Can you give us a general overview of the importance of pain management and patient/professional education?
Providing pain management to our patients is something that truly benefits quality of life. For the oncology patient, that's the goal of our practices. An important part of SHC that makes us different from other cancer centers is our commitment to providing comprehensive pain and symptom management services in all of our cancer centers. Towards that goal we are in the process of incorporating palliative care services and coordinating referrals to hospice care as part of a comprehensive care model.

What role will organizations such as SCCPI (Southern California Cancer Pain Initiative) play in pain management?
I am a founding board member of SCCPI and we are working to provide optimum pain management for all cancer patients in California. It's a great group and we really came into existence because of SHC's support. We needed to come together to determine how to best meet patients' needs in California since we're such a big State. Most of the physicians in our State don't carry triplicates, and therefore don't have the ability to provide proper pain medication. We're looking at ways to get our patients the medicines they need beyond Vicodin and Codeine and Tylenol.

We at SCCPI were also supportive of the Assembly Bill that requires pain and end of life education of all physicians in our state by relicensure in 2006. Therefore part of what we will be doing is coordinating CME opportunities for our physicians to help them complete the 12 CME's they will need in this area before they renew in 2006.

Physicians may not all recognize the importance of this requirement. But I believe the additional education for some of the older physicians not educated as comprehensively in pain management will appreciate the information and find it truly makes a difference in their practice.

Standards of Care and the Salick Approach
JCAHO has a regulation now that states patients' pain cannot be ignored. Medical staff must refer them to a pain program or treat them and must also document how patients rate their pain, and what was done. Any patient who rates their pain at a 4 or greater (on a scale of 0 to 10, with 0 being no pain at all and 10 being the worst pain you can imagine) must have something done. Many studies show that patients who rate their pain as 4 or greater experience reduced quality of life, and in cancer treatment we want the highest quality of life possible for the longest time possible.

JCAHO standards for our hospitals require that we all assess and treat pain, their standards are pretty clear and yet it is not done routinely. Certainly cancer centers by their nature tend to focus on pain and symptom management, but improving the practice and assisting our cancer centers to provide the highest standards of care in regards to pain and symptom management is our goal.

I came from Cedars-Sinai, where I was the nurse coordinator for the cancer pain management service for seven years with Dr. Wolcott and Dr. Strouse; I understood the philosophy of Salick Health Care and the importance that they have placed on pain management as a company. It was very exciting to carry my role from there into my current position here.

Each of our cancer centers function differently, but all of them include comprehensive care for their patients, which includes pain management, social work, nutritionists, physical therapists, pharmacists, and nurses. That is unique to our centers. Access to those specialties in other facilities is very limited, if it exists at all.

I am always inspired when I interact with different specialties at the different cancer centers. Desert CCC has completed a really unique project within their psychosocial department. For patients who are very fatigued and can't work on traditional art projects, they give them cameras so they can take pictures of things that matter to them, and then create individual stories based on those photos. It is a wonderful project and very rewarding to the patients, their families as well as the staff. Many times as caregivers we don't always understand the "big picture". How the illness and the treatment truly affect the patient and their family.

Through my work as an Oncology Nurse Educator and also past president of my local Oncology Nursing Society Chapter, I have had the opportunity to visit and speak to many nurses in many different facilities. Comprehensive pain and symptom management services do not exist in any other setting. Salick Healthcare has done it like no one else can. The ability to pull together all of the key resources that make pain and symptom management work is done in the most comprehensive way. The management support beyond lip service is what makes it work. It is not easy, and truly the director of the Cancer Center program is the key. Their devotion and commitment to the program is essential.

My mother went though lung cancer treatment at the local university related cancer center. I know those people well. Their commitment to care is real but without administrative support it is impossible for them to provide pain and symptom management in an effective manner. Many truly wonderful and educated professionals but no way to coordinate there expertise into each patient individual needs. It was a very frustrating experience since I knew at our local cancer center it was being done everyday. I had to fight everyday to get what she needed. She had no dietitian to consult with, and she really needed that. She continued to lose weight throughout her whole diagnosis and being aware of additional supplements or procedures to help would have made her life so much better. Trying to coordinate psychosocial care was impossible. Pain management was so important to me but as her daughter was concerned about overmedicating because of my background and truly needed another professional to coordinate her care. I wanted to be her daughter not her pain nurse. They tried but just could not get it all together. Finally when we got to hospice my Mother and my family got the coordinated care we needed. So in the end I did get what my goal was. My Mother died in her home like she wanted with all of us there with her. You can see why I believe in what we do. I know that families who experience the support and care that a truly comprehensive team can provide will know where to return if they should have a cancer diagnosis in the future.

Pain management is not an exact science but today there is so much more science behind what we do we can be successful for so many of those hard to manage patients whom in the past had very little quality of life.

How important are legislative issues concerning pain management?
They can be very important. We just had a bill passed before Gray Davis was recalled to remove triplicates from our State. Our hope by doing this was that we would increase access to medications for all of our patients. The bill was signed but it's not in practice yet. Unfortunately our County Sheriff's department is blocking that bill for fear of increasing addiction in our state with what they believe to be decreased restrictions to opioid use. Very sad and frustrating but we need to continue to watch what legislators are trying to do. Part of what SCCPI does is work together with other State Initiatives in an effort to educate the legislators in pain management and provide information and statistical evidence as available to help them understand what does happen when opioids are not triplicate based. California happens to be one of only 2 states that require a 3-part prescription plan.

What is your new role (reflecting SHC's commitment) to provide support to the Cancer Centers in pain and symptom management?
My role is a new role for SHC in that I am to provide support to all of our cancer centers to help them achieve whatever pain management service they want in their facility. Part of what I'm doing is traveling to all our centers, meeting the people who are important in pain management, to see how I can help them with policies and procedures, standards of practice, education for staff. There is a course that I co-teach for City of Hope that is designed to educate nurses and other healthcare providers in areas of pain management, side effect management, non-pharmacological interventions, and cultural impact. My ability to provide one-hour courses or three-day courses depends on what the facility needs.

Yesterday I was at our Desert center and discovered that the pharmacist there is very involved in pain management for patients. This is unique to this center and so their setup is a bit different than our other centers. Pain management is really a value-added service that our cancer centers offer. You can't put a price tag on it but it makes a huge difference in patient satisfaction. We were available by phone, we could manipulate medications to reduce side effects, and we really made a difference. The 24-hour treatment area was really essential in accommodating patients' needs. Families appreciated the efforts and knew they were not alone at home.

We're looking at ways to measure our success. Starting with JCAHO standards, and also looking at doing chart audits to make sure patients' pain is truly being rated consistently. Patient satisfaction surveys tell us so much. I am hoping to help our centers participate in research projects. Oncology Nursing Society has organized a program called PRISM. PRIority Symptom Management. The goal is to help support symptom management research to continue to develop evidence based practice. My hope is to help centers that are interested to establish research projects and publish their work. It is overwhelming in many ways but if my role works, as it should, I will be able to help those things happen within the centers.

How do you plan to facilitate Cancer Center's participation in pain management research protocols?
We are a unique facility that can really play an important role in research. One of my goals is to help each of our centers play a role, starting with nursing. Reproducing studies that have been published may help us build our research programs. I'll be setting up a couple of ideas, working with our research department here at SHC, and will offer those to our centers. Our goal is to see research done at SHC published, and become more visible to the community.