An Implementation Study to Improve Cancer Pain Management in Jordan Using a Case Study

An Implementation Study to Improve Cancer Pain Management in Jordan using a Case StudyManaging the symptoms of cancer effectively is one of the most important challenges facing health care providers. Many symptoms are reported by cancer patients, including, pain, depression, distress and change in life style. Pain continues to be the most frequently reported symptom, however, cancer pain is treated inadequately and cancer patients continue to suffer pain. The use of pain assessment tools is essential to effectively manage cancer pain. Despite that, research findings indicate that pain assessment tools are routinely not used in practice. In addition, there is a paucity of data about cancer pain management in Jordan, and no published information is available about adult cancer pain assessment and barriers to optimal pain management in the country. A single-site case study with mixed methods was used to implement and evaluate a pain monitoring programme (PMP). The PMP was comprised of a pain assessment tool and included pain education of 6 hours for nurses, the goal of which was to improve cancer pain management. This case study was conducted in a referral hospital in the northern part of Jordan. Overall, 130 patients and their medical records, 6 physicians, 12 nurses, 50 family caregivers, two nurse administrators, and two Islamic scholars participated in this study. Quantitative and qualitative data were collected, using observation, semi-structured interviews, medical chart audit and questionnaires that included a demographic data sheet (DDS), brief pain inventory (BPI), and barriers questionnaire (BQ). The study utilized the Promoting Action on Research Implementation in Health Services (PARIHS) and aspects of change theory model as a framework to guide the study. Quantitative data were analysed using both inferential and descriptive statistics using SPSS release 17. Qualitative data were translated from Arabic to English and thematically analysed. It was found that pain was prevalent among Jordanian cancer patients who were frequently under-medicated. Barriers to cancer pain management were identified and they were related to patients, healthcare providers and the setting (such as lack of knowledge, and belief in God? s Will). Moreover, introducing the PMP into practice might improve the adequacy of cancer pain treatment. The results of this case study showed that the implementation process is multi-layered and complex. Using the Champions, nursing administration support, and recognition of the need for change, and education were seen as determinants of successful implementation process within the Arab-Islamic culture. The PARIHS model was found to be helpful in guiding the process of knowledge translation and was suitable to the Arab culture. The study results highlight that each implementation process should be designed based upon the needs, culture, and norms of its context. In addition, it confirmed the need for assessing pain in order to have better pain management. Overall, it is suggested that having PMP in force in each healthcare setting may serve the ultimate goal of optimal cancer pain management.