Edinburgh Pain Assessment Tool (EPAT©) Study

NCT ID: NCT00595777

Last Updated: 2012-09-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1928 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-12-31

Study Completion Date

2012-08-31

Brief Summary

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To determine if the institutionalisation of a regular systematic approach to the assessment of pain in inpatient cancer units using the Edinburgh Pain Assessment Tool (EPAT©) leads to better control of pain than that achieved by usual care.

Detailed Description

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Background and relevance to cancer - Pain associated with cancer has a severe negative impact on quality of life and can also limit a patient's ability to tolerate potentially life-saving tumoricidal treatment. Unfortunately in practice only half of cancer patients receive adequate pain control. A fundamental reason for this is inadequate assessment of pain. The institutionalisation of pain assessment as a 5th vital sign on the bedside chart combined with training and guidance in pain management (EPAT) is a potentially effective solution.

We have already evaluated the feasibility and efficacy of EPAT in a randomised trial of 150 oncology inpatients and found that by Day 4 after admission 90% reported adequate pain control compared to only 52% of those who received usual care.

Aims - We now want to evaluate the effectiveness and cost-effectiveness of EPAT in practice and ask: Does it reduce cancer pain more that usual care? Are there adverse effects? Is it cost effective?

Outline plan - A UK-wide cluster randomised controlled trial of 18 inpatient cancer centres of which half will use the EPAT package and half usual care. The trial outcomes are clinically significant improvement, adverse effects such as opiate toxicity and cost effectiveness.

Conditions

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Cancer

Keywords

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Institutional change Improved pain management

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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1. Comparison

The centres allocated to the comparison group will continue to provide usual care only.

Group Type NO_INTERVENTION

No interventions assigned to this group

2. Experimental

The EPAT package consists of an educational programme, which deals with the common barriers to effective cancer pain control and the bedside pain tool.

Group Type EXPERIMENTAL

EPAT© Educational Package

Intervention Type BEHAVIORAL

The EPAT package consists of an education programme, which deals with the known common barriers to effective pain control and the bedside pain tool. The pain tool is uniquely incorporated into the vital signs chart to enable a systematic approach to cancer pain assessment and review. EPAT consists of 2 steps: step 1 is a colour-coded pain assessment on the bedside vital signs chart. Patients with moderate or severe pain on step 1 will progress to to step 2, which helps to identify the aetiology of the pain, screening for opioid side effects and is linked via flags to simple management plans. The intervention will be delivered to the clusters randomised to the intervention, after collection of baseline data (pre-intervention data) on 50 patients.

Interventions

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EPAT© Educational Package

The EPAT package consists of an education programme, which deals with the known common barriers to effective pain control and the bedside pain tool. The pain tool is uniquely incorporated into the vital signs chart to enable a systematic approach to cancer pain assessment and review. EPAT consists of 2 steps: step 1 is a colour-coded pain assessment on the bedside vital signs chart. Patients with moderate or severe pain on step 1 will progress to to step 2, which helps to identify the aetiology of the pain, screening for opioid side effects and is linked via flags to simple management plans. The intervention will be delivered to the clusters randomised to the intervention, after collection of baseline data (pre-intervention data) on 50 patients.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Able and consent to complete a Brief Pain Inventory score
* Aged over 18 years
* Have a pain score equal to or greater than 4 out of 10 at first assessment point (within 24 hours of admission) and pain is cancer related
* Are expected to be available for pain assessment at 3 days after admission

Exclusion Criteria

* Do not consent to take part in the study or who are too ill to take part, including those with severe mental health problems
* Do not have cancer-related pain
* Are under 18 years of age
* Have a pain score of less than 4
* Are not expected to be available for pain assessment at 3 days after admission
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Cancer Research UK

OTHER

Sponsor Role collaborator

University of Edinburgh

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Marie Fallon

Role: STUDY_DIRECTOR

University of Edinburgh

Michael Sharpe

Role: STUDY_DIRECTOR

University of Edinburgh

Lesley Colvin

Role: STUDY_DIRECTOR

University of Edinburgh

Gordon Murray

Role: STUDY_DIRECTOR

University of Edinburgh

Locations

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Mount Vernon Cancer Centre

Northwood, Middlesex, United Kingdom

Site Status

Bristol Haematology and Oncology Centre

Bristol, Sommerset, United Kingdom

Site Status

Belfast City Hospital

Belfast, , United Kingdom

Site Status

Queen Elizabeth Hospital

Birmingham, , United Kingdom

Site Status

Addenbrookes Hospital

Cambridge, , United Kingdom

Site Status

Velindre Hospital

Cardiff, , United Kingdom

Site Status

The Western General Hospital

Edinburgh, , United Kingdom

Site Status

Beaston Oncology Centre

Glasgow, , United Kingdom

Site Status

Hull Royal Infirmary

Hull, , United Kingdom

Site Status

St. James's Hospital

Leeds, , United Kingdom

Site Status

Clatterbridge Centre for Oncology

Liverpool, , United Kingdom

Site Status

The Royal Marsden Hospital

London, , United Kingdom

Site Status

The Christie

Manchester, , United Kingdom

Site Status

Freeman Hospital

Newcastle, , United Kingdom

Site Status

City Hospital

Nottingham, , United Kingdom

Site Status

Churchill Hospital

Oxford, , United Kingdom

Site Status

Derriford Hospital

Plymouth, , United Kingdom

Site Status

Southampton University Hospital

Southampton, , United Kingdom

Site Status

The Royal Marsden Hospital

Sutton, , United Kingdom

Site Status

Countries

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United Kingdom

References

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Fallon M, Walker J, Colvin L, Rodriguez A, Murray G, Sharpe M; Edinburgh Pain Assessment and Management Tool Study Group. Pain Management in Cancer Center Inpatients: A Cluster Randomized Trial to Evaluate a Systematic Integrated Approach-The Edinburgh Pain Assessment and Management Tool. J Clin Oncol. 2018 May 1;36(13):1284-1290. doi: 10.1200/JCO.2017.76.1825. Epub 2018 Mar 15.

Reference Type DERIVED
PMID: 29543567 (View on PubMed)

Other Identifiers

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06/MRE10/84

Identifier Type: -

Identifier Source: org_study_id