Background & Aims

Standardising pain assessment in oncology outpatient clinics leads to improvements in patients’ pain and quality of life (1, 2). Fallon et al. reported that implementing standardised pain management process (Edinburgh Pain Assessment Tool (EPAT)) on inpatient oncology wards (the original setting) significantly reduced post-surgical pain in cancer patients (i.e. the original clinical scenario) and led to more appropriate analgesic prescribing (1). However, in the UK, there is no standardised, integrated process for managing cancer pain in oncology outpatient services in the National Health Service (NHS)(1). Therefore, we undertook a contextual adaptation of EAPT applying a theoretical framework for adapting complex interventions (3) using participatory, stakeholder methods. Here we present an experiential step-by-step approach to adapt EPAT, to support the management of pain for people with cancer (a new clinical scenario) in the new setting of oncology outpatient services.

Methods

The adaptation process followed Moore et al.’s (2021) ADAPT guidance (3): Step 1: We reviewed existing literature and conducted semi-structured interviews with healthcare professionals to understand the new context (oncology outpatient settings);Step 2: We identified ‘core’ and ‘peripheral’ components of EPAT, and identified the contextual challenges involved in adapting the intervention for the new setting (i.e., outpatient clinic) and new clinical scenario (i.e. cancer patients with pain); Step 3: We undertook a series of iterative co-design workshops and stakeholder meetings, where the core and peripheral EPAT components were adapted and reconfigured to fit the new setting and clinical scenario. Ongoing feedback from oncology healthcare professionals was used to further refine the intervention; Step 4: Lastly, we piloted our adapted version of EPAT in clinical practice to identify practical issues related to its use that were not identified during the earlier adaptation stages.

Results

Data from literature review and semi-structured interviews are published elsewhere (4). Feedback from stakeholder engagement, co-design workshops, and piloting of the adapted intervention in outpatient settings highlighted several key adaptation outcomes for the adapted version of EPAT. These included the need for a condensed version of EPAT due to time constraints in outpatient appointments, the importance of re-assessing pain (core component) and facilitating patients to self-monitor their pain at home, and the necessity for the creation of new peripheral components to the intervention to support communication with primary care providers (i.e., support writing clinic letters to primary care).

Conclusions

This paper contextualises Moore at al.’s (3) adapting complex intervention guidelines. We describe a systematic step-by-step approach, outlining how a cancer-pain management intervention was adapted to fit a new clinical context (i.e., cancer patients with pain) in oncology outpatient settings. The study used theoretically driven concepts of adaption to provide a systematic, rigours adaptation of an existing cancer pain management tool. We are currently undertaking a multi-centre cluster randomised pilot trial to evaluate the feasibility of implementing EAPT within routine care pathways in oncology outpatient services in the North of England.

References

1.Fallon M, Walker J, Colvin L, Rodriguez A, Murray G, Sharpe M. Pain Management in Cancer Center Inpatients: A Cluster Randomized Trial to Evaluate a Systematic Integrated Approach-The Edinburgh Pain Assessment and Management Tool. J Clin Oncol. 2018;36(13):1284-90.
2.Williams JE, Peacock J, Gubbay AN, Kuo PY, Ellard R, Gupta R, et al. Routine screening for pain combined with a pain treatment protocol in head and neck cancer: a randomised controlled trial. Br J Anaesth. 2015;115(4):621-8.
3.Graham M, Mhairi C, Lauren C, Peter C, Ani M, Pat H, et al. Adapting interventions to new contexts—the ADAPT guidance. BMJ. 2021;374:n1679.
4.Robinson CO, Pini S, Flemming K, Campling N, Fallon M, Richards H, S., et al. Exploration of pain assessment and management processes in oncology outpatient services with healthcare professionals: a qualitative study. BMJ Open. 2023;13(12):e078619.

Presenting Author

Olivia Robinson

Poster Authors

Olivia Robinson

BSc, MSc, PhD

University of Leeds

Lead Author

E-mail

Professor Suzanne. H Richards

University of Leeds

Lead Author

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Professor Marie Fallon

University of Edinburgh

Lead Author

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Dr Elaine. G Boland

Hull University Teaching Hospitals

Lead Author

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Dr Daniel Swinson

Leeds Teaching Hospitals NHS Trust

Lead Author

E-mail

Dr Sue. M Hartup

Leeds Teaching Hospitals NHS Trust

Lead Author

E-mail

Dr Matthew. R Mulvey

University of Leeds

Lead Author

E-mail

Topics

  • Assessment and Diagnosis