Evidence map›Paper›PMID 30012122›Full record

ArticleBMC health services research2018

Protocol for a phase III pragmatic stepped wedge cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of screening and guidelines with, versus without, implementation strategies for improving pain in adults with cancer attending outpatient oncology and palliative care services: the Stop Cancer PAIN trial.

Tim Luckett, Jane Phillips, Meera Agar, Lawrence Lam, Patricia M Davidson, Nicola McCaffrey, Frances Boyle, Tim Shaw, David C Currow, Alison Read and 2 more

Open access · goldAbstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC health services research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
1.5field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it, 28 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Trial
  5. Trial
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 7 institutions in 3 countries.

Tim LuckettFaculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Level 7, 235 Jones St, Ultimo, (PO Box 123), Sydney, NSW, 2007, Australia. Tim.luckett@uts.edu.au.ORCID 0000-0001-6121-5409
Jane PhillipsFaculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Level 7, 235 Jones St, Ultimo, (PO Box 123), Sydney, NSW, 2007, Australia.
Meera AgarFaculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Level 7, 235 Jones St, Ultimo, (PO Box 123), Sydney, NSW, 2007, Australia.
Lawrence LamTung Wah College, Mongkok, Kowloon, Hong Kong.
Patricia M DavidsonSchool of Nursing, Johns Hopkins University, Baltimore, MD, USA.
Nicola McCaffreyDeakin Health Economics, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, Australia.
Frances BoyleThe Mater Hospital, Cancer Care, Sydney, NSW, Australia.
Tim ShawFaculty of Health Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
David C CurrowFaculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Level 7, 235 Jones St, Ultimo, (PO Box 123), Sydney, NSW, 2007, Australia.
Alison ReadDepartment of Renal/Oncology, Gosford Hospital, Gosford, NSW, Australia.
Annmarie HosieFaculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Level 7, 235 Jones St, Ultimo, (PO Box 123), Sydney, NSW, 2007, Australia.
Melanie LovellDepartment of Palliative Care, HammondCare, Greenwich Hospital, Sydney, NSW, Australia.
University of Technology Sydney · AUDeakin University · AUGosford Hospital · AUJohns Hopkins University · USMater Health Services · AUThe University of Sydney · AUTung Wah College · CN

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPain is a common and distressing symptom in people with cancer, but is under-recognised and under-treated. Australian guidelines for 'Cancer Pain Management in Adults' are available on the Cancer Council Australia Cancer Guideline Wiki. This study aims to evaluate the effectiveness and cost-effectiveness of a suite of guideline implementation strategies for improving pain outcomes in adults with cancer in oncology and palliative care outpatient settings.

methodsThe study will use a stepped-wedge cluster randomised controlled design, with oncology and palliative care outpatient services as the clusters. Patients will be eligible if they are adults with cancer and pain presenting to participating services during the study period. During an initial control arm, services will routinely screen patients for average and worst pain over the past 24 h using a 0-10 numerical rating scale (NRS) and have unfettered access to online guidelines. During the intervention arm, staff at each service will be encouraged to use: 1) a patient education booklet and self-management resource; 2) an online spaced learning cancer pain education module for clinicians from different disciplines; and 3) audit and feedback of service performance on key indices of cancer pain screening, assessment and management. Service-based clinical change champions will lead implementation of these strategies. The trial's primary outcome will be the probability that patients initially screened as having moderate-severe (≥5/10 NRS) worst pain experience a clinically important improvement one week later, defined as  ≥ 30% reduction. Secondary outcomes will include patient empowerment and quality of life, carer experience, and cost-effectiveness. For the main analysis, linear mixed models will be used, accounting for clustering and the longitudinal design. Eighty-two patients per service at six services (N = 492) will provide > 90% power. A qualitative sub-study and analyses of structural and process factors will explore opportunities for further refinement and tailoring of the intervention. DISCUSSION: This pragmatic trial will inform implementation of guidelines across a range of oncology and palliative care outpatient service contexts. If found effective, the implementation strategies will be made freely available on the Wiki alongside the guidelines.

trial registrationRegistered 23/01/2015 on the Australian New Zealand Clinical Trials Registry ( ACTRN12615000064505 ).

Indexed as

AdultAmbulatory CareAustraliaCancer PainClinical Trials, Phase III as TopicCluster AnalysisCost-Benefit AnalysisEarly Detection of CancerFemaleHumansMaleMulticenter Studies as TopicNeoplasmsOutpatientsPain ManagementPalliative CareAudit and feedbackCancerClinical change championsGuidelinesHealth professional educationImplementationPainPatient educationSelf-managementTranslation

Identifiers

PMID30012122
PMCPMC6048744
OpenAlexW2884241647

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.