Author: Dr S.A.S.S. Dilankani
The National Cancer Institute of Sri Lanka (NCISL), Apeksha Hospital is the nation’s premier tertiary care centre for oncology and palliative care. Established in 1956, it has evolved into a 1,100-bed government hospital, providing comprehensive and free cancer treatment and research services. Each year, the institute registers around 13,000 new patients, including 800 children. With 130 dedicated paediatric oncology beds, it serves as Sri Lanka’s only specialized childhood cancer unit, offering advanced, compassionate care to young patients and their families.
Even with the major advancements in cancer treatment, many children at NCISL continue to experience pain and anxiety during routine needle-based procedures such as blood draws, cannulation and lumbar punctures. Several challenges persist for the implementation of procedural pain relief including limited funding, heavy patient loads, shortages of essential materials, and lack of child-friendly spaces. Staff turnover and the need for ongoing refresher training also pose sustainability concerns.
The Hopeful Comfort Project was launched to address these barriers to improve procedural pain management and promote compassionate, family-centred care. The project focuses on reducing preventable pain that young patients with cancer repeatedly endure, pain that is often overlooked yet causes significant distress to both children and their families.
At the core of the Hopeful Comfort Project is the St. Jude Comfort Promise, an internationally recognized, evidence-based framework developed to minimize pain and distress during needle-based procedures. The initiative empowers healthcare professionals with the knowledge, practical skills, and essential resources needed to manage procedural pain effectively. It combines pharmacological methods, such as topical anaesthetics, with non-pharmacological approaches, including distraction, comfort positioning, and active family involvement. The ultimate goal is to make effective procedural pain management a routine and sustainable practice within pediatric oncology care at NCISL, ensuring that every child receives safe, compassionate, and evidence-based treatment.
The key objectives of the project include reducing needle-related procedural pain by 50%, training at least 80 per cent of healthcare professionals in evidence-based pain management techniques, improving access to essential pain-relief resources, and embedding sustainable family-centred practices into routine clinical protocols.
Implementation began with strong stakeholder engagement, including discussions with consultant paediatric oncologists and nursing in-charges. This collaborative approach led to broad institutional support and expansion of the project to include all paediatric oncology units. In the capacity-building phase, six workshops were conducted with participation from about 70 per cent of the paediatric oncology workforce. The National Cancer Control Programme (NCCP), Ministry of Health, Sri Lanka, sponsored and supported these sessions, highlighting the importance of system level commitment in improving paediatric cancer care.
The project integrated several steps:
- Essential materials were collected through donations, including EMLA cream (provides temporary numbing), distraction toys, and reward tools such as stickers, which were distributed to each paediatric unit/ward.
- Posters outlining the St. Jude Comfort Promise principles were displayed across the wards/ units to reinforce awareness and adherence.
- Bedside training sessions were conducted to strengthen staff confidence and the practical application of the principles.
The pilot implementation, launched in the Day Chemotherapy Unit, received positive feedback from both staff and parents, highlighting its effectiveness and acceptability in routine clinical practice. Discussions with hospital administrators ensured institutional engagement and sustainability planning.
The next steps include maintaining a continuous supply of materials, expanding implementation to all paediatric wards, and conducting bedside training for parents using trilingual educational leaflets in Sinhala, Tamil, and English. Continued professional development sessions are planned to keep staff champions motivated and skilled.
The project has shown remarkable success dealing with some of the existing barriers, improving parental satisfaction, reducing pain scores, shortening procedure times, and enhancing staff confidence. With stakeholder engagement and commitment at national level, the initiative’s expansion across all paediatric units marks a major step toward compassionate, child-centred oncology care at NCISL, where every child’s healthcare experience is grounded in comfort, dignity, and hope.
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