Patients with terminal and preterminal cancer- Evidence Based Practice Assignment

Patients with terminal and preterminal cancer- Evidence Based Practice - Assignment Example Round the clock administration of oral morphine for acute and chronic pain in patients with terminal and preterminal cancer is a widely accepted procedure. However, the need to administer the drug frequently and the increased risk of analgesic efficacy poses a problem in the management of pain in cancer patients. Several studies have reported other means of administration of opioid without altering the analgesic efficacy and without cumbersome dosing schedules. A couple of such important strategies are controlled-release morphine tablets and fentanyl-transdermal therapeutic system. To ascertain as to which is a better strategy for pain relief in cancer patients review of literature is essential. Making clinical decisions based on appropriate evidence is known as evidence-based practice. According to McKibbon (1998), "Evidence-based practice (EBP) is an approach to health care wherein health professionals use the best evidence possible, i.e. the most appropriate information available, to make clinical decisions for individual patients. EBP values, enhances and builds on clinical expertise, knowledge of disease mechanisms, and pathophysiology. It involves complex and conscientious decision-making based not only on the available evidence but also on patient characteristics, situations, and preferences." Literature review is the most critical exercise for EBP. Literature search for EBP can be done effectively by creating appropriate question in PICO format. In this assignment, literature review for an evidence-based answer of a clinical question will be discussed after deciphering the question in PICO format. The literature search will be performed in a systematic manner through electronic databases. Clinical Question "In patients with terminal and preterminal cancer, which is the most appropriate strategy for pain relief? Oral sustained release morphine or transdermal fentanyl?" PICO Population: Patients with cancer in preterminal or terminal stages with acute or chronic pain Intervention: Orals sustained release morphine Comparison: Intradermal fentanyl Outcome: Relief from pain Search Process The commencement of search in electronic databases was based on the inclusion/exclusion criteria and knowledge of the hierarchies of evidence. Hierarchy provides a confidence measure to the end-user (Evans, 2003). According to Evans (2003), random control trials can be considered of good standard and they are in fact labeled as the gold standard of research for providing optimal research designs to answer pertinent questions. However, systemic reviews and meta-analysis have topped the hierarchy list. The databases used for search were PUBMED, Google Scholar and CINAHL. The MESH terms used in PUBMED were cancer pain (AND), morphine (AND), fentanyl (AND), & pain (AND). The limits used were adults and