Year 2018 / Volume 25 / Number 6

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Opinaudit study: clinical uses in breakthrough pain, is scientific evidence being followed up?

Rev. Soc. Esp. Dolor. 2018; 25(6): 325-334 / DOI: 10.20986/resed.2018.3634/2017

Javier Carceller Ruiz, Jordi Guitart Vela, Diana Monge Martín, Fernando Caballero Martínez


ABSTRACT

Introduction: Breakthrough pain (BTP) is a common health problem, badly known and poorly treated in spite of the advancement in its treatment. Guidelines have been published recently by Scientific Societies involved in their management in order to improve the diagnosis and treatment.
Objectives: To know the degree of knowledge and professional agreement with Scientific Societies recommendations, the auto perception in the follow-up and the real follow-up by doctors in their outpatient clinics.
Materials and methods: A descriptive study from professionals’ opinions that were recorded in an electronic survey at two sequential times. A self-audit of clinical habits was performed between them. Professionals evaluated the level of agreement and the application of 12 recommendations from the guidelines in five patients with BPT in their outpatient clinics.
Results: A total of 202 doctors from breakthrough pain units and palliative care participated in the study, at a national level; the mean of professional experience was 11.9 years. Mean age was 47.9 years and 45 % were women. Recommendations’ document was known by 86.6 %. Recommendations with lower degree of agreement or considered less followed-up by professionals were: 1. Recommendation related to the patient’s follow-up during medication titration process: 78.7 % and 18.3 % of surveyed were totally or partially agree with it while 59.4
% always applied it. 2. Recommendation related to prevention of opioid side effects from the beginning of the treatment: 56.4 % and 18.8 % of surveyed were totally or partially agree with it while 66.3 % always applied it. 3. Recommendation related to the need of the patient of receiving opioids for baseline pain: 76.7 % and 35.6 % of surveyed were totally or partially agree with it while 66.8 % always applied it.
After clinical records self-audit, recommendations regarding patients’ follow-up and prevention of side effects were not applied between 15 and 20 % of the times, in line to previous perceptions from specialists. However, recommendation related to the use of opioids for baseline pain isclosed a lower breach (7 %) than perceived (33.2 %).
Conclusions: Professionals from Pain Units and Palliative Care Units have a realistic and accurate perception of the quality of their job in patients with breakthrough pain as well as the improvement areas in their daily job regarding the follow-up and application of recommendations based in scientific evidence.



RESUMEN

Introducción: El dolor irruptivo oncológico (DIO) es un problema de salud frecuente, mal conocido e incorrectamente tratado a pesar de los avances en su tratamiento. Las sociedades científicas implicadas en su manejo han publicado recientemente recomendaciones para la optimización de su diagnóstico y tratamiento.
Objetivos: Conocer el grado de conocimiento y de acuerdo de los profesionales con las recomendaciones de las sociedades científicas, la autopercepción del seguimiento de las mismas por los médicos y su seguimiento real en la clínica.
Material y métodos: Estudio descriptivo de las opiniones de los profesionales recogidas en un cuestionario electrónico en dos momentos secuenciales entre los que intermedió una autovaloración (self-audit) de hábitos clínicos. Los profesionales evaluaron el grado de acuerdo y la aplicación de 12 recomendaciones de las guías en cinco pacientes con DIO en seguimiento en consulta.
Resultados: En el estudio participaron 202 médicos de unidades del dolor y cuidados paliativos de ámbito nacional con una media de 11,9 años de experiencia laboral. La edad media fue 47,9 años y el 45 % fueron mujeres. El 86,6 % conocía el documento de recomendaciones.
Las recomendaciones que alcanzaban menor grado de acuerdo o se percibían como menos aplicadas por los profesionales fueron: 1. La recomendación relacionada con el seguimiento del paciente durante la titulación del tratamiento: el 78,7 % y el 18,3 % de los encuestados mostraron un acuerdo pleno o parcial con la misma y el 59,4 % la aplicaba casi siempre. 2. La recomendación sobre la prevención de efectos secundarios del tratamiento con opioides desde el inicio: el 76,7 % y el 18,8 % mostraron acuerdo pleno o parcial, el 66,3 % la aplicaba casi siempre. 3. La recomendación sobre la necesidad de que el paciente esté recibiendo opioides para el tratamiento del dolor basal: el 56,4 % y el 35,6 % mostraron acuerdo pleno o parcial, el 66,8 % la aplicaba casi siempre.
Tras el self-audit de historias clínicas, las recomendaciones sobre el seguimiento de los pacientes y la prevención de efectos secundarios no se aplicaban en el 15 y 20 % de las ocasiones, en línea con las percepciones previas de los especialistas. Sin embargo, la recomendación sobre la utilización previa de opioides para el dolor basal reveló un incumplimiento menor (7 %) al percibido (33,2 %).
Conclusiones: Los profesionales de Unidades del Dolor y de Unidades de Cuidados Paliativos tienen una percepción realista y precisa de la calidad de su trabajo en los pacientes con dolor irruptivo, así como de los aspectos mejorables de su práctica clínica diaria en relación con el seguimiento y la aplicación de las recomendaciones basadas en la evidencia científica.


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Instrucciones para citar

Carceller Ruiz J, Guitart Vela J, Monge Martín D, Caballero Martínez F. Opinaudit study: clinical uses in breakthrough pain, is scientific evidence being followed up?. Rev Soc Esp Dolor 2018; 25(6): 325-334 / DOI: 1020986/resed20183634/2017


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Ficha Técnica

Recibido: 30/11/2017

Aceptado: 04/12/2017

Prepublicado: 08/01/2018

Publicado: 13/12/2018

Tiempo de prepublicación: 39 días

Tiempo de edición del artículo: 378 días


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