The CAPTURE study: Cancer Pain-Assessment Toolkit for Use in RoutinE in oncology outpatient services

Start date: August 2021
End date: February 2026
Value: £350,000
Partners and collaborators: Yorkshire Cancer Research The Leeds Clinical Trials Research Unit (CTRU) Leeds Teaching Hospital Trust Hull Teaching Hospital Trust Sheffield Teaching Hospital Trust University of York University of Edinburgh
Primary investigator: Dr Matthew Mulvey Associate Professor M.R.Mulvey@leeds.ac.uk
Co-investigators: Co-investigators Dr Olivia Robinson CAPTURE Research Fellow and Trial Manager University of Leeds Professor Suzanne Richards, University of Leeds Dr David Meads, University of Leeds Professor Amanda Farrin, University of Leeds Michelle Collinson, University of Leeds Professor Kate Flemming, University of York Dr Adam Hurlow, Leeds Teaching Hospital Trust Dr Sue Hartup, Leeds Teaching Hospital Trust Dr Daniel Swinson, Leeds Teaching Hospital Trust Jean Gallagher, Patient and Public Involvement Representative Professor Marie Fallon, University of Edinburgh Dr Catriona Mayland, Sheffield Teaching Hospitals Dr Elaine Boland, Hull University Teaching Hospital

Description

This research study aims to adapt, and feasibility test a theoretically informed intervention to standardise pain assessment in oncology outpatient’s services.

We have two overall aims:

Aim 1: To co-design, with oncology healthcare professionals and Patient and Public Involvement and Engagement (PPIE) panel, an adapted version of the Edinburgh Pain Assessment Toolkit (EPAT) that is practicable within NHS oncology outpatient services.

Aim 2: To test the feasibility of undertaking a definitive phase III Randomised controlled trial and cost-effectiveness evaluation of this intervention, via a multi-centre cluster randomised feasibility trial and embedded qualitative process evaluation.

Our study has three phases:

Phase one: Understanding current pain management practices in oncology outpatient settings.

We interviewed 20 healthcare professionals from 3-NHS oncology tertiary referral centres with varied experience (e.g. registrar, consultant), job role (e.g. nurse, pharmacist) and cancer speciality (e.g. breast, prostate, lung) that support people to manage pain in outpatient settings.

We did this to understand what pain management practices work well, and what could be done to improve pain management for patients with cancer.

Phase two: Adapt an existing routine pain management tool to implement into oncology outpatient services.

The Edinburgh Pain Assessment Tool (EPAT) was originally developed at the University of Edinburgh for post-surgical cancer pain for inpatient settings. EPAT comprised of a simple pain screening tool, a detailed pain assessment, and a basic pain management algorithm to guide analgesic prescribing and onward referrals to specialist teams.

We adapted EPAT in co-production with key stakeholders. This included four 1-hour workshops with healthcare professionals, and three patient and public involvement and engagement groups.

Four healthcare professionals trialled the prototype intervention in two-NHS oncology tertiary referral centres. Amendments were made to the intervention to ensure it fit within routine practice of an outpatient setting.

Phase three: A multi-clustered randomised pilot trial and embedded process evaluation

We are currently running a multi-clustered randomised pilot trial in two-NHS oncology referral centres. We have recruited four oncology outpatient services from each referral centre to take part in the study (8 oncology outpatient services in total). The recruited outpatient services have been randomised (1:1) to either the ‘intervention arm’ or the ‘usual care arm’.

Outpatient service randomised to the intervention arm of trial are asked to use EPAT with all people experiencing pain. Outpatient services in the intervention arm of the trial are provided with training and regular support on how to use EPAT. We have identified an intervention champion in all intervention clinics to support embedding EPAT within routine clinical practice by providing training and support to their clinical colleagues. Intervention champions have received bespoke training and support from the research team.

We aim to recruit 120 participants (15-patients with cancer from 8 oncology outpatient services) from two-NHS oncology referral centres to complete questionnaires at four time points for a total of 8-weeks (baseline, 1-week, 1-month, 2-month).

At the end of the trial participants, healthcare professionals and intervention champions will be invited to take part in an end of study interview to explore acceptability, fidelity of the intervention and trial procedures.

Impact

Cancer pain can significantly affect a person’s quality of life, causing both physical and emotional distress and impacting the wellbeing of patients and their families. When cancer pain isn’t well managed, it can lead to more calls for out-of-hours medical help and increased hospital visits and admissions.
By adapting and testing a standardised pain assessment tool, we aim to make it part of routine care in NHS outpatient clinics. This has the potential to improve care for all cancer patients across Yorkshire.
We’ll collaborate closely with patient groups, local and national NHS Trusts, and decision-makers like NICE to ensure the tool is rolled out into clinical practice quickly and effectively, helping as many patients as possible.

Publications and outputs

Robinson, C. O., Pini, S., Flemming, K., Fallon, M., Richards, S., Mayland, C., Boland. E., Swinson, D., Hurlow, A., Hartup, S., Mulvey, M. (2023). Exploration of pain assessment and management processes in oncology outpatient services with healthcare professionals: a qualitative study, BMJ Open;13:e078619. doi: 10.1136/bmjopen-2023-078619.
Robinson, C. O., Pini, S., Flemming, K., Fallon, M., Richards, S., Mayland, C., Boland. E., Swinson, D., Hurlow, A., Hartup, S., Mulvey, M. (2023). IPOS 2023 abstracts booklet, Journal of Psychosocial Oncology Research and Practice, 5 (S1): e111, 120. DOI: 10.1097/OR9.0000000000000111