New England Cancer Pain Update, Winter 2006-07 Issue

The Vermont Pain Initiative is a volunteer, interdisciplinary organization committed to promoting optimum pain relief for all persons with pain. The guiding principle is that through education, research, and advocacy we will assure access to skilled and appropriate pain management for all individuals.

The Vermont Pain Initiative has the support of the American Cancer Society along with in-kind support from several participating organizations including the Madison-Deane Initiative, the VNA of Chittenden and Grand Isle Counties, the Vermont Medical Society, the Vermont Hospice and Palliative Care Council, and the Vermont Ethics Network. The American Cancer Society provides office space, telephone, voice mail, fax, computer, and printer capabilities along with access to printing and mailing services.

The Initiative's goals are to:

• Improve provider knowledge and skills by developing strategies that will increase accessibility and quality of pain management education for health care providers.
• Improve Vermont’s Policy Study Group grade from C to B+ by developing strategies in collaboration with the Vermont Office of the Attorney General to bring about a positive policy climate for effective pain management.
• Improve public awareness of effective pain management by developing collaborations that bring education about pain management, including dispelling myths, to Vermonters.

The Vermont Pain Initiative has appointed Professor Marilyn Rinker of the Norwich University Nursing Program faculty as the interim convener. Judith D. Murphy, EdD, CHES, an American Cancer Society community executive for cancer control, will remain the point person at the Society. The Society will continue to host the meetings at no cost.

Power Over Pain is designed to publicize America's pain epidemic, arm people with pain with practical information, increase their demand for pain management services, improve pain care, and position pain management as a major healthcare priority.

The overarching purpose of the Power Over Pain Campaign is to increase the number of Vermonters who receive effective pain relief. The goals of the campaign are to:

• Inform: Provide people with pain, their families, caregivers, the general public, healthcare professionals, policy makers, and the media with the most current information about pain, and educate people with pain about their right to get the care they need and deserve.
• Involve: Call people to action around the issue of pain from the local to the state level, and encourage the development of sustainable grassroots coalitions that will work for improved pain management.
• Help: Provide support, resources, and information to people with pain, their families, friends, and caregivers.
  Increasing Health Care Providers’ Knowledge and Skills

  The Vermont Pain Initiative is collaborating with the Vermont Medical Society and the Madison–Deane Initiative on a project to improve physicians’ knowledge and skills in effective pain management. This project involves a pilot project at the state’s flagship medical center and only medical school, Fletcher Allen Health Care and the University of Vermont. The goal is to set an example of provider education that can be disseminated to Vermont’s other hospitals. Our objective is to provide a standard for education in pain management that would be required of all physicians with admitting privileges or seeking admitting privileges and to provide a full menu of choices for how that education will occur.

  The Vermont Pain Initiative produces a quarterly e-newsletter for health care professionals that includes news, policy updates, programs, reports, research, resources, RFPs, and an events calendar. If you don't receive this newsletter but would like to, please email Judith Murphy at Judith.Murphy@cancer.org

  Creating a Positive Regulatory and Legislative Climate

  The Vermont Pain Initiative, in collaboration with the Vermont Office of the Attorney General and many other partners, has been working to develop reasonable public recommendations on policies and legislation to reinforce effective pain management. On January 31, 2005 Vermont Attorney General William Sorrell released the report Initiative on End of Life Care. This report makes recommendations, including proposed legislation, designed to make it easier for patients to use the various end-of-life documents and to assure doctors that, without fear, they can honor the dying wish of their patient who wants his pain aggressively managed.

  Sorrell said not enough Vermonters have living wills and that some doctors are worried that, even with a living will, they could be liable if aggressive pain management hastens death. Sorrell said physicians should not worry if the "unintended consequence" of aggressive pain management is death of the patient. "They need not worry that they're going to be subject to prosecution," he said. The issue is intent. "If you're intending to hasten death, that's wrong. If you are trying to treat a condition and it has an unintended consequence, that's within the acceptable standard of care."

  The Vermont Pain Initiative is supporting the Vermont Medical Society in identifying how to improve the Vermont Medical Board guidelines regarding pain relief. We will be using the most recently published recommended guidelines as our framework.

  Institutional Change

  The Vermont Pain Initiative is working with the Vermont Program for Quality Health Care (VPQHC) and VPQHC’s committee on Excellent Collaboration in End of Life Care (ExCEL) to remove systemic barriers to effective pain management from health care agencies and institutions. The first objective in this project is to gather data about the present situation in Vermont regarding pain and symptom management at the end of life. We will then be able to compare Vermont with national data. This will also increase validation of the tool for Brown University where the tool was created. The data gathered will become the baseline to measure our progress.