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Problem and Significance: Pain is multidimensional. It is more than simply a physiologic or sensory response. Pain management programs are best developed by selecting interventions based on the individual’s pain experience. Evidence suggests that patients and family often have conflicting expectations. Palliative care teams find negotiation critical in effective relationships between providers and patients. In a research facility, the continuity of care for the patient and family is supported by communication and a strong partnership with the primary biomedical research team and the palliative care team. Study Design: This is a randomized, repeated measures, evaluation study to explore the effectiveness of the inpatient Pain and Palliative Care Service. Patients with advanced malignancies who are currently participating in NCI Surgery Branch protocols are eligible. Quantitative measures to evaluate outcomes include 1) APACHE II; 2) Symptom Distress Scale; 3) Gracely Pain Intensity and Unpleasantness Scale; 4) Center for Epidemiologic Studies Depression Scale; and 5) Palliative Care Outcome Scale. Qualitative interviews also are used to assess issues related to social support, self-efficacy, satisfaction with care, and perceptions of communication with healthcare providers. Patients are given the opportunity to share their personal experiences surrounding pain and symptom issues related to their disease during face-to-face interviews prior to surgery, post-operatively and during their regularly scheduled outpatient follow-up visits. Results: In preliminary findings, patients and their families identified continuity of care and communication between themselves and care givers as an important element of ongoing pain and symptom management. Difficulties patients have in attaching a number value to their pain have emerged as well as the importance of social support from family, friends, and co-workers. Implications for Clinical Practice: Individual pain experiences serve to illuminate the value of diverse, multidisciplinary partnerships with patients as guides in an effort to meet their pain and symptom management needs.
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