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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald

4 Issues per year

CiteScore 2017: 0.84

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Source Normalized Impact per Paper (SNIP) 2017: 0.452

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Volume 17, Issue 1

COMBAT study – Computer based assessment and treatment – A clinical trial evaluating impact of a computerized clinical decision support tool on pain in cancer patients

Sunil X. Raj
  • Corresponding author
  • European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
  • Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Cinzia Brunelli
  • Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Pål Klepstad
  • Department of Anaesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  • Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Stein Kaasa
  • European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
  • Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-10-01 | DOI: https://doi.org/10.1016/j.sjpain.2017.07.016


Background and aims

The prevalence of pain in cancer patients are relatively high and indicate inadequate pain management strategies. Therefore, it is necessary to develop new methods and to improve implementation of guidelines to assess and treat pain. The vast improvement in information technology facilitated development of a computerized symptom assessment and decision support system (CCDS) - the Combat system - which was implemented in an outpatient cancer clinic to evaluate improvement in pain management.


We conducted a controlled before-and-after study between patient cohorts in two consecutive study periods: before (n = 80) and after (n = 134) implementation of the Combat system. Patients in the first cohort completed questionnaires with the paper-and-pencil method and this data was not shown to physicians. Patients in the latter cohort completed an electronic questionnaire by using an iPad and the data were automatically transferred and presented to physicians at point of care. Additionally, the system provided computerized decision support at point of care for the physician based on the electronic questionnaires completed by the patients, an electronic CRF completed by physicians and clinical guidelines.


The Combat system did not improve pain intensity and there were no significant alterations in the prescribed dose of opiates compared to the cohort of patients managed without the Combat system.


The Combat system did not improve pain management. This may be explained by several factors, however, we consider lack of proper implementation of the CCDS in the clinic to be the most important factor. As a result, we did not manage to change the behaviour of the physicians in the clinic.


There is a need to conduct larger prospective studies to evaluate the efficacy of modern information technology to improve pain management in cancer patients. Before introducing new information technology in the clinics, it is important to have a well thought out implementation strategy. The trial is registered at Clinialtrials.gov, number NCT01795157.

Keywords: CCDS; Computer; Pain; Decision support; Cancer outpatients


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About the article

Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, St. Olavs University Hospital, NO-7006 Trondheim, Norway

Received: 2017-05-13

Revised: 2017-06-12

Accepted: 2017-07-07

Published Online: 2017-10-01

Published in Print: 2017-10-01

Ethical issues The study was approved by the Regional Committees for Medical and Health Research Ethics in Norway and all patients provided written informed consent to participate in the study before inclusion.

Conflict of interest The authors declare no conflict of interest. Cinzia Brunelli has provided consultancy for Mundipharma Pharmaceurticals. The main author has full control of all primary data and will allow the journal to review the data if requested.

Citation Information: Scandinavian Journal of Pain, Volume 17, Issue 1, Pages 99–106, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2017.07.016.

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