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Improving Patient-reported Pain During Radiotherapy Through Nurse Involvement and Patient Education

Holtzman, Adam L., MD; Williams, Jodie P., LPN; Hutchinson, Debra F., RN; Morris, Christopher G., MS; Yeung, Anamaria R., MD

American Journal of Clinical Oncology: October 2018 - Volume 41 - Issue 10 - p 1028–1030
doi: 10.1097/COC.0000000000000415
Original Articles: Health policy

Objectives: Pain management during radiotherapy helps assess quality of care. By establishing an intervention to address pain during on-treatment visits (OTVs), we aim to lower patient-reported pain scores.

Methods: A total of 171 patients were included in the analysis: 58 were retrospectively reviewed to provide a control and 113 were prospectively enrolled and evaluated after the intervention. The intervention included (1) a pain management in-service performed with the resident physician and nurses, (2) distribution of pain management educational materials, and (3) nurse consultation for patients with a pain score ≥5 within 2 days of the in-service. Study aims were to reduce the number of pain scores ≥5 by 30% and increase the number of pain scores documented during every OTV to >90%.

Results: Median patient age was 65 years. Before the intervention, the average DVPRS score at initial consultation was 2 (range, 0 to 9) and 98% of patients had scores documented during OTVs. Overall, 26% (44/171) of OTV scores measured ≥5. Following the intervention, average DVPRS score at initial consultation was 2 (range, 0 to 10) and 99% of scores were documented during OTVs. About 14% (49/341) of patient-reported scores were ≥5, representing an ~50% relative reduction (P=0.023). The number of patients with 2+ pain scores ≥5 was reduced from 21% (12/58) before the intervention to 11% (12/109) after the intervention (P=0.1068).

Conclusion: Involving nursing staff in the education and follow-up of patients with uncontrolled pain during radiotherapy led to an ~50% relative reduction in patient-reported DVPRS scores of 5+ during weekly OTVs.

The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL

Presented at ASTRO’s 58th Annual Meeting in Boston, MA, USA.

The authors declare no conflicts of interest.

Reprints: Anamaria R. Yeung, MD, 2000 SW Archer Road, P.O. Box 100385, Gainesville, FL 32610-0385. E-mail:

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