Robinson, O.C. orcid.org/0000-0002-3171-4407, Richards, S.H. orcid.org/0000-0003-1416-0569, Shoesmith, E. et al. (3 more authors) (2025) 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. Psycho-Oncology, 34 (3). e70132. ISSN 1057-9249
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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2025 The Author(s). This is an open access article under the terms of the Creative Commons Attribution License (CC-BY 4.0), which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. |
Keywords: | adaptation, cancer, complex intervention, outpatient services, pain management |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) |
Funding Information: | Funder Grant number Yorkshire Cancer Research Account Ref: 2UOLEEDS L428 |
Depositing User: | Symplectic Publications |
Date Deposited: | 30 May 2025 09:39 |
Last Modified: | 30 May 2025 09:39 |
Status: | Published |
Publisher: | Wiley |
Identification Number: | 10.1002/pon.70132 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:227216 |