Addressing Educational Needs in Managing Complex Pain in Cancer Populations: Evaluation of APAM: An Online Educational Intervention for Nurses

Abstract

Context:

Cancer-related pain is associated with significant suffering and is one of the most challenging symptoms to manage. Studies indicate that front-line clinicians often lack the knowledge on best practices in cancer pain management.

Objectives:

The current project, a quality improvement (QI) initiative, evaluated the outcome of an online educational intervention for nurses on complex cancer pain management.

Methods:

An online 7-module educational intervention, Advanced Pain Assessment and Management, was offered from 2012 to 2017. Pre–post course evaluations included self-reported knowledge and confidence across cancer pain management domains. In-course competency assessments included knowledge examination, online discussion forum participation, opioid dosage calculation assignment, and small-group-based case study. A mixed-model statistical analysis was used to assess pre–post course change in pain management confidence level.

Results:

In all, 306 nurses from 89 hospitals in Ontario, Canada, were enrolled in the course; 81.4% returned the precourse survey and 71.9% successfully completed the course. The average confidence level on pain management was low at baseline (57.5%) but improved significantly post-course. In-course competency assessments ranged from 81% to 89%. Mixed-model results showed post-course improvements in confidence levels, independent of sociodemographic background, clinical role, and professional educational level. Nurses with longer years of practice and more cancer cases reported greater confidence.

Conclusion:

A facilitator-led online educational intervention focusing on complex cancer pain management can significantly improve nurses’ knowledge, confidence, and skills. Low baseline knowledge among nurses highlights the pressing need for health-care organizations to implement cancer pain management training as an integral part of health-care QI initiative.

Keywords

online learning pain management cancer pain assessment continued education and training and nurses

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References

Deandrea

Corli

Consonni

Villani

Greco

Apolone

. Prevalence of breakthrough cancer pain: a systematic review and a pooled analysis of published literature. J Pain Symptom Manage. 2014;47(1):57–76.

van den Beukenvan-Everdingen

Hochstenbach

Joosten

TjanHeijnen

Janssen

. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manage. 2016;51(6):1070–1090.e1079.

Esin

Yalcin

. Neuropathic cancer pain: what we are dealing with? How to manage it? OncoTargets and therapy. 2014;7:599–618.

Canal-Sotelo

Trujillano-Cabello

Larkin

. Prevalence and characteristics of breakthrough cancer pain in an outpatient clinic in a Catalan teaching hospital: incorporation of the Edmonton Classification System for Cancer pain into the diagnostic algorithm. BMC Palliat Care. 2018;17(1):81.

American Medical Association. Resolution 217: Pain as the fifth vital sign reports of reference committees of the American Medical Association house of delegates 2016 annual meeting. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/hod/a16-resolutions.pdf.

Latchman

Improving pain management at the nursing education level: evaluating knowledge and attitudes. J adv pract oncol. 2014;5(1):10.

DeCaria

Patel

Relationship of Chronic Pain and Suicide. Challenging Cases and Complication Management in Pain Medicine. Berlin, Germany: Springer; 2018:21–26.

Rodríguez-Prat

Monforte-Royo

Porta-Sales

Escribano

Balaguer

. Patient perspectives of dignity, autonomy and control at the end of life: systematic review and meta-ethnography. Plos One. 2016;11(3):e0151435.

Carlson

Waller

Groff

Bultz

. Screening for distress, the sixth vital sign, in lung cancer patients: effects on pain, fatigue, and common problems—secondary outcomes of a randomized controlled trial. Psychooncology. 2013;22(8):1880–1888.

10.

Wagner-Johnston

Carson

Grossman

. High outpatient pain intensity scores predict impending hospital admissions in patients with cancer. J Pain Symptom Manage. 2010;39(2):180–185.

11.

Nipp

El-Jawahri

Moran

. The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer. Cancer. 2017;123(23):4720–4727.

12.

Dietrich

Ramchandran

. Addressing Cancer-Related Pain: A Common Management Issue. Philadelphia, PA: LWW; 2017.

13.

Registered Nurses’ Association of Ontario. Assessment and Management of Pain Ontario. Toronto, Canada: Registered Nurses’ Association of Ontario; 2013.

14.

Canadian Nurses Association. Code of Ethics for Registered Nurses. https://www.cna-aiic.ca/-/media/cna/page-content/pdf-en/code-of-ethics-2017-edition-secure-interactive.pdf.

15.

Erol

Unsar

Yacan

Pelin

Kurt

Erdogan

. Pain experiences of patients with advanced cancer: a qualitative descriptive study. Eur J Oncol Nurs. 2018;33:28–34.

16.

Ortiz

Carr

Dikareva

. An integrative review of the literature on pain management barriers: implications for the Canadian clinical context. CJNR. 2014;46(3):65–93.

17.

Perri

Yeung

Green

. A survey of knowledge and attitudes of nurses about pain management in end-stage liver disease in a geriatric palliative care unit. Am J Hosp Palliat Med®. 2018;35(1):92–99.

18.

Berna

Kulich

Rathmell

. Tapering long-term opioid therapy in chronic noncancer pain: evidence and recommendations for everyday practice. Mayo Clin Proc. 2015;90(6):828–842.

19.

McInnes

Peters

Bonney

Halcomb

. An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice. J adv nur. 2015;71(9):1973–1985.

20.

Herr

Marie

Gordon

. An interprofessional consensus of core competencies for prelicensure education in pain management: curriculum application for nursing. J Nurs Educ. 2015;54(6):317–327.

21.

Costello

Thompson

. Preventing opioid misuse and potential abuse: the nurse’s role in patient education. Pain Manag Nurs. 2015;16(4):515–519.

22.

Dequeker

Van Lancker

Van Hecke

. Hospitalized patients’ vs. nurses’ assessments of pain intensity and barriers to pain management. J Adv Nur. 2018;74(1):160–171.

23.

Fallon

Walker

Colvin

Rodriguez

Murray

Sharpe

. 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):1284–1290.

24.

Zhou

Liu

Tan

Pratt

Peng

. Nurse-led educational interventions on cancer pain outcomes for oncology outpatients: a systematic review. Int Nurs Rev. 2015;62(2):218–230.

25.

Holtzman

Williams

Hutchinson

Morris

Yeung

. Improving patient-reported pain during radiotherapy through nurse involvement and patient education. Am J Clin Oncol. 2018;41(10):1028–1030.

26.

Smith-Stoner

. There’s still no place like home: results of the home healthcare nurse 2002 survey of nurses working in home care and hospice for 20+ years. Home Healthc Now. 2002;20(10):657–662.

27.

Weissman

Griffie

Gordon

Dahl

. A role model program to promote institutional changes for management of acute and cancer pain. J Pain Symptom Manage. 1997;14(5):274–279.

28.

Malloy

Paice

Virani

Ferrell

. End-of-life nursing education consortium: 5 years of educating graduate nursing faculty in excellent palliative care. J Prof Nurs. 2008;24(6):352–357.

29.

Park

Yoon

Choi

. A train the trainer program for healthcare professionals tasked with providing psychosocial support to breast cancer survivors. BMC cancer. 2018;18(1):45.

30.

Madaus

Lim

. Teaching pain management in interprofessional medical education: a review of three portal of geriatric online education modules. J Am Geriatr Soc. 2016;64(10):2122–2125.

31.

Bartoszczyk

Gilbertson-White

. Interventions to nurse-related barriers in cancer pain management. Oncol Nurs Forum. 2015;42(6):634–641.

32.

Karaman

. Nurses’ perceptions of online continuing education. BMC Med Edu. 2011;11:86.

33.

Phillips

Heneka

Hickman

Lam

Shaw

. Impact of a qstream online learning module on palliative care nurses’ pain assessment competencies and patients’ reports of pain: results from a quasi-experimental pilot study. Asia Pacific J Clin Oncol. 2013;9:84–84.

34.

Bonkowski

De Gagne

Cade

Bulla

. Evaluation of a pain management education program and operational guideline on nursing practice, attitudes, and pain management. J Contin Educ Nurs. 2018;49(4):178–185.

35.

Phillips

Heneka

Hickman

Lam

Shaw

. Can a complex online intervention improve cancer nurses’ pain screening and assessment practices? Results from a multicenter, pre-post test pilot study. Pain Manag Nurs. 2017;18(2):75–89.

36.

Melzack

Casey

K.L

. Sensory, motivational and central control determinants of chronic pain: a new conceptual model. In: Kenshalo

, ed. The Skin Senses. Springfield, IL: Thomas; 1968:423–443.

37.

Esplen

Wong

Green

Richards

. Building a high quality oncology nursing workforce through lifelong learning: the de souza model. Int J Nurs Educ Scholarsh. 2018;15(1).

38.

Clark

. ‘Total pain,’ disciplinary power and the body in the work of Cicely Saunders, 1958–1967. Socl Sci Med. 1999;49(6):727–736.

39.

Schafer

. Analysis of Incomplete Multivariate Data. Boca Raton, FL: CRC press; 1997.

40.

Grant

Ferrell

Hanson

Sun

Uman

. The enduring need for the pain resource nurse (PRN) training program. J Cancer Educ. 2011;26(4):598–603.

41.

Porter

Keefe

. Psychosocial issues in cancer pain. Curr Pain Headache Rep. 2011;15(4):263–270.

42.

Frenk

Chen

Bhutta

. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376(9756):1923–1958.

43.

Kamimura

Schneider

Lee

Crawford

Friese

. practice environments of nurses in ambulatory oncology settings: a thematic analysis. Cancer Nurs. 2012;35(1):E1–E7.

44.

Bennett

Flemming

Closs

. Education in cancer pain management. Curr Opin Support Palliat Care. 2011;5(1):20–24.

45.

McLeod

Esplen

Wong

. Enhancing clinical practice in the management of distress: the Therapeutic Practices for Distress Management (TPDM) Project. Psychooncology.2018;27(9):2289–2295.

46.

Pelz

. (My) Three principles of effective online pedagogy. J Asynchr Learn Network. 2010;14:103–116.