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Pain assessment and management in paediatric oncology: a cross-sectional audit
Karin Plummer1,2,3,4, Maria McCarthy1,2, Ian McKenzie4
1Children's Cancer Centre, Royal Children's Hospital, Parkville, Melbourne, Vic., Australia.
Insights
Pain management for children with cancer needs improvement. Documentation of pain and use of non-pharmacological methods were insufficient, despite most pain being mild and appropriately managed.
Area of Science:
- Pediatric Oncology
- Pain Management
- Clinical Audit
Background:
- Children undergoing cancer treatment experience significant pain.
- High-quality pain management is crucial for pediatric oncology inpatients.
- Antineoplastic therapy intensifies pain vulnerability in children with cancer.
Purpose of the Study:
- To document pain assessment and management by healthcare professionals in a Children's Cancer Centre.
- To compare these practices against international recommendations.
- To evaluate the quality of pain management in pediatric oncology.
Main Methods:
- A single-site, cross-sectional audit of documented pain-related care.
- Reviewed 258 episodes of care over two months in an Australian tertiary-level Children's Cancer Centre.
- Examined a 24-hour period of care for randomly selected inpatients.
Main Results:
- Pain from cancer treatment was common (57%) and persistent.
- Pain presence was inconsistently recorded (51%).
- Opioids were primary interventions (56%), non-pharmacological methods were underused (26%), though most pain was mild (35%) and appropriately managed (87% by Pain Management Index).
Conclusions:
- Pain management practices did not fully align with current pediatric pain guidelines.
- Inadequate documentation hindered assessment of intervention effectiveness.
- Routine pain screening and efficacy assessment are recommended for children receiving cancer therapy.
Aims And Objectives:
To describe the pain assessment and management practices documented by health professionals within a tertiary-level Children's Cancer Centre and to evaluate how these practices were compared with international recommendations.
Background:
Children with cancer are vulnerable to pain due to the intensity of antineoplastic therapy. Therefore, it is imperative to ensure that current pain management practices provided to paediatric oncology inpatients are of a high quality.
Design:
A single-site cross-sectional audit.
Methods:
A 24-hour period of documented pain-related care in randomly selected inpatients of an Australian tertiary-level Children's Cancer Centre was examined. The current pain management practices were audited over a two-month period resulting in 258 episodes of pain-related care being reviewed.
Results:
Pain related to medical treatment for cancer was common (n = 146/258, 57%) and persistent. The presence of pain was not consistently recorded by health professionals (n = 75/146, 51%). Pain was mild (n = 26/75, 35%) and opioids were the mainstay of pain management interventions (n = 63/112, 56%). Adjuvants were an important component of pain management (n = 47/112, 42%), and nonpharmacological methods of managing pain were under-represented in this audit (n = 38/146, 26%). According to the Pain Management Index, pain was appropriately managed for the majority of children (n = 65/76, 87%).
Conclusions:
Pain management practices did not fully reflect the recommendations of contemporary paediatric pain management. Due to limitations in the documentation of children's pain, it was difficult to determine the effectiveness of pain management interventions.
Relevance To Clinical Practice:
This study highlights the ongoing problem of pain for children receiving antineoplastic therapy. It is recommended that health professionals routinely screen for the presence of pain during hospitalisation and assess the efficacy of pain-related care.
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