Is there evidence that guidelines work or improve patient care? Researchers in Washington State found that clinical practice guidelines improved management of cancer pain. In a study of 81 cancer patients, researchers at Washington State's Swedish Medical Center found that the use of a treatment algorithm for pain management, based on guidelines from AHCPR, improved "usual pain" outcomes. The study's Cancer Pain Algorithm addresses pain assessment, analgesic drug choice decisions, and reassessment. The decision tree includes side effect treatment protocols, equianalgesic conversion charts, and a primer for intractable pain.
Researchers followed patients for three months, taking pain measurements at five intervals: at baseline; at two weeks; and at one, two, and three months after the start of the intervention. Pain outcomes were "usual" and "worst" pain as measured by a Brief Pain Inventory. Pain outcome tools included:
Patients whose care was facilitated by use of the pain algorithm had statistically superior results in reduction of "usual pain." Control group patients had an initial decrease in pain intensity, but finished the study with a slight increase in usual pain scores. Patients in the algorithm group, however, experienced a steady decrease in usual pain scores. (Du Pen, et al., 1999)
This text is derived from the book Improving Care for the End of Life : A Sourcebook for Health Care Managers and Clinicians.