Patient and caregiver experiences of utilising out of hours primary care for cancer pain

Background/introduction: Pain is the most frequent complication of cancer. Cancer pain control is often suboptimal despite effective treatments being available. Cancer pain can result in increased healthcare utilization including unscheduled and emergency presentations. The circumstances of out of hours (OOH) primary care use by patients with cancer pain are poorly understood. Cancer pain management may be an appropriate and necessary function of an OOH service. It is also conceivable that some OOH contacts are undesirable and could reflect suboptimal baseline pain management or inadequate anticipatory planning.
Research question: What are the circumstances of primary care OOH use by patients who require assistance with cancer pain management?
Methods: OOH computerised records in Grampian we researched for Read codes relating to cancer on a weekly basis.Adults who had made contact for help with cancer pain were invited to participate in a semi structured interview, with or without a caregiver. Interviews were transcribed verbatim and analysed using Framework analysis.
Results: Face-to-face interviews were conducted with 11 patients, and four caregivers (joint interviews). Six themes emerged: (1) Making sense of pain and predicting its course.
Participants made a judgement about pain in the context of their underlying illness. (2) Beliefs about analgesics. Participants had concerns about using analgesics. (3) Daytime access.Arrangements were often in place for priority access. (4) Continuity of care. Participants valued personal continuity for scheduled care but not unscheduled care. (5) Barriers and facilitators to help-seeking. The presence of a caregiver particularly facilitated help-seeking; and (5) Satisfaction with OOH care. Structured anticipatory care summaries assisted help-seeking, OOH access, and improved patient satisfaction.Conclusions: Patient’s beliefs and understanding about cancer pain and analgesics should be explored during scheduled care.Barriers to help-seeking should be addressed. A structured palliative care summary can improve the OOH primary care experience.