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Can patient-reported measurements of pain be used to improve cancer pain management? A systematic review and meta-analysis
  1. Rosalind Adam1,
  2. Christopher D Burton1,
  3. Christine M Bond1,
  4. Marijn de Bruin2 and
  5. Peter Murchie1
  1. 1 Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
  2. 2 Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Rosalind Adam, Centre of Academic Primary Care, University of Aberdeen, Room 1:131, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK; rosalindadam{at}abdn.ac.uk

Abstract

Purpose Cancer pain is a distressing and complex experience. It is feasible that the systematic collection and feedback of patient-reported outcome measurements (PROMs) relating to pain could enhance cancer pain management. We aimed to conduct a systematic review of interventions in which patient-reported pain data were collected and fed back to patients and/or professionals in order to improve cancer pain control.

Methods MEDLINE, EMBASE and CINAHL databases were searched for randomised and non-randomised controlled trials in which patient-reported data were collected and fed back with the intention of improving pain management by adult patients or professionals. We conducted a narrative synthesis. We also conducted a meta-analysis of studies reporting pain intensity.

Results 29 reports from 22 trials of 20 interventions were included. PROM measures were used to alert physicians to poorly controlled pain, to target pain education and to link treatment to management algorithms. Few interventions were underpinned by explicit behavioural theories. Interventions were inconsistently applied or infrequently led to changes in treatment. Narrative synthesis suggested that feedback of PROM data tended to increase discussions between patients and professionals about pain and/or symptoms overall. Meta-analysis of 12 studies showed a reduction in average pain intensity in intervention group participants compared with controls (mean difference=−0.59 (95% CI −0.87 to −0.30)).

Conclusions Interventions that assess and feedback cancer pain data to patients and/or professionals have so far led to modest reductions in cancer pain intensity. Suggestions are given to inform and enhance future PROM feedback interventions.

  • Cancer
  • Pain
  • PROM
  • Clinical assessment
  • self-report

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Twitter Follow Rosalind Adam at @rosadamaberdeen

  • Contributors RA was involved in the design of this review, carried out database searches, assessed studies for inclusion in the review, performed data extraction, assessed risk of bias and was involved in the synthesis of results. CDB was involved in the design of this review, assessed studies for inclusion in the review, assessed risk of bias of included studies, and contributed to drafting and revising the article critically. CMB was involved in the design of this review, assessed studies for inclusion in the review, and contributed to drafting and revising the article critically. MdB was involved in the design of this review, assessed studies for inclusion in the review, and contributed to drafting and revising the article critically. PM was involved in the design of this review, assessed studies for inclusion in the review, and contributed to drafting and revising the article critically.

  • Funding RA completed this review during a clinical academic fellowship funded by the Chief Scientist Office of the Scottish Government, grant reference RG12141-10.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.