Every year in England and Wales, 105,000 people with advanced cancer suffer pain that is often poorly controlled at home, despite effective treatments being available. This research addresses a persistent failure in community palliative care: patients and their carers lack adequate support, pain assessment is inconsistent, and access to timely medication is unreliable. The programme, called IMPACCT, aims to close the gap between what is known about pain management and what actually happens in routine NHS care. If successful, the project will design and test a practical cancer pain pathway that enables early intervention and self-management. It will demonstrate whether routine pain monitoring can work within the NHS, promote non-medical prescribing by community pharmacists, and evaluate the cost-effectiveness of these changes. The ultimate goal is to reduce distress from cancer pain for patients living at home and to cut avoidable hospital admissions near the end of life. The findings could also be adapted to manage other symptoms in cancer and in advanced chronic diseases, improving care for a much wider group of patients.
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AIMS AND OBJECTIVESOur overall aim is to improve the management of cancer pain for palliative care patients and their carers who are living at home. Our principal objectives are to enable patients and their carers to more easily access support and advice, communicate their pain, obtain timely and effective medication; and to evaluate the impact of our interventions in routine care. BACKGROUNDEach year in England and Wales, 140,000 people die from cancer and 105,000 will suffer cancer pain. Patients spend 65-80% of their last 6 months of life at home though many are admitted as inpatients nearer to death. For community based cancer patients, research shows that pain remains common, severe and under-treated. Barriers to good pain control include inadequate support and patient education, poor assessment and communication, and lack of access to an adequate prescription and timely analgesia. Effective interventions to address these have been described but are poorly implemented in routine practice. RESEARCH PLANSWe plan a coherent and integrated programme of work that will address our four principal objectives and that will focus on enabling patients and carers to experience improved cancer pain management within routine care. Our work streams focus on: WS 1. People: An integrated system of supportWS 2. Data: Routine assessment and monitoring of painWS 3. Medicines: Good management of analgesic drugsWS 4. Evaluation: Cost effectiveness and feasibility RESEARCH TEAMWe bring together senior researchers, clinicians and patients with expertise and strong track records in qualitative and quantitative methods, synthesising evidence, understanding behaviours, implementing interventions, evaluating their cost and clinical benefits, and disseminating to user communities. Through our Programme Development Grant (PDG), we have consolidated our team and demonstrated our cohesion and ability to work together successfully to deliver substantial outputs. PROGRAMME MANAGEMENTThe programme will be led by Bennett, who successfully led the PDG and has a track record of leadership at national and international level. Each work stream has designated leads and staff and all applicants will meet three times per year. Bennett will meet regularly with and support work stream leads, and will be helped by a programme co-ordinator. We have secured the support of leading UK experts to act as an advisory panel. RESEARCH ENVIRONMENTLeeds offers an internationally recognised environment for conducting research across the interface between primary, secondary and palliative care sectors. Close and successful working relationships exist between Leeds Institute of Health Sciences, Clinical Trials Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Specialist Palliative Care services. This provides a perfect framework within which to undertake IMPACCT and will ensure that the findings will be readily applicable and transferable to the NHS throughout the UK. We have been given excellent support from local clinical leads, palliative care and hospice services, the West Yorkshire CLRN, Leeds Local Pharmaceutical Committee, H3Plus (the largest GP Commissioning Consortium in Leeds), and TPP (producers of SystmOne database).ANTICIPATED OUTPUTS AND IMPACT WS 1. Design and test a cancer pain pathway that allows early intervention and promotes self management. WS 2. Demonstrate the feasibility of routine cancer pain monitoring within the NHS.WS 3. Promote non-medical prescribing and develop role of community pharmacists. WS 4. Establish cost-effectiveness and feasibility of our intervention in routine care. Overall we aim to reduce distress from cancer pain in palliative care patients and reduce the impact on the NHS of avoidable admissions. Our work is transferable to other symptoms in cancer and to other advanced chronic diseases. DISSEMINATION OF FINDINGSWe will work closely with our advisory panel, NHS commissioners and national clinical leads for end of l
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