ABSTRACT
Title
Development and validation of “CeNSE”: a score to Classify paiN and palliative care SErvices.
Authors
E. Lucenteforte1, V. Maggini1, S. Rodella2, F. Collini2, G. Guidi3, M. Scollo Abeti3, A. Messeri4, A. Mugelli1, F. Lapi1, A. Vannacci1
1. Dipartimento di Farmacologia Preclinica e Clinica “M. Aiazzi Mancini”, Università di Firenze
2. Osservatorio Qualità ed Equità, Agenzia Regionale di Sanità della Toscana
3. Commissione Regionale di Coordinamento per le Azioni di Lotta al Dolore, Regione Toscana
4. Servizio di Terapia del Dolore, Ospedale Meyer
1. Dipartimento di Farmacologia Preclinica e Clinica “M. Aiazzi Mancini”, Università di Firenze
2. Osservatorio Qualità ed Equità, Agenzia Regionale di Sanità della Toscana
3. Commissione Regionale di Coordinamento per le Azioni di Lotta al Dolore, Regione Toscana
4. Servizio di Terapia del Dolore, Ospedale Meyer
Abstract
Introduction: Pain is considered an excellent warning to detect several health issues. However, if its cause is understood, its persistence turns into a useless suffering and should be promptly eased. Unrelieved pain remains a major problem in hospital. Guidelines and recommendations for chronic pain management and treatment have been issued in several countries. These guidelines classified pain and palliative care services according to the quality degree of the provided patient’s care. Currently, a specific culture on management of chronic pain is still lacking in Italy.
Aim: The main aim of the project was to Classify paiN and palliative care SErvices (CeNSE)of the Tuscany Region. Furthermore, there was the purpose to evaluate the knowledge about pain management and treatment.
Methods: The study was conducted between December 2009 and March 2010 and included 32 pain and palliative care services and 9 hospices. Information on centre organization and knowledge of pain were collected using two validated questionnaires. Both center directors and 3 healthcare providers were interviewed through a face-to-face approach. Afterwards, two groups of experts, blinded one another, evaluated if a service was of high or low quality. Fifteen services were considered of high quality, and 17 of low quality. For all features which were significantly different between high and low quality services, mono-variable logistic regression β coefficients were calculated. The CeNSE score was calculated using these coefficients.
Results: The CeNSE score ranged between 0 to 100. The overall area under the ROC curve was 0.9863. For a score ≥50, sensibility was 100% and specificity was 92.12%, while for a score ≥80, was 73.33% and 100.00%, respectively. Herein, cut-off points of 50 and 80 were chosen to classify services into 3 level of quality. According to that, the area under the ROC curve was 0.9922. Eleven services were classified of ‘advanced’ quality, 5 of ‘intermediate’ quality, and 16 of ‘elementary’ quality. As concern knowledge of pain treatment, 222 subjects were interviewed. Among ‘intermediate’ quality services there was the lowest percentage of wrong answers (13%), and in the ‘elementary’ quality ones there was the highest percentages of right answers (76%). Answers were significantly different among the 3 levels only for half (out of 25) questions.
Conclusions: Our results suggest that the CeNSE score, developed using a small set of simple information, is a reliable tool to classify pain and palliative care services in Tuscany. However, a high CeNSE score, did not show a positive correlation with a good knowledge of pain treatment and management among healthcare providers.
Aim: The main aim of the project was to Classify paiN and palliative care SErvices (CeNSE)of the Tuscany Region. Furthermore, there was the purpose to evaluate the knowledge about pain management and treatment.
Methods: The study was conducted between December 2009 and March 2010 and included 32 pain and palliative care services and 9 hospices. Information on centre organization and knowledge of pain were collected using two validated questionnaires. Both center directors and 3 healthcare providers were interviewed through a face-to-face approach. Afterwards, two groups of experts, blinded one another, evaluated if a service was of high or low quality. Fifteen services were considered of high quality, and 17 of low quality. For all features which were significantly different between high and low quality services, mono-variable logistic regression β coefficients were calculated. The CeNSE score was calculated using these coefficients.
Results: The CeNSE score ranged between 0 to 100. The overall area under the ROC curve was 0.9863. For a score ≥50, sensibility was 100% and specificity was 92.12%, while for a score ≥80, was 73.33% and 100.00%, respectively. Herein, cut-off points of 50 and 80 were chosen to classify services into 3 level of quality. According to that, the area under the ROC curve was 0.9922. Eleven services were classified of ‘advanced’ quality, 5 of ‘intermediate’ quality, and 16 of ‘elementary’ quality. As concern knowledge of pain treatment, 222 subjects were interviewed. Among ‘intermediate’ quality services there was the lowest percentage of wrong answers (13%), and in the ‘elementary’ quality ones there was the highest percentages of right answers (76%). Answers were significantly different among the 3 levels only for half (out of 25) questions.
Conclusions: Our results suggest that the CeNSE score, developed using a small set of simple information, is a reliable tool to classify pain and palliative care services in Tuscany. However, a high CeNSE score, did not show a positive correlation with a good knowledge of pain treatment and management among healthcare providers.