Chen, J., Lu, X.Y., Wang, W.J., Shen, B., Ye, Y., Jiang, H., . . . Cheng, B. (2014). Impact of a clinical pharmacist-led guidance team on cancer pain therapy in China: A prospective multicenter cohort study. Journal of Pain and Symptom Management, 48, 500–509.
To assess the value of pharmacist-led teams as a model for improving drug delivery and implementing the role of the clinical pharmacist in direct patient care using cancer pain management as a focus area
Clinical guidance teams included clinical pharmacists, nurses registered in oncology, oncologists, and administrators. Pharmacists had at least two years' residency in the oncology department and underwent training in opioid pharmacotherapeutics, National Comprehensive Cancer Network guidelines, and Chinese practice guidelines, and they had to pass an examination. The pharmacist was responsible for patient and physician education, consulting in complex cases, and monitoring for drug efficacy and side effects. Patients with a history of cancer-related pain were enrolled. Patients were assigned consecutively to the intervention group, in which the guidance team was involved, or the control group, in which no guidance from the cancer pain therapy team was given. Outcomes were evaluated after six months. Patients in the experimental group had follow-up appointments via face to face or telephonic interviews twice a month. Study data were obtained from medical records and follow-ups.
Cohort design
Compared to the control group, there were more frequent pain severity evaluations before opioid administration, more standardized dose titrations, more sustained-release formulations (p < 0.001), and fewer errors in dose conversion to other opioids (p = 0.017) in the experimental group. Pain scores were lower in the experimental group (p < 0.05), and the incidence of constipation, nausea, and vomiting was lower in the experimental group (p < 0.05).
The implementation of the clinical pharmacist role in guidance teams for cancer-related pain was associated with improvements in the process of medication management and pain scores.
The findings of this study suggested that the intervention of a multidisciplinary team to guide pain management can improve medication management, monitoring, and chronic pain outcomes.