| BackgroundsIn1979, International Association for the Study of Pain (IASP) introduced the definition of pain:pain is an unpleasant sensory and emotional experience accompanied by substantial or potential tissue damage. In2011, Health Ministry of China issued a regulation which required every teaching hospital to set up cancer pain standardization treatment unit, the regulation emphasized The responsibilities of clinical pharmacist in the treatment of cancer pain were emphasized according to the regulation. Clinical pharmacists are responsible to provide professional knowledge on pain and pain-killer, and help patients effectively control pain.Pain is one of the most common symptoms in cancer patients. There are about14million cancer patients in the world with about7million new cancer patients each year, and30%-60%of them suffering with cancer pain. Nearly2million new cancer patients increase each year in China. More than50%patients occur cancer pain and can not be effectively treated. In1986the three-step analgesic ladder was proposed by the World Health Organization (WHO) and it had been widely used all over the world, which was demonstrated to be safe, effective, simple and feasible. Since1990, it had been popularized in China. So far some improvement of cancer pain treatment has achieved, yet a certain proportion of cancer patients do not get effective control.One barrier of effective cancer pain management is poor cancer pain knowledge. China is a developing country with huge population, and many Chinese are uneducated. Most cancer patients lack of cancer pain management knowledge which result in cancer insufficient pain relief. It is essential to perform educational intervention to improve patients’cognitions on cancer pain and behavior to solve this problem. Patients’ education plays an important role in diminishing patient-related barriers and optimizing outcomes in cancer pain management. The previous educational intervention for patients with cancer pain is provided mainly by oncology physicians or nurses, and patients benefited a lot from the education. However the time of patient education was not enough due to the physicians and nurses’ heavily work burden resource. As a member of the clinical team, clinical pharmacists should shoulder the medication education on cancer pain and promoting the rational use of cancer drug which are both professional requirement and responsibilities of pharmacist.ObjectivesThe purpose of this study was to assess the current status of patients’ knowledge on caner pain and pain control, to explore the effect of pharmacist’s medication education in cancer pain patients, to build a feasible working model of pharmacists in cancer pain control.MethodsA multi-center randomized controlled study was conducted at six tertiary hospitals of Guangzhou, China from October2011to May2012.256cancer patients were randomly assigned to education intervention group (n=128) and control group (n=128) by Random Number Table. Twelve clinical pharmacists from these six hospitals got a unified training in order to provide consistent education and investigation method. There are2pharmacists in each center, one was assigned to help patient to finish the questionnaire; the other was assigned to educate patients. Each patient in education group was distributed with three booklets including Opioid and Analgesic Guideline, Cancer and Pain, and Medication Knowledge and Skills with Cancer Patients. Besides, patients in education group were provided with8face-to-face educational sessions on pain and pain control by pharmacists over4weeks period besides conventional treatment. Each session lasted for approximately30minutes. Patients in the control group only received conventional treatment. Data were analyzed with SPSS13.0software, the examination standard is:a=0.05(two-sided).Results1. In the education intervention group,5participants dropped out during the follow-up period due to death or advances in illness from the study, the final effective cases were123cases. In the control group,2participants dropped out during the follow-up period because of death or advances in illness,6participants withdrew from the study, the final effective cases were114cases.2. Result of the multiple linear regression equation showed that usage of analgesics, education level and age were the significant influencing factors for total pain-related knowledge scores, multiple correlation coefficient R was0.354and the coefficient of determination R2was0.125.3. Before the study, there was no significant difference in baseline values between control group and the education intervention group such as pain knowledge score, analgesics knowledge score, total pain-related knowledge scores, pain intensity and pain interference (all P>0.05).4. At the end of the study, patients’ knowledge on caner pain and pain control was significantly increased both in control group and in education group. The total pain-related knowledge scores raised from the first investigation12.53±2.63to the second investigation14.62±3.22[t=-7.386,95%CI(-2.659,-1.534), P-0.000] in control group and from the first investigation12.39±2.55to post-study17.92±2.38[t=-23.350,95%CI (-5.988,-5.052), P=0.000]in education intervention group, respectively. There was significant difference for the second investigation total scores in2groups [14.62±3.22vs17.92+2.38(F=81.681, P=0.000)]. The growth of total pain-related knowledge scores had higher gained in patients who had never used analgesics than those patients who were using or had used analgesics in control group3.12±3.59vs1.24+2.16(Z=-3.143, P=0.002).5. Five types of pain intensity scores of patients in two groups showed a significant decrease. Moreover, worst pain intensity [4.22±2.47vs4.81±3.02(F=34.252, F=0.038)], usual pain intensity [2.87±2.22vs3.50±2.69(F=41.211, P=0.014)], current pain intensity [2.41±2.03vs2.94±2.66(F=52.968, P=0.013)], pain intensity at rest [2.37±1.95vs2.95±2.64(F=57.396, P=0.009)] and pain intensity with movement [3.03±2.28vs3.45±2.28(F=56.784, P=0.037)] reduction slope in education group were significantly larger than those in control group.6. Patients in two groups had significant decreased (all P<0.01) between the first investigation and the second within-group. Education intervention had no effect on relationship with others (F=112.277, P=0.102), but had significant effect on general activity (F=69.557, P=0.002), mood, walking ability(F=104.280, P=0.016), normal work (F=52.292, P=0.013), sleep (F=33.985, P=0.010) and enjoyment of life (F=39.093,P=0.040) between two groups.ConclusionsMost cancer patients lack of knowledge about cancer pain management. Medication education led by clinical pharmacists is positive in increasing pain-related knowledge, reducing pain intensity and pain interference, which ultimately ensures better cancer pain control. BackgroundsCancer has become a common but serious disease with an increasing trend of morbidity and mortality. There were about14million cancer patients in the world, about7million new cancer patients each year,5million died of cancer. Cancer has become the first major killer of endangering human life. Chemotherapy is one of important methods in treating malignant tumor, which has very important clinical significance in prolonging patient’s life and improving their quality of life. However, most anticancer drugs have varying degrees of toxicity, which often lead to adverse drug reactions (ADRs). Mild ADRs reduce the quality of life of cancer patients, prolong stay time, increase their financial burden and reduce the survival rate,, meanwhile severe ADRs often interrupt the chemotherapy and bring about chemotherapy failure. Fear for toxicity and expectations for outcome of chemotherapy lead patients fall into a "trend-avoid" psychological conflict.Clinical pharmacy is a common development trend in hospital pharmacy both at home and abroad. In the developed countries,45%of hospitals have clinical pharmacists. With the development of medical and health services, hospital pharmacy transformed from drug-centered service to patient-centered care in China. The oncology pharmacy is one of the most active areas in hospital clinical pharmacy, many oncology pharmacists have worked in oncology department especially in cancer pain wards. With the clinical pharmacists’ intervention on cancer patients, we wish to better complete clinical chemotherapy of cancer patients.ObjectivesThe objective of this study was to evaluate the effect of medication-education-centered pharmacy intervention led by clinical pharmacist on cancer patients.MethodsA randomized controlled study was conducted at Department of Oncology in Zhujiang Hospital of Southern Medical University from October2011to December2012.155cancer patients were randomly assigned to control group(n=76) and intervention group(n=77) by Random Number Table. Each patient in intervention group was distributed with booklets Skills with Cancer Patients. Patients in intervention group were provided with2times per week sessions on clinical pharmacy intervention by pharmacists over2months period besides conventional treatment. Each session lasted for approximately30minutes. Patients in the control group only received conventional treatment, the questionnaire on (Knowledge, Attitude, Practice, KAP) and (Quality Of Life, QOL) were used to assess the effect after the intervention had finished. Data were analyzed with SPSS13.0software, the examination standard is:a=0.05(two-sided).Results1. During the investigation,2participants dropped out during the follow-up period due to death or advances in illness,2participants withdrew from the study, the final effective cases were72cases in the control group,2participants dropped out during the follow-up period due to death or advances in illness, the final effective cases were77cases in the intervention group. There were no differences with respect to demographic and clinical characteristics between two groups. 2. Before intervention, there was no significant difference between two groups in knowledge scores, attitude scores, behavior scores, each scores of quality of life at the baseline (all P>0.05).3. At the end of study, knowledge scores (17.71±2.11vs9.94±3.84), attitude scores (22.04±12.38vs15.64±3.92), behavior scores (5.69±0.47vs4.82±0.84) were significantly increased compared with baseline values in the intervention group (all P<0.01). Knowledge scores was significantly increased in the control group [t=-4.219,95%CI (-1.370,-0.491),P=0.000], attitude scores and behavior scores were no significantly increased (all P>0.05). Knowledge scores, attitude scores and behavior scores were significant different between two groups (all P<0.01).4At the end of study, the patients’scores of emotional function and overall quality of life was statistically increased (all P<0.01), meanwhile the scores of fatigue, nausea and vomiting, pain, insomnia, constipation, diarrhea were statistically decreased (all P<0.01). Each item scores were no significant changes in the control group (all P>0.05). The scores of emotional function, fatigue, nausea and vomiting, pain, insomnia, constipation, diarrhea and overall quality of life were significant different between two groups (all P<0.01).ConclusionsPharmacy intervention led by clinical pharmacist has a positive role in increasing chemotherapy-related knowledge, improving patients’ negative emotions, dealing with chemotherapy adverse reactions and improving the quality of life of patients. |
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