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Palliative care pain control: inpatient consultation versus corounding models compared
  1. Chang Zhi Ng1,
  2. Yin Bun Cheung2,3,
  3. Audrey Rui Xuan Koh4,
  4. Han Rou Teo4,
  5. Natalie Kah Mun Mok4 and
  6. Grace Meijuan Yang4,5,6
  1. 1Duke-NUS Medical School, Singapore
  2. 2Program in Health Services & Systems Research and Centre for Quantitative Medicine, Duke-NUS Medical School, Duke-NUS Medical School, Singapore
  3. 3Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere University, Tampere, Finland
  4. 4Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
  5. 5Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
  6. 6Department of General Medicine, Sengkang General Hospital, Singapore
  1. Correspondence to Grace Meijuan Yang, Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore 169610, Singapore; grace.yang.m.j{at}singhealth.com.sg

Abstract

Background Compared with the current inpatient consultation model, a novel corounding model of care whereby palliative specialists round with oncology teams, increases healthcare collaboration and may improve quality of care for inpatients. Whether this translates to better pain control for patients is unexplored.

Objective To determine whether the corounding model provides better pain control compared with the consultation model for cancer inpatients.

Methods Cancer patients with moderate or severe pain severity during the admission were included in this observational study. Pain severity was determined using electronic records. Improvement to mild or no pain by day 3 of identification of moderate or severe pain was defined as good pain control and proportion of admissions achieving this was compared between models.

Results A total of 142 and 128 admissions admitted under the consult and corounding model, respectively, had moderate or severe pain. The proportion of patients that achieved good pain control was 77.3% (99/128) and 71.8% (102/142) in the corounding and consult model, respectively. The difference in proportion of admissions achieving good pain control was significantly higher in the corounding model after adjusting for differences in baseline characteristics (unadjusted OR, 1.34; 95% CI, 0.77 to 2.33; adjusted OR, 2.25; 95% CI, 1.19 to 4.26).

Discussion The odds of achieving good pain control was significantly better in the corounding model. However, the mechanism behind this is unexplored. This study can serve as precedence for future studies evaluating the corounding model of care.

  • pain
  • cancer
  • hospital care
  • service evaluation
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Footnotes

  • Presented at This study was presented as a poster presentation at 19th Oceanic Palliative Care conference, Perth Australia, 10–13 September 2019.

  • Contributors Conception and design: CZN, YBC and GMY. Collection and assembly of data: CZN, ARXK, HRT and NKMM. Data analysis and interpretation: CZN, YBC and GMY. Manuscript writing: CZN, YBC and GMY. Final approval of manuscript: all authors.

  • Funding This study was supported by Temasek Foundation Singapore Millennium Foundation Research Grant Programme and the Duke-NUS Medical Student Fellowship award (AM-ETHOS01/FY2018/21-A21).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval SingHealth Centralised Institutional Review Board (IRB) approval for the main study was exempted as it was deemed to be a service evaluation project (CRIB: 2017/799). A separate IRB clearance for this project was deemed not necessary by the Safety, Health and Emergency Management department of Duke-NUS Medical School, and was thus not sought for in view that it remains a service evaluation project.

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