Identifying gaps in cancer pain management among oncology clinicians: A needs assessment to inform a targeted quality improvement intervention.

Abstract

301 Background: Cancer-related pain is a common and debilitating symptom experienced by patients with advanced malignancy. Despite NCCN and ASCO guidance, significant variability persists in how oncology clinicians assess, triage, and initiate management for cancer pain. This study aims to characterize clinician confidence, practice patterns, and barriers as the foundation for developing a quality improvement initiative targeting cancer pain education for oncology practitioners at an urban academic medical center. Methods: An anonymous, voluntary electronic needs-assessment survey (REDCap) was administered to hematology-oncology fellows, advanced practice providers (APPs), and attending oncologists across three NYU Langone Health sites (Manhattan, Brooklyn, Long Island). The survey assessed self-reported confidence across 17 cancer pain domains (4-point Likert scale); frequency of key clinical behaviors (5-point scale); perceived barriers to optimal pain management; perceptions of subspecialty services (palliative care, radiation oncology, interventional pain); and educational resource preferences. Descriptive statistics were used to summarize responses. Results: Forty-nine clinicians responded: 24 APPs (49%), 13 attending oncologists (27%), and 12 fellows (24%). The majority practiced at the Manhattan campus (n=41, 84%), followed by Long Island (n=5, 10%) and Brooklyn (n=3, 6%). Highest confidence was reported for knowing when to refer to palliative care (3.96/5) and identifying red-flag pain symptoms (3.71/5). Lowest confidence was observed for knowing when to refer to interventional pain management (2.63/5), managing multifactorial cancer pain (2.69/5), and opioid titration (2.76/5). Among practice behaviors, routine pain assessment was frequent (4.65/5), whereas referral to interventional pain management was markedly infrequent (2.47/5). Respondents reported limited visit time (3.08/5), limited formal training in cancer pain management (2.67/5), and difficulty accessing interventional pain specialists (2.67/5) as main barriers to pain assessment and management. Clinicians reported greater comfort referring to palliative care (4.57/5) versus interventional pain (3.37/5). The most frequently endorsed educational priorities were pain triage/referral algorithms (82%) and quick-reference opioid prescribing guides (76%). Conclusions: This institutional needs assessment identified important gaps in oncology clinician confidence and practice regarding the management of cancer pain; in particular, opioid titration, referral to interventional pain and the management of multifactorial cancer pain. Based on these findings, a multidisciplinary cancer pain quality improvement initiative is being developed standardized referral guidelines, utilizing targeted education, and prescribing resources.