Implementation of SIGN 44 guidelines for managing cancer pain in a community setting

This paper discusses the realistic evaluation of an evolving managed clinical network (MCN) in palliative care. The primary focus of this community-based MCN was to improve cancer patients' pain by implementing clinical guidelines. The methods of evaluation included three case studies which featured interviews with patients, relatives and health professionals involved in their care. The results of the case studies were fed back to the network executive group during focus group interviews. The case studies and focus group interviews were carried out at approximately five-monthly intervals. The model of care being implemented by health professionals was refined by the network executive group following each focus group interview. The context, mechanisms and outcomes which evolved from the evaluation contained some elements of a best practice model for controlling pain for patients with advanced cancer.