Abstract
Aim
To evaluate the effectiveness of a HPCT in improving:
1) pain and symptom control, effective communication and discharge planning in patients with advanced cancer
2) the knowledge, skills and attitudes of medical and nursing staff in relation to cancer pain management
Project Outline/Methodology
A pre and post test non-equivalent-group design was used to measure the above areas on two separate occasions (5-14 days apart). The intervention patients completed the research questionnaires both before and after the intervention from the HPCT. The control sample was drawn from two hospitals who did not have HPCTs. The samples of patients in the intervention and control arms all had advanced cancer and were recruited from general surgical and urology wards. During the 4 year study period 465 patients were eligible for the study but 271 patients were either too ill, did not consent or withdrew from the
study. A total of 194 patients (102 controls and 92 intervention) completed both the pre and post tests.
There were very few statistical differences between these samples, however the control sample patients were from a more deprived social background. A
further 19 patients received an additional in-depth research interview after discharge. In addition to this 232 medical and nursing staff completed
questionnaires at the beginning and at the end of the study measuring issues in relation to pain and symptom control.
Key Results
Although recruitment to the study was difficult, the numbers were large enough to detect statistical and clinically significant differences. The following results
found that patients in the intervention group:
• had significant improvements in all aspects of pain and improvements in mood, and sleeping
• were more satisfied with information provided about their illness, medication and treatment
• were more likely to be involved in discharge planning were less likely to be re-admitted in the month following discharge.
All patients in the in-depth interviews spoke positively about the involvement of the HPCT. The nursing / medical staff in the intervention sample all
demonstrated significant improvements (when compared to the control group) in the following:
• knowledge /attitudes to cancer pain management
• greater compliance to national standards and improvements in analgesic prescribing
Conclusions
This study suggests that HPCTs have a vital role in hospitals in improving unrelieved pain and symptoms in patients with advanced cancer. The findings also suggest that the observed difference in deprivation does not infuence the control of pain. However, this and other possible differences between the samples should be considered when interpreting these results.
What does this study add to the field?
This study is the largest study in the field of specialist palliative care that examinies the influence of HPCTs. It confirms findings of smaller studies and descriptive studies that have not used controls. The highly significant improvement in pain control is encouraging, as is the improvement in staff attitudes.
Implications for Practice or Policy
Many hospitals in Scotland do not have access to HPCTs. This should be questioned in light of these findings.
Where to next?
Further research into different aspects and models of service delivery is needed. However, it is hoped that both regional cancer advisory groups and individual
health boards will underline the potential benefits in supporting the development of HPCTs.
To evaluate the effectiveness of a HPCT in improving:
1) pain and symptom control, effective communication and discharge planning in patients with advanced cancer
2) the knowledge, skills and attitudes of medical and nursing staff in relation to cancer pain management
Project Outline/Methodology
A pre and post test non-equivalent-group design was used to measure the above areas on two separate occasions (5-14 days apart). The intervention patients completed the research questionnaires both before and after the intervention from the HPCT. The control sample was drawn from two hospitals who did not have HPCTs. The samples of patients in the intervention and control arms all had advanced cancer and were recruited from general surgical and urology wards. During the 4 year study period 465 patients were eligible for the study but 271 patients were either too ill, did not consent or withdrew from the
study. A total of 194 patients (102 controls and 92 intervention) completed both the pre and post tests.
There were very few statistical differences between these samples, however the control sample patients were from a more deprived social background. A
further 19 patients received an additional in-depth research interview after discharge. In addition to this 232 medical and nursing staff completed
questionnaires at the beginning and at the end of the study measuring issues in relation to pain and symptom control.
Key Results
Although recruitment to the study was difficult, the numbers were large enough to detect statistical and clinically significant differences. The following results
found that patients in the intervention group:
• had significant improvements in all aspects of pain and improvements in mood, and sleeping
• were more satisfied with information provided about their illness, medication and treatment
• were more likely to be involved in discharge planning were less likely to be re-admitted in the month following discharge.
All patients in the in-depth interviews spoke positively about the involvement of the HPCT. The nursing / medical staff in the intervention sample all
demonstrated significant improvements (when compared to the control group) in the following:
• knowledge /attitudes to cancer pain management
• greater compliance to national standards and improvements in analgesic prescribing
Conclusions
This study suggests that HPCTs have a vital role in hospitals in improving unrelieved pain and symptoms in patients with advanced cancer. The findings also suggest that the observed difference in deprivation does not infuence the control of pain. However, this and other possible differences between the samples should be considered when interpreting these results.
What does this study add to the field?
This study is the largest study in the field of specialist palliative care that examinies the influence of HPCTs. It confirms findings of smaller studies and descriptive studies that have not used controls. The highly significant improvement in pain control is encouraging, as is the improvement in staff attitudes.
Implications for Practice or Policy
Many hospitals in Scotland do not have access to HPCTs. This should be questioned in light of these findings.
Where to next?
Further research into different aspects and models of service delivery is needed. However, it is hoped that both regional cancer advisory groups and individual
health boards will underline the potential benefits in supporting the development of HPCTs.
| Original language | English |
|---|---|
| Publisher | Scottish Executive |
| Commissioning body | Scottish Executive |
| Number of pages | 1 |
| Publication status | Published - 2004 |
| Externally published | Yes |
Publication series
| Name | Focus on Research |
|---|---|
| Publisher | Scottish Executive Health Department Chief Scientist Office |
