Australian Pathways for Specialist Pain Management and Early Palliative Care for People With Pancreatic Cancer: Developed Using a Community Consensus Approach.

Abstract

Despite evidence of improved outcomes, people with pancreatic cancer have highly variable access to effective pain relief and palliative care. We aimed to develop evidence-based, community-informed standardised pathways to timely pain management and early palliative care for people with pancreatic cancer. Using a multi-method, comprehensive, community engagement and evidence-informed approach, we developed pathways to standardise referral to pain management and early palliative care for people with pancreatic cancer. Community engagement included representation from multidisciplinary clinicians, community groups and people with lived experience from across regions and all Australian states. We developed two pathways: (i) a pathway for pain management for people with resectable pancreatic cancer and (ii) an integrated pathway for pain management and palliative care for people with unresectable pancreatic cancer (https://www.pancare.org.au/pancreatic-cancer-roadmap-projects/pancreatic-cancer-pathways). Clinical guidance providing practical steps and links to evidence accompany the pathways. Key elements of the pathways included: screening for pain at each encounter, comprehensive holistic assessment and management; early consideration of interventional pain management in the event of refractory pain; introduction of palliative care at time of diagnosis of metastatic or unresectable pancreatic cancer with links to suggested language to address potential community hesitancy; and recommendation to discuss referrals for palliative care and interventional pain management at cancer multidisciplinary meetings. The pathways developed have set forth best practice standards grounded in evidence and expert consensus. The extensive clinical and community engagement ensures the relevance and ownership of these pathways. Implementation of the pathways will reduce existing variation in access and enhance the quality of care for people with pancreatic cancer. Furthermore, the pathways offer an opportunity to benchmark practice within and between services.