Contextual Adaptation of a Complex Intervention for the Management of Cancer Pain in Oncology Outpatient Services: A Case Study Example of Applying the ADAPT Guidelines

Abstract

Objectives: Standardising pain assessment in oncology outpatient services (OOS) leads to improvements in patients' pain and quality of life. The Edinburgh Pain Assessment Tool (EPAT) is a standardised cancer pain management tool that has been implemented on inpatient oncology wards (the original setting). Routine use of EPAT reduced post-surgical pain in cancer patients (the original scenario) and led to more appropriate analgesic prescribing. We describe here a case study of adapting the EPAT intervention for use in tertiary OOS in the United Kingdom (UK) National Health Services (NHS), using the ADAPT guidelines.

Methods: The adaptation process followed Moore et al.'s ADAPT guidance: Step 1: We assessed rationale for adapting EPAT by reviewing existing literature of pain management in OOS. Step 2: Semi-structured interviews with 20-healthcare professionals (HCPs) to understand current practice and how the intervention might fit the new context (OOS). Step 3: Identified the 'core' and 'peripheral' components of EPAT, undertook four co-design workshops with 7-HCPs to reconfigure EPAT to fit OOS (adapted version is referred to as EPAT+). Four HCPs trialled the EPAT+ intervention in practice to refine the intervention.

Results: Combining qualitative data from interviews with feedback from the co-design workshops and preliminary testing the prototype intervention highlighted several key adaptation goals for EPAT+. These included: (1) reduce length/time to complete EPAT+ due to time constraints in outpatient appointments, (2) the importance of pain re-assessment and using EPAT to facilitate patients to self-monitor their pain at home, and (3) the creation of new peripheral components to support communication with primary care providers.

Conclusions: Using a theoretical driven conceptual guidance provided important learning on how to adapt an existing cancer pain management tool to a new setting (OOS). The result is a novel complex theory- and evidence-based intervention that will be formally tested in a cluster randomised pilot trial.

Keywords: adaptation; cancer; complex intervention; outpatient services; pain management.