Medical and Medicine Evidence-Based Nursing Peer-Reviewed Journal

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Generally, the level of evidence for most of the studies is low. Ten studies are classified as level 2c which represents 'outcomes research' (evidence is obtained from uncontrolled trials without randomization) and two studies are classified as level 5 meaning 'expert opinion without explicit critical appraisal'.

#5 Were the results similar from study to study?

What is best?

When the compiled studies are homogenous, statistical applications can be useful, and meta-analysis is achievable (Stevens, 2009).

This paper: Yes ( No ( xx Unclear (

Comment:

The studies were heterogeneous; therefore, meta-analysis could not be performed. Most of the included studies describe integrated processes but there is a variety in the described outcomes and processes within the models. At this moment standardized outcome measures in pain management are not available, so it is not always possible to make a proper comparison between the outcomes. Therefore, generalization of the results can be problematic.

What were the results?

The paper resulted in a narrative review because meta-analysis could not be performed. The results for all models indicate that they are beneficial to the management of pain in cancer patients. The authors identified the fact that the level of evidence is limited, as there are no strong methodological trials.

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They explained that it was nearly impossible to meet all methodological quality criteria when conducting a trial in the field of (advanced) cancer pain. For clinical practice they recommended the development of policies for referrals to a pain consultation service. These policies could be integrated within a clinical pathway. Further research for testing the effectiveness of a clinical pathway in combination with a pain consultation service is needed.

A clinical pathway can be seen as a comprehensive institutionalization model. It pays more attention to other integrated processes such as an interdisciplinary approach and continuity of care and follows the patient through all stages of care. A pain consultation service seems to be a 'stand-alone' model, concentrating on complex pain management issues and available on demand. Consultation on demand can be problematic: the effectiveness of the service depends on the willingness of other professionals to ask for help.

The authors also recommend standardization of the outcome measures in order to evaluate the effectiveness of pain management models. Evaluation of the quality of pain management should involve measurements of both patient outcomes and process outcomes.

How are the results presented?

The results were presented as a narrative discussion; no statistics, other than those from each study, were.....

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