Best of the Best Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2020

  A cluster randomised controlled trial of guidelines and screening with implementation strategies versus guidelines and screening alone to improve pain in adults with cancer (#96)

Melanie R Lovell 1 2 3 , Jane L Phillips 2 , Meera Agar 2 , Tim Luckett 2 , Lawrence Lam 2 , Nikki McCaffrey 4 , Fran M Boyle 3 , Tim Shaw 3 , Patricia M Davidson 5 , David C Currow 2 , Seong CHEAH 2
  1. HammondCare, Greenwich, NSW, Australia
  2. University of Technology, Sydney
  3. Sydney University, Sydney
  4. Deakin University, Melbourne, Victoria, Australia
  5. Faculty of Nursing, Johns Hopkins University, Baltimore


This trial aimed to evaluate the effectiveness and cost-effectiveness of a suite of cancer pain guideline implementation resources designed to improve pain outcomes for patients attending ambulatory oncology and palliative care.


A stepped-wedge cluster randomised controlled trial. Australian patients with moderate unrelieved cancer pain (≥ 5) Numerical Rating Scale (NRS) were recruited from 8 ambulatory oncology and palliative care services (‘clusters’). During the control phase, services routinely screening patients for pain. During the training phase, ‘clinical champions’ and staff at each centre were provided with a suite of tailored implementation strategies to be implemented in accordance with their service’s needs.The trial’s primary outcome was patients’ pain severity one week after presenting with pain ≥5 NRS. Secondary outcomes, included quality of life, health empowerment and carer experience.


Out of 8743 patients screened, 754 consented with 329 randomised to the intervention and 425 to the control, with 591 contributing to the primary outcome. Primary outcome: No significant difference in the number of respondents with at least 30% reduction in worst pain from baseline pain. Mean average pain improved by ≥0.5 standard deviation at all time points in both arms. Mean worst pain improved by ≥0.5 standard deviation at week 1 for those with pain NRS ≥5 but not at other time points or for patients with worst pain NRS 2-4 at Week 1. There was no difference between groups in quality of life or health empowerment.


Achieving better pain management outcomes in cancer clinical practice is challenging even in services with clinical champions using evidence-based strategies.

  1. Luckett T, Davidson PM, Green A, Marie N, Birch M, Stubbs J, Phillips J, Agar M, Boyle F, Lovell M. (2019) Development of a cancer pain self-management resource to address patient, provider and health system barriers to care. Journal of Supportive and Palliative Care. 17 (4) p472-8.
  2. 15. Luckett T, Phillips J, Agar, M, Lam l, Davidson PM, McCaffrey N, Boyle FM, Shaw T, Currow DC, Read A, Hosie A, Lovell M. (2018) Protocol for a phase III pragmatic stepped wedge cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of screening and guidelines with, versus without, implementation strategies for improving pain in adults with cancer attending outpatient oncology and palliative care services: the Stop Cancer PAIN Trial BMC Health Services Research 18(1):558 PubMed id 30012122. ISSN 1472-6963.