Effectiveness of Pain Management in Elderly Cancer Patients: A PICO Analysis

The research report analyses the effectiveness of pain management and the ways through which can be reduced. It has been analysed that in Australia, cancer rate is common such that in 2021, around 151000 Australians diagnosed with cancer (like, 413 per day) however, 49000 dies in a day (Cancer in Australia 2021). This is most common in aging population and that is why, Australian people are suffered highest with this pain. The report uses the PICO framework to answer the research question and provides relevant data and analysis. The report highlights the importance of physical and occupational therapy in pain management and its relevance for clinical practice.

Research

TABLE OF CONTENTS
INTRODUCTION.......................................................................................................................................................................................3
METHODOLOGY......................................................................................................................................................................................4
RESULTS....................................................................................................................................................................................................6
DISCUSSION..............................................................................................................................................................................................7
RELEVANCE FOR CLINICAL PRACTICE.............................................................................................................................................8
REFERENCES..........................................................................................................................................................................................10

INTRODUCTION
The research report will analyses the effectiveness of pain management and the ways through which can be reduced. It has
been analysed that in Australia, cancer rate is common such that in 2021, around 151000 Australians diagnosed with cancer (like, 413
per day) however, 49000 dies in a day (Cancer in Australia 2021). This is most common in aging population and that is why,
Australian people are suffered highest with this pain. In Australia, psychology, psychiatry, physical and occupational therapy among
people is considered the best intervention that helps to detect the pain and cure the same. However, the therapy is less effective among
the adults and underprivileged people.
PICO framework is consist of patient/population, intervention, comparison and outcome that is used as a prompt device in
nursing that assist professionals regarding components to drawn a well-focused clinical question (Krs and et.al., 2020). This
framework assists to break down the question into four components (see figure 1), the research question for the report is by choosing
pain management as a key theme: What is the role of psychology, psychiatry, physical and occupational therapy among elderly adult
people to relieve from cancer? To answer it, search strategy used in order to find a suitable paper to be discussed. The report will
analyze the finding of the research paper along with validity, limitations and clinical significance by answering PICO question.
Lastly, it will describe the relevance for clinical practice.

Population Intervention Comparison Outcome
Older age people psychology,
psychiatry, physical
and occupational
therapy
Nil Reducing pain among
the patient
(Figure 1: PICO question)
METHODOLOGY
For the present study PubMed as a database is used that helps to identify the papers for the current evidence. It is a database
which is used for biomedical and life science literature whose main aim is to improve the health either globally or personally. It is
mainly containing 33 million citations and highly preferable database because it is reliable and highly influential resource. Canese and
Weis (2013) also explained that it is free access to Medline and provide free links to all the relevant articles that provide possible
results. However, Cinahl is not used for the present study because it does not include many intervention of cancer treatment whereas
PubMed do.
The first term searched was ‘pain management and cancer treatment’ that derived from the PICO framework because the entire
question is related to it (attached in figure-2). In this, 2340 results generated (S1) and then next therapy is added at the end (S2) during
research in order to determine the actual results related to PICO framework. Under this therapy, different term is also mentioned like,
chemotherapy and radiation therapy is used in order to evaluate the actual results which 275 results generated. In next level, with the
help of Boolean operator, additional term is investigated in which only therapy is used which also reflect the same result i.e. 275 under
S3. Thus, in the last search term, only different term used like pain medication, consultant under the intervention of PICO framework

with elderly people under population that helps to provide a short list of results (Willis and et.al., 2021). By using this, 3 results has
been reflected in which one of the article has been selected in order to proceed for the further research.
At each concept as well as keyword in PICO question help to search separately and this in turn provide a valid results in the
form of 2340 results. On the other side, with the help of Boolean connector i.e. AND”, S1, S2, S3 and S4 were combined that assist to
create a better outcome and refined the article by reducing the number from lowest. Such that the results reduced from 2340 (S1) to
275 (S2) to 3 (S4). As a result, the final three article has been selected in which only one selected that helps to determine the answer
for PICO framework. While researching for the database, it has been identified that up to date articles has been focused because it
provide an authentic results and that is why, the search was limited to last decade i.e. 2010 – 2020 that clearly reflect the results to n =
3 (S4). After proper search, the article, ‘Role of Pain Medications, Consultants, and Other Services in Improved Pain Control of
Elderly Adults with Cancer in Geriatric Evaluation and Management Units’ has been selected by considering its reliability, study
design method and adherence of PICO question. Also, in this inclusion and exclusion criteria is also used in order to select the best
article for the research where under exclusion, systematic, meta analysis has been rejected because it is not required for the paper.
However, under inclusion, study under 2010 to 2020 are selected, where elderly people, cancer treatment, therapy such words are used
that helps to answer the designed PICO question.

Figure 2: PubMed with Full Text (Ebsco) search history
RESULTS
Nipp and et.al., (2012) stated that the number of older adults are keep increasing in the world and that is why, cancer is found
among all the aged people or older adults. The research paper also shows that the burden of pain among individuals with cancer is well
documents because fatigue, pain and distress are recognized some of the common reported symptoms. As a result, World Health
organization, international and national professional organization lay down stress upon the focus on pain management as a part of
routine cancer care. The chosen study design for the present study is quantitative in which 99 older people were randomized to receive

care in a geriatric inpatients unit. These individual are cancer patients but exclude form non-melanoma skin cancer in which 44
received geriatric evaluation and management unit (GEMU) care and 55 usual care. The chosen sample and study design is accurate
because it help to determine which therapy is best suited for the cancer patients in order to relieve from cancer.
The chosen participants are appropriate because a small size always help to determine the accurate answer and this in turn also
able to answer PICO framework. Apart from this, both primary as well as secondary data collection methods has been used under the
chosen research paper. Under primary research, questionnaire as a method used in which different questions has asked that helps to
determine the views of selected participants (Farrington, Richardson and Bridges, 2020). However, under secondary data collection
methods, only books, article and statistics has been selected from the database like, Medline, PubMed, Cinhal etc. The chosen data
collection methods are appropriate because it provide authentic data and answer the questions and with the help of primary data,
scholar is able to determine the fresh information whereas secondary data assist to determine the trend used to treat or reduce the pain
of cancer among patients.
for data analysis, pain medication used that helps to measure at baseline and discharge, consultation and other service were
quantified. Along with this, SPSS software is also used that helps to determine the difference between the variable and examine the
relationship between the same. Hence, the chosen method is beneficial for the study because it helps to quantify the measurement and
this in turn assist to meet the defined aim by analyzing the therapy for pain management.
The results identified within the present study reflects that there is no significant difference in pain medication use among
GEMU and usual care group and it is so because the value of p (0.16) is greater than 0.05. Also, results entails that there was no
change among the two groups with regard to utility of opioids. Moreover, another table of consultation and service, reflect that GEMU
inpatients has a higher mean number of the consultation as compared to usual care unit and as a result, alternative hypothesis is
accepted due to low value of p (0.002) as compared to 0.05. Hence, the outcome generated from the entire research reflected that there
is a need of proper care for pain management among people and that is why, there different therapy include psychology, psychiatry,

physical and occupational therapy is used to treat cancer patients and this may also benefit to the people in order to get proper
treatment among cancer patients. Also, rather than using more consultants and service, it is necessary to use therapy because it do not
cost high in hospitals and provide proper treatment to older age cancer patients as well.
DISCUSSION
The magnitude of pain as well as impact in elderly adults with cancer is considerable, though there are many studies highlight
the prevalence of pain among people but the studies only demonstrate measure to treat the pain to those who are largely suffered from
the cancer, however this research identify the ways through which pain can be minimized (Mohammadi and et.al., 2021). The results
shows that total number of consultation used was significantly high in GEMU group and that is why, their interest is higher to use
psychology and psychiatry consultation. Similarly, the greater use of social work service also have a same impact because all the
mental professionals are highly contribute to treat the people. A study of methylphenidate versus placebo for cancer-related fatigue
also shows that the positive effect of mental health. Thus, in the research paper, occupational, physical therapy and speech pathology
is also used more extensively in GEMU.
In older people, the pain is not identified clearly because the source is not clear and seeking to specific source of pain is not
appropriate because it require holistic approach. Hence, a multifactorial contribution to symptoms and interdisciplinary approach of
GEMU make this as a powerful resource for the individual. So, palliative care intervention also shows the effectiveness in managing
pain but it can be attained only by using effective programs (Brunello and et.al., 2019). That is why, it can be stated that with the
results generated shows pain medication use is not varied between intervention and usual care. Hence, in order to treat he cancer
people, there is a need to adopt the effective therapy which in turn assist to create a better outcome and with the help of such therapy,
individual change their lifestyle and exercise properly whereas, in the medication only radioactive chemotherapy is used that only
remove the cancer. However, the care is also required among people that assist to improve their quality of life. The research clearly
indicated that rather than better interdisciplinary care, individual need to use effective use of physical and occupational therapy that

helps to create better outcome and also generate a strong outcome in order to provide better care to the cancer patients (Pergolotti and
et.al., 2015). That is why, the chosen research paper mainly helps to provide the better outcome in term to recognize best therapy for
the elderly adult cancer patients.
RELEVANCE FOR CLINICAL PRACTICE
In accordance with the PICO question, the report assist to discover the role of psychology, psychiatry, physical and
occupational therapy among elderly adult people to relieve from cancer. Here, only elderly adult people selected who assist to meet
the defined aim because in the country, older people are highly suffered from cancer and there is a need to cure the same in order to
provide a better outcome. Also, the message taken from the paper reflected that occupational therapy plays a major role to treat the
people with cancer because it resume the functional daily routine (Magnuson and et.al.., 2016). However, there are many therapies
used to cure cancer patients but physical as well as occupational therapy are high preferred due to affordability. Research also suggest
that there is a need to provide care to patients to reduce the chance of pain because it increase the level of stress and to improve the
quality of life, it is also necessary for the professionals to provide proper care and therapy to treat such disease.
Thus, the therapy described under the research paper is also used to understand the process and make effective decision so that
effective outcome can be generated and this in turn help to patients as well. The research also indicated that Palliative care
interventions has also assist to reduce the level of pain but a specific program need to be developed that assist to provide better care to
the patients and improve their life (Cooper, 2013). Also, the value of such report reflected how the old age people receive cancer
treatment in order to provide cure so that they can improve their quality of life and generate a better outcome. The offered therapy is
also beneficial for the longer term severe cases because it assist to provide better care with affordable range which is not possible in
other areas. Like, physical therapy assist to address the pain through range of motion and strengthen strategies like massage and
transcutaneous electrical nerve stimulation units. On the other side, occupational therapy further reflect positive outcome over the pain

and quality of life. Thus, it can be stated that a thorough assessment need to be carried out before applying the treatment so that the
quality life of the people can be improved and also, professionals need to be incorporate with treatments so that effective results can
be generated.
Also, future result should also include more data in order to prove the confidence interval and the impact of using such therapy
upon the cancer patient’s lives. This helps to improve the results and also helpful in the health care because adopting best method for
treatment assist to create a better outcome. Along with this, it will be far beneficial for further good quality research because it derive
better outcome by using range of measurement.

REFERENCES
Books and Journals
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study. Journal of Geriatric Oncology. 10(4). 637-642.
https://www.sciencedirect.com/science/article/abs/pii/S1879406818302182.
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%20major%20cause,die%20(135%20per%20day).
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Mohammadi, A. & et.al., (2021). The effect of play-based occupational therapy on symptoms and participation in daily life activities
in children with cancer: A randomized controlled trial. British Journal of Occupational Therapy. 84(7). 400-409.
https://journals.sagepub.com/doi/abs/10.1177/0308022620987125
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