ONS Connections: Opioid titration by oncology nurses leads to more titrations

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PHOENIX—Patients who had their opioids managed by clinic nurses who used an opioid titration protocol had more opioid titrations than those who had their opioids managed by standard care, which was their oncologist. This research was reported at the Oncology Nursing Society (ONS) Connections: Advancing Care Through Science conference.

When cancer pain is controlled well, patients have improved function, mood, and quality of life. Lack of timely opioid adjustment is one barrier to controlling cancer pain, said . Well-controlled pain can lead to better patient experiences. This study sought to determine average and worst pain, as measured on a rating scale from 0 to 10.

This clinical trial randomized 99 patients at 9 clinics in Tennessee and Kentucky to receive either pain managed by clinic nurses through an opioid titration protocol, or pain managed by standard care, which was by their oncologist. The patients whose pain was managed by the study nurse had dose adjustments based on pain level and use of breakthrough medication. To be eligible, the patients had to be currently using opioids for pain control. Study participation lasted 8 weeks.

The analyses included the 47 patients who completed a minimum of 5 weeks of data. The patients completed a daily pain dairy, and they were contacted each week by telephone to assess pain control and side effects. The researchers collected data on the type of analgesics prescribed and the number of opioid titration made.

At the beginning of the study, all the patients had a fixed dose opioid, and most (73%-100%) had a prescription for opioids as necessary. More opioid titrations occurred among the patients whose pain was managed by clinic nurses (n=25) than among those managed by standard care (n=22; P<.05). Both treatment arms did not differ in their mean scores for average and worst pain, and these scores also did not differ by time. The worst pain remained moderate for both groups, and the average pain shifted from moderate to mild over the course of the study.

No severe adverse events occurred, which confirmed the feasibility and safety of the protocol. The research team stated that future research on the timing of assessment, opioid adjustment, and meeting patients' pain goals is warranted.

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