure that incorporates the concept of "partial credit" for "near misses" or a measure reflecting exact rater agreement, no one scale emerged as having a significantly higher likelihood of agreement among raters. We propose that what may be more important than clinical experience or rater profession is the level of training an individual health care professional rater receives on the administration of any particular performance scale. In addition, given that low levels of exact rater agreement could have substantial clinical implications for patients, we suggest that this parameter be considered in the design of future comparative studies.
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J Pain Symptom Manage · Feb 2010
A single set of numerical cutpoints to define moderate and severe symptoms for the Edmonton Symptom Assessment System.
Symptom intensity in cancer and palliative care patients is frequently assessed using a 0-10 ranking score. Results are then often grouped into verbal categories (mild, moderate, or severe) to guide therapy. Numerical cutpoints separating these categories are often variable, with previous work suggesting different cutpoints across different symptoms, which is unwieldy for clinical use. ⋯ For the combined grouping of moderate or severe, results were less uniform. A cutpoint of either 4 or 5 would be supported by our data, with a greater sensitivity using 4 and improved specificity using 5 as the cutpoint. Across all ESAS symptoms, then, 7 or higher represents a severe symptom by patient definition, whereas a cutpoint of either 4 or 5 could reasonably define combined moderate and severe symptoms.
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J Pain Symptom Manage · Feb 2010
High outpatient pain intensity scores predict impending hospital admissions in patients with cancer.
Pain intensity scores (PIS) are frequently collected in the outpatient setting. The implications for patients with high PIS have not been well-studied. ⋯ Outpatients with cancer and high PIS are at increased risk of hospital admission within 30 days. This high-risk group should be targeted for early supportive care interventions aimed at reducing hospitalizations and improving quality of life.