Robinson Olivia C, Richards Suzanne H, Shoesmith Emily, Pini Simon, Fallon Marie, Mulvey Matthew R
Faculty of Medicine and Health, School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Department of Health Sciences, University of York, York, UK.
Psychooncology. 2025 Mar;34(3):e70132. doi: 10.1002/pon.70132.
Standardising pain assessment in oncology outpatient services (OOS) leads to improvements in patients' pain and quality of life. The Edinburgh Pain Assessment Tool (EPAT) is a standardised cancer pain management tool that has been implemented on inpatient oncology wards (the original setting). Routine use of EPAT reduced post-surgical pain in cancer patients (the original scenario) and led to more appropriate analgesic prescribing. We describe here a case study of adapting the EPAT intervention for use in tertiary OOS in the United Kingdom (UK) National Health Services (NHS), using the ADAPT guidelines.
The adaptation process followed Moore et al.'s ADAPT guidance: Step 1: We assessed rationale for adapting EPAT by reviewing existing literature of pain management in OOS. Step 2: Semi-structured interviews with 20-healthcare professionals (HCPs) to understand current practice and how the intervention might fit the new context (OOS). Step 3: Identified the 'core' and 'peripheral' components of EPAT, undertook four co-design workshops with 7-HCPs to reconfigure EPAT to fit OOS (adapted version is referred to as EPAT+). Four HCPs trialled the EPAT+ intervention in practice to refine the intervention.
Combining qualitative data from interviews with feedback from the co-design workshops and preliminary testing the prototype intervention highlighted several key adaptation goals for EPAT+. These included: (1) reduce length/time to complete EPAT+ due to time constraints in outpatient appointments, (2) the importance of pain re-assessment and using EPAT to facilitate patients to self-monitor their pain at home, and (3) the creation of new peripheral components to support communication with primary care providers.
Using a theoretical driven conceptual guidance provided important learning on how to adapt an existing cancer pain management tool to a new setting (OOS). The result is a novel complex theory- and evidence-based intervention that will be formally tested in a cluster randomised pilot trial.
在肿瘤门诊服务（OOS）中实现疼痛评估标准化可改善患者的疼痛状况和生活质量。爱丁堡疼痛评估工具（EPAT）是一种标准化的癌症疼痛管理工具，已在肿瘤住院病房（最初的应用场景）实施。EPAT的常规使用减轻了癌症患者的术后疼痛（最初的情形），并促使更合理地开具镇痛药处方。在此，我们描述了一个案例研究，即按照ADAPT指南，将EPAT干预措施调整后用于英国国家医疗服务体系（NHS）的三级肿瘤门诊服务。
调整过程遵循了摩尔等人的ADAPT指南：步骤1：通过查阅肿瘤门诊服务中疼痛管理的现有文献，评估调整EPAT的基本原理。步骤2：对20名医疗保健专业人员（HCP）进行半结构化访谈，以了解当前的实践情况以及该干预措施如何适应新环境（肿瘤门诊服务）。步骤3：确定EPAT的“核心”和“外围”组成部分，与7名HCP开展了四次联合设计研讨会，以重新配置EPAT以适应肿瘤门诊服务（调整后的版本称为EPAT+）。四名HCP在实践中试用了EPAT+干预措施以完善该干预措施。
将访谈的定性数据与联合设计研讨会的反馈以及对原型干预措施的初步测试相结合，突出了EPAT+的几个关键调整目标。这些目标包括：（1）由于门诊预约时间有限，缩短完成EPAT+的时长/时间；（2）疼痛重新评估的重要性以及使用EPAT促使患者在家中自我监测疼痛；（3）创建新的外围组成部分以支持与初级医疗服务提供者的沟通。
使用理论驱动的概念性指南为如何将现有的癌症疼痛管理工具调整至新环境（肿瘤门诊服务）提供了重要经验。结果是一种基于理论和证据的新型复杂干预措施，将在一项整群随机试点试验中进行正式测试。
