Enhancing cancer pain control regimens through patient education

doi:10.1016/0738-3991(87)90128-5

Patient Education and Counseling

Volume 10, Issue 3, December 1987, Pages 267-277

https://doi.org/10.1016/0738-3991(87)90128-5 Get rights and content

Abstract

The problem of cancer-related pain afflicts millions of people annually. The study described here was aimed at improving cancer patients' pain control through a planned patient education program. A randomized clinical trial with a Solomon Four-Group design was used to assess the effectiveness of a patient education intervention consisting of nurse counseling and printed materials. The sample included 230 cancer patients. One month later, patients in the experimental group were more likely to have taken their pain medicine on the correct schedule and to have taken the correct dosage. The experimental group also was significantly less likely to report stopping the medicine when they felt better. In addition, they were significantly less worried about tolerance and addiction to pain medicines. Forty-four percent of the experimental group compared to 24% of the control group reported no or mild pain at the posttest.

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To assess the effect of a teach-back educational intervention using Behavior Change Wheel (BCW) framework on perioperative pain among patients with lung cancer.
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To describe the changing dynamics of patient-provider communication with proposals for optimizing this important relationship.
Current research, national programs and guidelines from the National Cancer Institute, the Commission on Cancer, the Institute of Medicine, and the Oncology Nursing Society.
There are important opportunities to apply evidence-based strategies to optimize patient-provider communication that will result in improved health outcomes.
Oncology nurses across all areas of practice, including clinical care, research, and education, can play a significant role in achieving the goal of positive health outcomes by addressing challenges that inhibit effective patient-provider communication.
Improvement of pain-related self-management for cancer patients through a modular transitional nursing intervention: A cluster-randomized multicenter trial
2014, Pain
Patients’ self-management skills are affected by their knowledge, activities, and attitudes toward pain management. This trial aimed to test the Self Care Improvement through Oncology Nursing (SCION)-PAIN program, a multimodular structured intervention to reduce patients’ barriers to self-management of cancer pain. Two hundred sixty-three patients with diagnosed malignancy, pain > 3 days, and average pain ⩾ 3/10 participated in a cluster-randomized trial on 18 wards in 2 German university hospitals. Patients on the intervention wards received, in addition to standard pain treatment, the SCION-PAIN program consisting of 3 modules: pharmacologic, nonpharmacologic pain management, and discharge management. The intervention was conducted by specially trained cancer nurses and included components of patient education, skills training, and counseling. Starting with admission, patients received booster sessions every third day and one follow-up telephone counseling session within 2 to 3 days after discharge. Patients in the control group received standard care. Primary end point was the group difference in patient-related barriers to self-management of cancer pain (Barriers Questionnaire – BQ II) 7 days after discharge. The SCION-PAIN program resulted in a significant reduction of patient-related barriers to pain management 1 week after discharge from the hospital: mean difference on BQ II was −0.49 points (95% confidence interval −0.87 points to −0.12 points; P = 0.02). Furthermore, patients showed improved adherence to pain medication; odds ratio 8.58 (95% confidence interval 1.66–44.40; P = 0.02). A post hoc analysis indicated reduced average and worst pain intensity as well as improved quality of life. This trial reveals the positive impact of a nursing intervention to improve patients’ self-management of cancer pain.
A systematic evaluation of content, structure, and efficacy of interventions to improve patients' self-management of cancer pain
2012, Journal of Pain and Symptom Management
Citation Excerpt :
In terms of the optimal educational level of the provider of the intervention, no discernable pattern was found. Active participation of patients in the intervention session was reported in 13 studies.27,28,38,41,53,54,59–61,63–66 In seven studies, patients were only allowed to ask questions,18,42,55–58,62 and no interaction took place in three studies.26,40,66
Cancer pain continues to be extensively undertreated, despite established guidelines. Although the efficacy of interventions that support patients' self-management of cancer pain has been demonstrated in several studies, the most effective components of these interventions remain unknown.
The purpose of this review of experimental and quasi-experimental studies was to systematically describe the structure and content components, as well as the efficacy of various components, of interventions designed to improve patients' self-management of cancer pain.
A systematic review of the literature was done that supplemented the 2009 meta-analysis of Bennett et al. Intervention components were categorized using content analysis. The intervention components were compared based on their calculated largest effect sizes (ESs) within each study (i.e., Hedges G_u for between-group differences in pain intensity scores).
Based on 34 publications (i.e., 24 interventions), seven structure and 16 content components were identified. In 11 studies with statistically significant ESs, the largest ES within each study ranged from −1.87 to −0.44, which represented clinically meaningful effects. No single component was found to have a discernable influence on ES.
This analysis provides researchers and clinicians with a detailed overview of the various structural and content components, as well as various combinations that were tested in intervention studies to improve cancer pain management. However, because of a variety of limitations, the most efficacious intervention components or combination of components remain to be determined in future studies.
A combined pain consultation and pain education program decreases average and current pain and decreases interference in daily life by pain in oncology outpatients: A randomized controlled trial
2011, Pain
Citation Excerpt :
However, they did not discover an improvement in the adequacy of pain treatment and patient adherence or a reduction of the interference by pain in daily living (daily interference) [7,13,22]. To diminish patient-related barriers, pain education programs (PEPs) were developed to improve patients’ knowledge and to stimulate participation in their own pain treatment [1,3,5,9,10,17–20,23,24,26,28,29,31–33,35,36]. PEP decreased patients’ pain intensity in 10 of 18 studies and improved pain knowledge in 13 of 18 studies.
Pain education programs (PEP) and pain consultations (PC) have been studied to overcome patient-related and professional-related barriers in cancer pain management. These interventions were studied separately, not in combination, and half of the studies reported a significant improvement in pain. Moreover, most PEP studies did not mention the adequacy of pain treatment. We studied the effect of PC combined with PEP on pain and interference by pain with daily functioning in comparison to standard care (SC). Patients were randomly assigned to SC (n = 37) or PC-PEP (n = 35). PEP consisted of patient-tailored pain education and weekly monitoring of pain and side effects. We measured overall reduction in pain intensity and daily interference over an 8-week period as well as adequacy of pain treatment and adherence. The overall reduction in pain intensity and daily interference was significantly greater after randomization to PC-PEP than to SC (average pain 31% vs 20%, P = .03; current pain 30% vs 16%, P = .016; interference 20% vs 2.5%, P = .01). Adequacy of pain management did not differ between the groups. Patients were more adherent to analgesics after randomization to PC-PEP than to SC (P = .03). In conclusion, PC-PEP improves pain, daily interference, and patient adherence in oncology outpatients.
Cancer Health Empowerment for Living without Pain (Ca-HELP): Effects of a tailored education and coaching intervention on pain and impairment
2011, Pain
We aimed to determine the effectiveness of a lay-administered tailored education and coaching (TEC) intervention (aimed at reducing pain misconceptions and enhancing self-efficacy for communicating with physicians) on cancer pain severity, pain-related impairment, and quality of life. Cancer patients with baseline “worst pain” of ⩾4 on a 0–10 scale or at least moderate functional impairment due to pain were randomly assigned to TEC or enhanced usual care (EUC) during a telephone interview conducted in advance of a planned oncology office visit (265 patients randomized to TEC or EUC; 258 completed at least one follow-up). Patients completed questionnaires before and after the visit and were interviewed by telephone at 2, 6, and 12 weeks. Mixed effects regressions were used to evaluate the intervention adjusting for patient, practice, and site characteristics. Compared to EUC, TEC was associated with increased pain communication self-efficacy after the intervention (P < .001); both groups showed significant (P < .0001), similar, reductions in pain misconceptions. At 2 weeks, assignment to TEC was associated with improvement in pain-related impairment (−0.25 points on a 5-point scale, 95% confidence interval −0.43 to −0.06, P = .01) but not in pain severity (−0.21 points on an 11-point scale, −0.60 to 0.17, P = .27). The improvement in pain-related impairment was not sustained at 6 and 12 weeks. There were no significant intervention by subgroup interactions (P > .10). We conclude that TEC, compared with EUC, resulted in improved pain communication self-efficacy and temporary improvement in pain-related impairment, but no improvement in pain severity.

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Original articleEnhancing cancer pain control regimens through patient education

Abstract

J Psychosom Res

Pain

Pain

Patient Educ Couns

Patient Educ Couns

Pain in metastatic breast cancer

Cancer

Public attitudes toward cancer pain

Cancer

Pain: Problem for the person with cancer

Cancer Nurs

Importance of the problem

Life Before Death

Diseases of the central nervous system: Relief of terminal cancer

Br Med J

Control of pain in terminal cancer

Nurs Times

Use of drugs for pain with cancer patients

Cancer Nurs

Undertreatment of medical inpatients with narcotic analgesics

Arch Int Med

The Patient in Pain: New Concepts

Home or hospital?

Original article
Enhancing cancer pain control regimens through patient education