Development of a pharmacist -led cancer related pain management module for cancer patients on opioids

Abstract

Pain is a significant symptom of cancer, profoundly affecting patients' quality of life. This project focuses on optimizing pain management in cancer patients using pharmacist-led interventions, supported by a well-defined, evidence-based module. A scoping review examined the effects of such interventions in adult cancer patients, analyzing studies published between 2000 and 2022. Of the 7042 studies screened, 37 were included. These studies highlighted the positive effects of educational programs on pain management. A cross-sectional study at a Turkish Palestinian Friendship Hospital (TPFH) assessed cancer pain and opioid nonadherence among 270 patients. Pain intensity and interference as well as adherence were evaluated using validated questionnaires. The average pain intensity score was 5.96 suggesting moderate pain intensity. Less than one third of the patients had high adherence score towards the opioid prescribed. Predictors of opioid adherence were educational level, perceived relief with analgesic and presence of side effects. Addressing these factorsoptimize adherence and educating patients are critical for effective pain management. To further explore facilitators and barriers towards opioid adherence, a qualitative study was conducted at TPFH between August and September 2023. This study involved telephone-based semistructured interviews with 15 high-adherence and 15 low-adherence patients based on the previous survey. It investigated their experiences with analgesic use, side effect management, support systems and routines during medication shortages that may have affected their adherence to opioids. Insights from these interviews revealed patient attitudes toward opioids and identified areas for improvement in adherence strategies. These comprehensive findings together with extensive review of the literature informed the development of a pharmacist-led module designed to improve cancer-related pain management outcomes. A Content Validity Index (CVI) was employed to evaluate the module. Three oncologists and three oncology pharmacists assessed the module’s content and usability using a 4-point Likert scale. The CVI measured content relevance through two metrics: the Average (S-CVI/Ave) and Universal Agreement (S-CVI/UA). Usability testing was conducted using the System Usability Scale (SUS) by participating pharmacists, confirming the module’s practical application. Both CVI and SUS showed good validity and usability, respectively. This research underscores the importance of tailored interventions in managing cancer pain, emphasizing patient education, adherence optimization, and collaboration among healthcare professionals. By addressing barriers to opioid use and enhancing pharmacist-led initiatives, the module offers a comprehensive approach to optimizing opioid use for cancer pain management improving the quality of life for cancer patients.