Introduction of a pain and symptom assessment tool in the clinical setting--lessons learned

It has long been acknowledged that pain is a subjective, multifaceted phenomenon which is influenced by many factors such as past experience and culture. However there are other symptoms that can be distressing such as dyspnea and nausea. In Ottawa, Canada there was recognition that inconsistencies existed in pain and symptom assessment methods and documentation in the different institutions and agencies when patients with cancer moved from one setting to another as their illness progressed. Therefore, a working group with clinical representatives was formed with a mandate to develop a standardized tool so that there would be a common language for pain and symptom assessment. Although various tools have been developed for pain assessment such as visual analogue or numeric rating scales, there has been limited attention focused on the sustainability of these tools in the practice setting. This paper will focus on the importance of the use of tools for pain and symptom management, issues around implementing them, and sustaining their use in the clinical setting. The Ottawa Pain and Symptom Assessment Record will be used as an exemplar.