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An Instructional Design on Cancer Pain Control

Department of Surgery

Ospital ng Maynila Medical Center

 

 

Setting:

 

Department of Surgery

Ospital ng Maynila Medical Center

 

2002 Census of Cancer Patients

            Total number: 132 admissions

            Common types of cancer: Breast, colorectal, thyroid, stomach, pancreas,

bone and soft tissue, larynx.

 

Usual causes of cancer pain:

            The cancer itself

            The treatment of cancer

            Mental anguish brought about by knowing one has a cancer

 

Trainees:        16 surgical residents

                        1 volunteer parasurgical staff (nurse)

                        Rotating medical clerks and interns

 

Philosophy and Assumptions:

  1. All physicians should know how to manage cancer pain.  They should be able to render the elemental pain management professional services and to know when and to whom to refer patients needing more complicated pain management professional services.
  2. Elemental pain management professional services include psychotherapy (advice and psychosocial support) and pharmacologic therapy (modified WHO analgesic ladder).
  3. All physicians should have an S2 license and yellow prescription pads to be able to accomplish the WHO analgesic ladder for cancer pain control.
  4. All surgeons should know how to manage cancer pain.  With majority of cancers being solid tumors, with malignant solid tumors being primarily treated by operation, and with operation being the recognized specialty of surgeons, the latter are expected to be cancer pain specialists more than any other medical specialists.
  5. The surgical residents, being the frontline physicians in a Department of Surgery and implementors of a Department’s cancer pain control program, should know how manage cancer pain.
  6. Parasurgical staff and medical clerks and interns, being part of the cancer pain management team of the Department of Surgery, are expected to know the theories and principles of cancer pain control to be able assist the surgical residents effectively.
  7. Education in cancer pain control should be comprehensive inclusive of administrative and medical aspect of management.

 

Learning Objectives:

 

General learning objective:

 

At the end of the course, the learners should be able to acquire the requisite competency in the management of a patient with cancer pain.

 

Terminal learning objectives:

 

At the end of the course, the learners should be able to:

 

  1. Pass a written exam covering the items specified in the learning content section of this instructional design.
  2. For the surgical residents, present and discuss satisfactorily a case management of cancer pain (using the standard Department’s evaluation form for case management presentation and discussion).
  3. Contribute to the achievement of the targets of the Department’s cancer pain control program.

 

Specific behavioral objectives:

 

At the end of the course, the learners should be able to:

 

  1. Answer accurately and concisely all the questions posed in the learning content section of this instructional design.
  2. Demonstrate expected competency in a simulated management of a patient with cancer pain.
  3. Demonstrate expected competency in an actual management of a patient with cancer pain.

 

 Content:

 

What is cancer pain?

What are the usual causes of cancer pain?

What is the magnitude of cancer pain health problem, particularly in the Philippines?

What are the usual problems encountered in cancer pain control program,  particularly in the Philippines?

What are the various ways of assessing degree of cancer pain in a patient and indications for their use?

What are the general principles in the management of a patient with cancer pain?

What are the usual options of treatment modalities for cancer pain control and how should selection be done for a particular patient with cancer pain?

What are WHO recommendations on pharmacologic cancer pain control? DOH recommendations on pharmacologic cancer pain control? What is/are the difference?

What are the administrative (legal) requirements for prescribing opioid analgesics?

How should the yellow prescriptions pad for morphine be filled up by a physician?

How should the success or failure of cancer pain relief for a particular patient be assessed?

How should a cancer pain control program in a department or hospital be formulated? Be evaluated?

 

Learning strategies:

 

“Must” learning strategies:

Independent study using the learning objectives and specified learning content as guide (hand-outs may be used)

Actual patient management with supervision

 

“Optional” learning strategies:

 

Presentation (lecture and/or case) and discussion

Simulated patient management

 

 

Learning resources:

 

Internet

            WHO cancer pain control program

DOH cancer pain control program

 

OMMC’s unified concept on cancer pain control program (April,2003)

OMMC’s cancer pain control program

OMMC Department of Surgery’s cancer pain control program

 

 

Evaluation Methods:

 

Written exam 

Case presentation and discussion for surgical residents only (one case per year)

Monitoring and assessment of Department’s Cancer Pain Control Program

            Premise: success or failure of the program is a reflection of the

competency of the Department’s cancer pain control team.