Loading...
Processing... Please wait.

Complex Cancer Pain: A Thorny Issue
20 April 2017

HCA’s Advance Practice Nurse Kahvidah Nathan delivered a talk on HCA’s Complex Cancer Pain Management Protocol on 28 March 2017.

FROM LEFT: APN KAHVIDAH NATHAN, MEDICAL DIRECTOR DR CHONG POH HENG AND DEPUTY MEDICAL DIRECTOR DR KYAW NAING

For patients afflicted with debilitating complex cancer pain, quality of life is greatly impacted. Managing complex cancer pain effectively requires a multifaceted approach, involving input from different members of the clinical and psychosocial teams.

As part of the monthly SHC-LCPC Multidisciplinary Palliative Care Forum, Kahvidah Nathan, Advanced Practice Nurse at HCA Hospice Care, delivered a talk titled “Innovation comes from re-thinking”.

She shared her experience of being part of the complex cancer pain team and introduced the HCA Complex Cancer Pain Management Protocol (CCP), a new service model of care developed in HCA to address complex cancer pain. The talk was well attended by the palliative care community, who contributed their own insights and professional opinions.

THE MONTHLY SHC-LCPC MULTIDISCIPLINARY PALLIATIVE CARE FORUM IS OFTEN WELL ATTENDED BY VARIOUS REPRESENTATIVES ACROSS THE INDUSTRY

Kahvidah started by discussing the current issues faced by the team, which included variable competencies and patchy provision of care for the patients. To achieve the objectives of establishing a consistent team that could provide care for patients with complex needs, a pilot study was conducted by HCA on the management of difficult cancer pain.

Spearheaded by HCA’s nurse manager Goh Sock Cheng and medical director Dr Chong Poh Heng, the study sought to improve clinical outcomes and promote mentorship of less-experienced nurses.

HCA’s Complex Pain Protocol

Six risk factors were identified, including psychological distress, neuropathic pain, drug misuse, cognitive impairment, age and incident pain. The referral process was clearly outlined as well, forming a well-defined protocol for the clinical team. Kahvidah went on to discuss the various interventions undertaken by the CCP team, which include methadone, adjuvants, opioids (titration and rotation), interventional procedures, neuropathic titrate and counselling.

It is interesting to note that in 82% of the cases, counselling was adopted as an intervention. “When pain is escalating, conducting a reassessment is the most important,” Kahvidah said. “It is important to collaborate with the psychosocial team.”

The Meaning of Hope

For many of HCA’s patients, the concept of time takes on a different meaning. Beyond just protocols and standard operating procedures, it is important to delve deeper into the patient’s last wishes in order to improve quality of life.

APN KAHVIDAH EXPLAINS THE IMPORTANCE OF A COMPREHENSIVE APPROACH TO MANAGING COMPLEX CANCER PAIN

“We need to ask: what does hope mean to the patient?,” Kahvidah said. “It could be, being able to attend a child’s wedding.”

To broaden the scope of discussion beyond the patient’s care, Kahvidah also discussed practical and care issues in the psychosocial realm, and the importance of support and empowerment for the caregiver, as well as financial support, if necessary. It is this comprehensive perspective on end-of-life issues and hospice care that defines the core of HCA Hospice Care.