Development of the Practice of Pharmaceutical Care for Cancer Pain Management in Outpatient Clinics Using the Delphi Method

Lu Zhang; Xia-Yang Ren; Hang-Xing Huang; Ya-Min Huang; Ling Huang; Xiao-Ping Chen; Yao Chen; Chen Wang; Jian Xiao

doi:10.3389/fphar.2022.840560

Development of the Practice of Pharmaceutical Care for Cancer Pain Management in Outpatient Clinics Using the Delphi Method

Front Pharmacol. 2022 Jun 2:13:840560. doi: 10.3389/fphar.2022.840560. eCollection 2022.

Authors

Lu Zhang^{1

2}, Xia-Yang Ren³, Hang-Xing Huang^{1

2}, Ya-Min Huang^{1

2}, Ling Huang^{1

2}, Xiao-Ping Chen⁴, Yao Chen⁴, Chen Wang⁵, Jian Xiao^{1

2}

Affiliations

¹ Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.
² Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
³ Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁴ Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.
⁵ Department of Pharmacy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.

Abstract

Background: There exists no broad agreement of experts on the practice of pharmaceutical care for cancer pain management in outpatient clinics. Objectives: This study aimed to use the Delphi consensus process to provide expert recommendations on the practice of cancer pain management in outpatient clinics from the point of view of pharmaceutical care in clinical practice and future clinical trials. Methods: A comprehensive literature review was conducted to draft the initial practice. In this process, 30-40 senior experts from various provinces in China were invited to rank the items of practice during the two Delphi consultations. The definitions of consensus included a combination with an average score of ≥4, the percentage of experts rating the scores at >4 points, and the coefficient of variation of the scores. Results: The expert panel comprised 18 pharmacists, 3 anesthesiologists, 6 oncologists, and 9 nurses. As a result of a comprehensive review, 33 items were initially formed. Among them, the consensus was reached for 27 items after the first Delphi round. The other six items and a total of five items for supplementation entered the second round, among which consensus was reached for eight items and three items were excluded. Expert consensus was achieved on 35 items after two rounds of consultation, which involved the collection of patient basic information, comprehensive pain assessment, breakthrough or neuropathic pain assessment, analgesic treatment evaluation, out-of-hospital follow-up, medical records, and evidence-based documents for reference. Conclusion: The final list of 35 items could be used to develop the practice of pharmaceutical care for cancer pain management in outpatient clinics in China. The practice may aid in the standardization of pharmaceutical care for pain, relieve pain to the greatest extent possible, and enhance the level of pain management in China.

Keywords: Delphi technique; ambulatory care; cancer pain; care practice; pharmaceutical services.