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Latter S, Hopkinson JB, Richardson A, Hughes JA, Lowson E, Edwards D. How can we help family carers manage pain medicines for patients with advanced cancer? A systematic review of intervention studies. BMJ Support Palliat Care 2016; 6:263-75. [PMID: 27150294 PMCID: PMC5013162 DOI: 10.1136/bmjspcare-2015-000958] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 01/18/2016] [Indexed: 12/03/2022]
Abstract
Background Family carers play a significant role in managing pain and associated medicines for people with advanced cancer. Research indicates that carers often feel inadequately prepared for the tasks involved, which may impact on carers’ and patients’ emotional state as well as the achievement of optimal pain control. However, little is known about effective methods of supporting family carers with cancer pain medicines. Aims To systematically identify and review studies of interventions to help carers manage medicines for pain in advanced cancer. To identify implications for practice and research. Method A systematic literature search of databases (MEDLINE, CINAHL, PsycINFO and AMED) was carried out to identify studies of pain medication management interventions that involved family carers of patients with advanced cancer, and reported specific outcomes for family carers. Patient pain outcomes were also sought. Studies were quality appraised; key aspects of study design, interventions and outcomes were compared and a narrative synthesis of findings developed. Results 8 studies were included; all had significant methodological limitations. The majority reported improvements in family carer knowledge and/or self-efficacy for managing pain medicines; no effect on patient pain outcomes; and no adverse effects. It was not possible to discern any association between particular intervention characteristics and family carer outcomes. Conclusions Current evidence is limited, but overall suggests face-to-face educational interventions supported by written and/or other resources have potential to improve carers’ knowledge and self-efficacy for pain management. Further research is needed to identify how best to help family carers manage pain medicines for patients with advanced cancer.
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Affiliation(s)
- Sue Latter
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Jane B Hopkinson
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK Department of Cancer Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jane A Hughes
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Elizabeth Lowson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Deborah Edwards
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales, UK
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102
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Lu F, Song L, Xie T, Tian J, Fan Y, Liu H. Current Status of Malignant Neuropathic Pain in Chinese Patients with Cancer: Report of a Hospital-based Investigation of Prevalence, Etiology, Assessment, and Treatment. Pain Pract 2016; 17:88-98. [PMID: 26991802 DOI: 10.1111/papr.12422] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/21/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Fan Lu
- Department of Pain Management; West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Li Song
- Department of Pain Management; West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Tian Xie
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan Province China
| | - Jie Tian
- Department of Pain Management; West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Yuchao Fan
- Department of Pain Management; West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Hui Liu
- Department of Pain Management; West China Hospital; Sichuan University; Chengdu Sichuan Province China
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103
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Meghani SH, Knafl GJ. Patterns of analgesic adherence predict health care utilization among outpatients with cancer pain. Patient Prefer Adherence 2016; 10:81-98. [PMID: 26869772 PMCID: PMC4734825 DOI: 10.2147/ppa.s93726] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Studies in chronic noncancer pain settings have found that opioid use increases health care utilization. Despite the key role of analgesics, specifically opioids, in the setting of cancer pain, there is no literature to our knowledge about the relationship between adherence to prescribed around-the-clock (ATC) analgesics and acute health care utilization (hospitalization) among patients with cancer pain. PURPOSE To identify adherence patterns over time for cancer patients taking ATC analgesics for pain, cluster these patterns into adherence types, combine the types into an adherence risk factor for hospitalization, identify other risk factors for hospitalization, and identify risk factors for inconsistent analgesic adherence. MATERIALS AND METHODS Data from a 3-month prospective observational study of patients diagnosed with solid tumors or multiple myeloma, having cancer-related pain, and having at least one prescription of oral ATC analgesics were collected. Adherence data were collected electronically using the medication event-monitoring system. Analyses were conducted using adaptive modeling methods based on heuristic search through alternative models controlled by likelihood cross-validation scores. RESULTS Six adherence types were identified and combined into the risk factor for hospitalization of inconsistent versus consistent adherence over time. Twenty other individually significant risk factors for hospitalization were identified, but inconsistent analgesic adherence was the strongest of these predictors (ie, generating the largest likelihood cross-validation score). These risk factors were adaptively combined into a model for hospitalization based on six pairwise interaction risk factors with exceptional discrimination (ie, area under the receiver-operating-characteristic curve of 0.91). Patients had from zero to five of these risk factors, with an odds ratio of 5.44 (95% confidence interval 3.09-9.58) for hospitalization, with a unit increase in the number of such risk factors. CONCLUSION Inconsistent adherence to prescribed ATC analgesics, specifically the interaction of strong opioids and inconsistent adherence, is a strong risk factor for hospitalization among cancer outpatients with pain.
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Affiliation(s)
- Salimah H Meghani
- Department of Biobehavioral Health Sciences, NewCourtland Center of Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Correspondence: Salimah H Meghani, Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Claire M Fagin Hall, 418 Curie Boulevard – Room 337, Philadelphia, PA 19104-4217, USA, Tel +1 215 573 7128, Fax +1 215 573 7507, Email
| | - George J Knafl
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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104
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Thronæs M, Raj SX, Brunelli C, Almberg SS, Vagnildhaug OM, Bruheim S, Helgheim B, Kaasa S, Knudsen AK. Is it possible to detect an improvement in cancer pain management? A comparison of two Norwegian cross-sectional studies conducted 5 years apart. Support Care Cancer 2015; 24:2565-74. [PMID: 26712631 DOI: 10.1007/s00520-015-3064-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 12/18/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE Cancer pain (CP) management is challenging. In recent years, efforts were undertaken to achieve better CP management, e.g. clinical research, new treatment modalities, development of guidelines, education and focus on implementation. The aim of the present study was to compare the prevalence and characteristics of pain and breakthrough pain (BTP) between cross-sectional studies conducted in 2008 and 2014. It was hypothesized that an improvement in pain control would be observed the years in between. METHODS Two cross-sectional studies were conducted where adult cancer patients answered questions from Brief Pain Inventory and the Alberta Breakthrough Pain Assessment Tool for cancer patients. Physicians reported socio-demographic and medical data. Regression models were applied for analysis. RESULTS In total, 168 inpatients, 92 in 2008 and 76 in 2014, and 675 outpatients, 301 in 2008 and 374 in 2014, were included. The patient characteristics of the samples were comparable. Prevalence of CP among inpatients was 55 % in 2008 and 53 % in 2014, and among outpatients, 39 and 35 %, respectively. Inpatients reported average pain intensity (0-10 numerical rating scale, NRS) of 3.60 (standard deviation, SD 1.84) (2008) and 4.08 (SD 2.11) (2014); prevalence of BTP was 52 % (2008) and 41 % (2014). For outpatients, average pain intensity was 3.60 (SD 2.04) (2008) and 3.86 (SD 2.20) (2014); prevalence of BTP was 43 % (2008) and 37 % (2014). None of the differences were statistically significant. CONCLUSION Unexpectedly, no improvement in pain control was observed. Efforts are still needed to improve cancer pain management.
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Affiliation(s)
- Morten Thronæs
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, NO 7491. .,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Kunnskapssenteret 4.Floor, St. Olavs Hospital, Trondheim, Norway, NO 7006.
| | - Sunil X Raj
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, NO 7491.,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Kunnskapssenteret 4.Floor, St. Olavs Hospital, Trondheim, Norway, NO 7006
| | - Cinzia Brunelli
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, NO 7491.,Palliative Care, Pain therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sigrun Saur Almberg
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Kunnskapssenteret 4.Floor, St. Olavs Hospital, Trondheim, Norway, NO 7006
| | - Ola Magne Vagnildhaug
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, NO 7491.,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Kunnskapssenteret 4.Floor, St. Olavs Hospital, Trondheim, Norway, NO 7006
| | - Susanna Bruheim
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, NO 7491
| | - Birgit Helgheim
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, NO 7491
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, NO 7491.,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Kunnskapssenteret 4.Floor, St. Olavs Hospital, Trondheim, Norway, NO 7006
| | - Anne Kari Knudsen
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, NO 7491.,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Kunnskapssenteret 4.Floor, St. Olavs Hospital, Trondheim, Norway, NO 7006
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105
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Santos Salas A, Fuentes Contreras J, Armijo-Olivo S, Saltaji H, Watanabe S, Chambers T, Walter L, Cummings GG. Non-pharmacological cancer pain interventions in populations with social disparities: a systematic review and meta-analysis. SUPPORTIVE CARE IN CANCER : OFFICIAL JOURNAL OF THE MULTINATIONAL ASSOCIATION OF SUPPORTIVE CARE IN CANCER 2015. [PMID: 26556211 DOI: 10.1007/s00520‐015‐2998‐9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Global advances in pain relief have improved the quality of life of cancer populations. Yet, variation in cancer pain outcomes has been found in populations with social disparities compared to mainstream groups. Populations with social disparities bear an inequitable distribution of resources such as ethnic minorities, low income individuals, and women in vulnerable circumstances. RESEARCH PURPOSE A systematic review and meta-analysis of the effect of non-pharmacological cancer pain interventions in cancer populations with social disparities of income, ethnicity, or gender. METHODS Randomized controlled trials, controlled trials, and before and after studies were targeted through comprehensive multidatabase searches. Two reviewers independently screened titles/abstracts for potentially relevant studies and reviewed the full text of relevant articles for inclusion. Data were extracted from included studies by one reviewer and verified by another reviewer. Four reviewers independently completed quality assessment. Studies were grouped by intervention. Effects were evaluated for heterogeneity and pooled. RESULTS The search found 5219 potential records. Full text of 26 reports was evaluated. Three randomized controlled trials (RCTs) met inclusion criteria, targeting ethnic minorities and underserved populations and/or women. Interventions included education, coaching, and online support groups. Studies found no significant differences in pain reduction between intervention and control groups or between ethnic minorities and their counterparts. A high risk of bias was found in all studies. Meta-analysis found no statistically significant difference on pain intensity among underserved groups, ethnic minorities, or between ethnic minorities and white counterparts. CONCLUSION Results show the need to examine supportive care interventions particularly in populations with social disparities.
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Affiliation(s)
- Anna Santos Salas
- Faculty of Nursing University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Jorge Fuentes Contreras
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Católica del Maule, Avda. San Miguel 3605, Talca, Chile
| | - Susan Armijo-Olivo
- Research Centre Faculty of Rehabilitation Medicine, 3-62 Corbett Hall, University of Alberta, 8205 114 Street, Edmonton, AB, T6G 2G4, Canada
| | - Humam Saltaji
- School of Dentistry, University of Alberta, 5-476 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Sharon Watanabe
- Department of Symptom Control and Palliative Care, Cross Cancer Institute and Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Room 2001, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Thane Chambers
- John W. Scott Health Sciences Library, University of Alberta Libraries, Edmonton, AB, T6G 2R7, Canada
| | - Lori Walter
- UBC Okanagan Library, The University of British Columbia, Okanagan Campus, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - Greta G Cummings
- Faculty of Nursing University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
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106
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Santos Salas A, Fuentes Contreras J, Armijo-Olivo S, Saltaji H, Watanabe S, Chambers T, Walter L, Cummings GG. Non-pharmacological cancer pain interventions in populations with social disparities: a systematic review and meta-analysis. Support Care Cancer 2015; 24:985-1000. [PMID: 26556211 DOI: 10.1007/s00520-015-2998-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/26/2015] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Global advances in pain relief have improved the quality of life of cancer populations. Yet, variation in cancer pain outcomes has been found in populations with social disparities compared to mainstream groups. Populations with social disparities bear an inequitable distribution of resources such as ethnic minorities, low income individuals, and women in vulnerable circumstances. RESEARCH PURPOSE A systematic review and meta-analysis of the effect of non-pharmacological cancer pain interventions in cancer populations with social disparities of income, ethnicity, or gender. METHODS Randomized controlled trials, controlled trials, and before and after studies were targeted through comprehensive multidatabase searches. Two reviewers independently screened titles/abstracts for potentially relevant studies and reviewed the full text of relevant articles for inclusion. Data were extracted from included studies by one reviewer and verified by another reviewer. Four reviewers independently completed quality assessment. Studies were grouped by intervention. Effects were evaluated for heterogeneity and pooled. RESULTS The search found 5219 potential records. Full text of 26 reports was evaluated. Three randomized controlled trials (RCTs) met inclusion criteria, targeting ethnic minorities and underserved populations and/or women. Interventions included education, coaching, and online support groups. Studies found no significant differences in pain reduction between intervention and control groups or between ethnic minorities and their counterparts. A high risk of bias was found in all studies. Meta-analysis found no statistically significant difference on pain intensity among underserved groups, ethnic minorities, or between ethnic minorities and white counterparts. CONCLUSION Results show the need to examine supportive care interventions particularly in populations with social disparities.
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Affiliation(s)
- Anna Santos Salas
- Faculty of Nursing University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Jorge Fuentes Contreras
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Católica del Maule, Avda. San Miguel 3605, Talca, Chile
| | - Susan Armijo-Olivo
- Research Centre Faculty of Rehabilitation Medicine, 3-62 Corbett Hall, University of Alberta, 8205 114 Street, Edmonton, AB, T6G 2G4, Canada
| | - Humam Saltaji
- School of Dentistry, University of Alberta, 5-476 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Sharon Watanabe
- Department of Symptom Control and Palliative Care, Cross Cancer Institute and Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Room 2001, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Thane Chambers
- John W. Scott Health Sciences Library, University of Alberta Libraries, Edmonton, AB, T6G 2R7, Canada
| | - Lori Walter
- UBC Okanagan Library, The University of British Columbia, Okanagan Campus, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - Greta G Cummings
- Faculty of Nursing University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
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107
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Briggs E. Evaluating the impact of pain education: how do we know we have made a difference? Br J Pain 2015; 6:85-91. [PMID: 26516475 DOI: 10.1177/2049463712449961] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
1. Education is a core activity for most healthcare professionals working in pain management and an effective evaluation strategy should assess its impact. 2. Evaluation may have one or more purposes: accountability, development or knowledge generation. Other key principles include making evaluation integral to the education process, reflecting with learners on progress, self-evaluation by the pain educator and involving all the key stakeholders. 3. A wide variety of methods are available, but the choice will be influenced by the nature and amount of the pain education, number of learners, purpose of the evaluation and time and resources available. 4. Patient education can be evaluated through knowledge and attitude questionnaires, concordance with the treatment plan, satisfaction and pain- and disability-related measures. 5. Further research is needed to explore the specific strategies or combination of techniques that are effective for different groups, and build on the theoretical base underpinning effective pain education and evaluation for patients and professionals. 6. The importance of education for the public has also been recently recognised, but this wider educational initiative should also be fully evaluated to assess whether this initiative is making a difference.
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Affiliation(s)
- Emma Briggs
- King's College London, Florence Nightingale School of Nursing and Midwifery, London, UK
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108
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Song Y, Oh M, Park S, Park M, Kim K, Lee U, Park M. The Methodological Quality of Systematic Reviews and Meta-Analyses on the Effectiveness of Non-pharmacological Cancer Pain Management. Pain Manag Nurs 2015; 16:781-91. [DOI: 10.1016/j.pmn.2015.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/10/2015] [Accepted: 06/10/2015] [Indexed: 01/08/2023]
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109
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Nkhoma K, Seymour J, Arthur A. An Educational Intervention to Reduce Pain and Improve Pain Management for Malawian People Living With HIV/AIDS and Their Family Carers: A Randomized Controlled Trial. J Pain Symptom Manage 2015; 50:80-90.e4. [PMID: 25666517 DOI: 10.1016/j.jpainsymman.2015.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 12/23/2014] [Accepted: 01/07/2015] [Indexed: 11/17/2022]
Abstract
CONTEXT Advances being made in improving access to HIV drugs in resource-poor countries mean HIV patients are living longer, and, therefore, experiencing pain over a longer period of time. There is a need to provide effective interventions for alleviating and managing pain. OBJECTIVES To assess whether a pain educational intervention compared with usual care reduces pain severity and improves pain management in patients with HIV/AIDS and their family carers. METHODS This was a randomized, parallel group, superiority trial conducted at HIV and palliative care clinics of two public hospitals in Malawi. A total of 182 adults with HIV/AIDS (Stage III or IV) and their family carers participated; carer participants were those individuals most involved in the patient's unpaid care. The educational intervention comprised a 30 minute face-to-face meeting, a leaflet, and a follow-up telephone call at two weeks. The content of the educational intervention covered definition, causes, and characteristics of pain in HIV/AIDS; beliefs and myths about pain and pain medication; assessment of pain; and pharmacological and nonpharmacological management. The primary outcome was average pain severity measured by the Brief Pain Inventory-Pain Severity subscale. Assessments were recorded at baseline before randomization and at eight weeks after randomization. RESULTS Of the 182 patient/carer dyads randomly allocated, 157 patient/carer dyads completed the trial. Patients in the intervention group experienced a greater decrease in pain severity (mean difference = 21.09 points, 95% confidence interval = 16.56-25.63; P < 0.001). CONCLUSION A short pain education intervention is effective in reducing pain and improving pain management for Malawian people living with HIV/AIDS and their family carers.
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Affiliation(s)
- Kennedy Nkhoma
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, Division of Nursing, Queen's Medical Centre, Nottingham, United Kingdom
| | - Jane Seymour
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, Division of Nursing, Queen's Medical Centre, Nottingham, United Kingdom.
| | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
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110
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Meghani SH, Thompson AML, Chittams J, Bruner DW, Riegel B. Adherence to Analgesics for Cancer Pain: A Comparative Study of African Americans and Whites Using an Electronic Monitoring Device. THE JOURNAL OF PAIN 2015; 16:825-35. [PMID: 26080042 DOI: 10.1016/j.jpain.2015.05.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 05/23/2015] [Accepted: 05/28/2015] [Indexed: 01/30/2023]
Abstract
Despite well-documented disparities in cancer pain outcomes among African Americans, surprisingly little research exists on adherence to analgesia for cancer pain in this group. We compared analgesic adherence for cancer-related pain over a 3-month period between African Americans and whites using the Medication Event Monitoring System (MEMS). Patients (N = 207) were recruited from outpatient medical oncology clinics of an academic medical center in Philadelphia (≥18 years of age, diagnosed with solid tumors or multiple myeloma, with cancer-related pain, and at least 1 prescription of oral around-the-clock analgesic). African Americans reported significantly greater cancer pain (P < .001), were less likely than whites to have a prescription of long-acting opioids (P < .001), and were more likely to have a negative Pain Management Index (P < .001). There were considerable differences between African Americans and whites in the overall MEMS dose adherence, ie, percentage of the total number of prescribed doses that were taken (53% vs 74%, P < .001). On subanalysis, analgesic adherence rates for African Americans ranged from 34% (for weak opioids) to 63% (for long-acting opioids). Unique predictors of analgesic adherence varied by race; income levels, analgesic side effects, and fear of distracting providers predicted analgesic adherence for African Americans but not for whites. Perspective: Despite evidence of disparities in cancer pain outcomes among African Americans, surprisingly little research exists on African Americans' adherence to analgesia for cancer pain. This prospective study uses objective measures to compare adherence to prescribed pain medications between African American and white patients with cancer pain.
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Affiliation(s)
- Salimah H Meghani
- Department of Biobehavioral Health Science, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania; NewCourtland Center of Transitions and Health, Philadelphia, Pennsylvania; Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Aleda M L Thompson
- Department of Biobehavioral Health Science, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jesse Chittams
- Department of Biobehavioral Health Science, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deborah W Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Barbara Riegel
- Department of Biobehavioral Health Science, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania; NewCourtland Center of Transitions and Health, Philadelphia, Pennsylvania
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111
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A randomized clinical trial of the efficacy of a self-care intervention to improve cancer pain management. Cancer Nurs 2015; 37:34-43. [PMID: 23666269 DOI: 10.1097/ncc.0b013e3182948418] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The undertreatment of cancer pain remains a significant clinical problem. OBJECTIVE The aim of this randomized controlled trial was to evaluate the efficacy of the PRO-SELF Pain Control Program that was modified for Norwegian cancer patients in decreasing pain and increasing opioid intake compared with control care. INTERVENTIONS/METHODS Oncology outpatients with pain from bone metastasis were randomized into the PRO-SELF (n = 87) or control (n = 92) groups. A nurse visited patients in the PRO-SELF group in their home at weeks 1, 3, and 6 and conducted telephone interviews at weeks 2, 4, and 5. Patients in both groups completed a daily diary of pain intensity ratings and analgesic intake. RESULTS For both groups, significant decreases in pain intensity scores and in hours per day in pain (both, P < .001) were found over the 6 weeks of the study. However, no significant group × time interactions were found for any of the pain measures. In both groups, total dose of opioid taken increased over time. However, no significant group × time interactions were found for changes over time in the total dose, around-the-clock dose, or as-needed dose of opioid analgesics taken. CONCLUSIONS Possible reasons for the lack of efficacy include an inadequate dose of the psychoeducational intervention, inadequate changes in analgesic prescriptions, and/or the impact of attention provided to the control group. IMPLICATIONS FOR PRACTICE Coaching, nursing support, and the use of a pain diary may be important interventions to reduce pain intensity.
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112
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Adam R, Bond C, Murchie P. Educational interventions for cancer pain. A systematic review of systematic reviews with nested narrative review of randomized controlled trials. PATIENT EDUCATION AND COUNSELING 2015; 98:269-282. [PMID: 25483575 DOI: 10.1016/j.pec.2014.11.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 10/08/2014] [Accepted: 11/08/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Educational interventions are one approach to improving cancer pain management. This review aims to determine whether educational interventions can improve cancer pain management and to characterize components of cancer pain educational interventions. METHODS Medline, EMBASE, CINAHL, and Cochrane databases were searched. Systematic reviews that assessed educational interventions to improve cancer pain management were included. Randomized controlled trials (RCTs) were identified from each review. A narrative approach was taken to summarizing the nature and components of interventions. RESULTS Eight systematic reviews and 34 randomized controlled trials (RCTs) were reviewed. Interventions targeting patients can achieve small to moderate reductions in pain intensity. Interventions targeting professionals can improve their knowledge but most trials have not assessed for resultant patient benefits. All interventions included at least one of seven core components: improving knowledge about the nature of cancer pain; aiding communication about cancer pain; enhancing pain assessment; improving analgesic prescribing; tackling barriers to analgesic non-adherence; teaching non-pharmacological pain management strategies; and promoting re-assessment. CONCLUSIONS Cancer pain educational interventions can improve pain outcomes. They are complex heterogeneous interventions which often contain a combination of active components. PRACTICE IMPLICATIONS Suggestions are made to aid the development of future interventions.
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Affiliation(s)
- Rosalind Adam
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
| | - Christine Bond
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Peter Murchie
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
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Zhou L, Liu XL, Tan JY, Yu HP, Pratt J, Peng YQ. Nurse-led educational interventions on cancer pain outcomes for oncology outpatients: a systematic review. Int Nurs Rev 2015; 62:218-30. [PMID: 25711778 DOI: 10.1111/inr.12172] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L. Zhou
- VIP Department; East Hospital; Shanghai China
- School of Medicine; Tongji University; Shanghai China
| | - X.-L. Liu
- Tenth People's Hospital; Tongji University; Shanghai China
- School of Nursing; JingGangShan University; Jian Jiangxi China
| | - J.-Y. Tan
- School of Nursing; Fujian University of Traditional Chinese Medicine; Fuzhou China
| | - H.-P. Yu
- VIP Department; East Hospital; Shanghai China
- School of Medicine; Tongji University; Shanghai China
| | - J. Pratt
- School of Nursing, Midwifery and Paramedicine; Australian Catholic University; Brisbane Qld Australia
- School of Nursing; Queensland University of Technology; Brisbane Qld Australia
| | - Y.-Q. Peng
- Department of Nursing; East Hospital; Shanghai China
- School of Medicine; Tongji University; Shanghai China
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114
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Hopkinson JB, Richardson A. A mixed-methods qualitative research study to develop a complex intervention for weight loss and anorexia in advanced cancer: the Family Approach to Weight and Eating. Palliat Med 2015; 29:164-76. [PMID: 25501313 DOI: 10.1177/0269216314556924] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Worldwide, most people with incurable cancer experience weight loss and anorexia. These symptoms can distress patients and their family caregivers. Interventions that take account of the relationship between patient and family caregiver may improve outcomes for both members of this dyad. AIM To report an example of process for the development of a complex intervention, the Family Approach to Weight and Eating. DESIGN A mixed-methods process informed by the Medical Research Council's guidelines for developing a complex intervention was used to develop a psychosocial intervention for patients with incurable cancer and weight loss or poor appetite and their family caregivers and then to test for its feasibility, acceptability and perceived benefit. SETTING South of England in 2010/2011. PARTICIPANTS A purposive sample of patient-family caregiver dyads under the care of a specialist community palliative care team. Patient participants had incurable cancer and were cachectic or at risk of cachexia. RESULTS The patient-family caregiver dyads comprised seven female and nine male patients (age range 41-84 years) and their carers. The emergent form of the Family Approach to Weight and Eating was found to aid family talk about food, feelings and reciprocity, without adverse consequences. Of the dyads, 15 reported benefits of the Family Approach to Weight and Eating. Three patient participants spoke of the approach evoking sadness and three carers of guilt. CONCLUSION The Family Approach to Weight and Eating should now be tested in a pilot trial and the effect on emotional health outcomes in patients and their family caregivers evaluated.
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Affiliation(s)
- Jane B Hopkinson
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Alison Richardson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK Faculty of Health Sciences, University of Southampton, Southampton, UK
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115
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Singh P, Chaturvedi A. Complementary and alternative medicine in cancer pain management: a systematic review. Indian J Palliat Care 2015; 21:105-15. [PMID: 25709198 PMCID: PMC4332115 DOI: 10.4103/0973-1075.150202] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Quality of life (QoL) encompasses the physical, psychosocial, social and spiritual dimensions of life lived by a person. Cancer pain is one of the physical component has tremendous impact on the QoL of the patient. Cancer pain is multifaceted and complex to understand and managing cancer pain involves a tool box full of pharmacological and non pharmacological interventions but still there are 50-70% of cancer patients who suffer from uncontrolled pain and they fear pain more than death. Aggressive surgeries, radiotherapy and chemotherapy focus more on prolonging the survival of the patient failing to realize that the QoL lived also matters equally. This paper reviews complementary and alternative therapy approaches for cancer pain and its impact in improving the QoL of cancer patients.
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Affiliation(s)
- Priyanka Singh
- Department of Pharmacology, Veer Chandra Singh Garhwali Government Institute of Medical Science and Research, Srikot, India
| | - Aditi Chaturvedi
- Department of Pharmacology, Subharti Medical College, Dehradun, Uttarakhand, India
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116
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Schumacher KL, Plano Clark VL, West CM, Dodd MJ, Rabow MW, Miaskowski C. Pain medication management processes used by oncology outpatients and family caregivers part I: health systems contexts. J Pain Symptom Manage 2014; 48:770-83. [PMID: 24704800 PMCID: PMC4185257 DOI: 10.1016/j.jpainsymman.2013.12.242] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/20/2013] [Accepted: 12/31/2013] [Indexed: 11/18/2022]
Abstract
CONTEXT Oncology patients with persistent pain treated in outpatient settings and their family caregivers have significant responsibility for managing pain medications. However, little is known about their practical day-to-day experiences with pain medication management. OBJECTIVES The aim was to describe day-to-day pain medication management from the perspectives of oncology outpatients and their family caregivers who participated in a randomized clinical trial of a psychoeducational intervention called the Pro-Self(©) Plus Pain Control Program. In this article, we focus on pain medication management by patients and family caregivers in the context of multiple complex health systems. METHODS We qualitatively analyzed audio-recorded intervention sessions that included extensive dialogue between patients, family caregivers, and nurses about pain medication management during the 10-week intervention. RESULTS The health systems context for pain medication management included multiple complex systems for clinical care, reimbursement, and regulation of analgesic prescriptions. Pain medication management processes particularly relevant to this context were getting prescriptions and obtaining medications. Responsibilities that fell primarily to patients and family caregivers included facilitating communication and coordination among multiple clinicians, overcoming barriers to access, and serving as a final safety checkpoint. Significant effort was required of patients and family caregivers to insure safe and effective pain medication management. CONCLUSION Health systems issues related to access to needed analgesics, medication safety in outpatient settings, and the effort expended by oncology patients and their family caregivers require more attention in future research and health-care reform initiatives.
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Affiliation(s)
- Karen L Schumacher
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA.
| | | | - Claudia M West
- University of California, San Francisco, San Francisco, California, USA
| | - Marylin J Dodd
- University of California, San Francisco, San Francisco, California, USA
| | - Michael W Rabow
- University of California, San Francisco, San Francisco, California, USA
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117
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Hopkinson JB. Challenges to pain medicine management at home: commentary on the Schumacher et al. papers. J Pain Symptom Manage 2014; 48:760-1. [PMID: 25281777 DOI: 10.1016/j.jpainsymman.2014.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 09/19/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Jane B Hopkinson
- Cardiff School of Healthcare Sciences, Cardiff University, Cardiff, Wales, United Kingdom.
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118
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McPherson CJ, Hadjistavropoulos T, Devereaux A, Lobchuk MM. A qualitative investigation of the roles and perspectives of older patients with advanced cancer and their family caregivers in managing pain in the home. BMC Palliat Care 2014; 13:39. [PMID: 25140119 PMCID: PMC4137110 DOI: 10.1186/1472-684x-13-39] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/31/2014] [Indexed: 12/04/2022] Open
Abstract
Background Pain in advanced cancer is complex and multifaceted. In older patients comorbidities and age-related functional decline add to the difficulties in managing cancer pain. The current emphasis on care in the community, and preference by patients with life-limiting disease to receive care in the home, has meant that patients and their family caregivers have become increasingly responsible for the day-to-day management of cancer pain. An appreciation of patients’ and caregivers’ roles and perspectives managing pain is, therefore, fundamental to addressing cancer pain in this setting. Consequently, we sought to explore and describe their perspectives and roles. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with a purposeful sample of patient- family caregiver dyads. Participants included 18 patients aged 65 years and over, with advanced cancer, receiving palliative care at home, and 15 family caregivers. The interview data were analysed using thematic analyses. Strategies were used to establish rigour. Results Two main themes were identified. The first theme, "Communicating the pain", represented pain assessment and incorporated four subthemes in which participants described: their roles in pain assessment, the identification and expression of pain, and the communication of pain between patients and caregivers. The second theme, "Finding a solution", comprised of four subthemes that reflected participants’ roles and approaches in controlling pain; as well as their beliefs about cancer pain control, experience with side effects, and perspectives on the goals of treatment. Conclusions The findings support other studies in identifying knowledge and attitudinal barriers to pain control; while adding to the literature by highlighting practical and relational barriers faced by older patients and their family caregivers. Health care professionals can do much to address the barriers identified by: correcting misconceptions regarding cancer pain, facilitating the communication of pain within dyads, and ensuring that patients and family caregivers have the knowledge, skills, and ability to assess and implement pain treatment strategies. This support needs to be individually tailored to meet the ongoing needs of both members of the dyad so that the shared goals of pain management are accomplished.
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Affiliation(s)
- Christine J McPherson
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451, Smyth Road, Ottawa, Ontario K1H 8M5, Canada
| | | | - Alana Devereaux
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451, Smyth Road, Ottawa, Ontario K1H 8M5, Canada
| | - Michelle M Lobchuk
- Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada
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119
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Lee YJ, Hyun MK, Jung YJ, Kang MJ, Keam B, Go SJ. Effectiveness of Education Interventions for the Management of Cancer Pain: A Systematic Review. Asian Pac J Cancer Prev 2014; 15:4787-93. [DOI: 10.7314/apjcp.2014.15.12.4787] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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120
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Syrjala KL, Jensen MP, Mendoza ME, Yi JC, Fisher HM, Keefe FJ. Psychological and behavioral approaches to cancer pain management. J Clin Oncol 2014; 32:1703-11. [PMID: 24799497 PMCID: PMC4031190 DOI: 10.1200/jco.2013.54.4825] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This review examines evidence for psychological factors that affect pain across the cancer continuum from diagnosis through treatment and long-term survivorship or end of life. Evidence is convincing that emotional distress, depression, anxiety, uncertainty, and hopelessness interact with pain. Unrelieved pain can increase a desire for hastened death. Patients with cancer use many strategies to manage pain, with catastrophizing associated with increased pain and self-efficacy associated with lower pain reports. A variety of psychological and cognitive behavioral treatments can reduce pain severity and interference with function, as indicated in multiple meta-analyses and high-quality randomized controlled trials. Effective methods include education (with coping skills training), hypnosis, cognitive behavioral approaches, and relaxation with imagery. Exercise has been tested extensively in patients with cancer and long-term survivors, but few exercise studies have evaluated pain outcomes. In survivors post-treatment, yoga and hypnosis as well as exercise show promise for controlling pain. Although some of these treatments effectively reduce pain for patients with advanced disease, few have been tested in patients at the end of life. Given the clear indicators that psychological factors affect cancer pain and that psychological and behavioral treatments are effective in reducing varying types of pain for patients with active disease, these methods need further testing in cancer survivors post-treatment and in patients with end-stage disease. Multidisciplinary teams are essential in oncology settings to integrate analgesic care and expertise in psychological and behavioral interventions in standard care for symptom management, including pain.
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Affiliation(s)
- Karen L Syrjala
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC.
| | - Mark P Jensen
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
| | - M Elena Mendoza
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
| | - Jean C Yi
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
| | - Hannah M Fisher
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
| | - Francis J Keefe
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
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121
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Lovell MR, Luckett T, Boyle FM, Phillips J, Agar M, Davidson PM. Patient Education, Coaching, and Self-Management for Cancer Pain. J Clin Oncol 2014; 32:1712-20. [DOI: 10.1200/jco.2013.52.4850] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose Multiple systematic reviews and meta-analyses have identified the effectiveness of patient education in improving cancer pain management. However, the mechanisms by which patient education improves pain outcomes are uncertain, as are the optimal delivery, content, timing, frequency, and duration. This review provides best-bet recommendations based on available evidence to guide service managers and clinicians in developing a patient education program. Methods We used patient-centered care, self-management, coaching, and a behavior change wheel as lenses through which to consider the evidence for elements of patient education most likely to be effective within the context of other strategies for overcoming barriers to cancer pain assessment and management. Results The evidence suggests that optimal strategies include those that are patient-centered and tailored to individual needs, are embedded within health professional–patient communication and therapeutic relationships, empower patients to self-manage and coordinate their care, and are routinely integrated into standard cancer care. An approach that integrates patient education with processes and systems to ensure implementation of key standards for pain assessment and management and education of health professionals has been shown to be most effective. Conclusion Patient education is effective in reducing cancer pain and should be standard practice in all settings. For optimal results, patient education should be integrated with other strategies for implementing evidence-based, person-centered care and overcoming barriers at the levels of patient, provider, and health system.
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Affiliation(s)
- Melanie R. Lovell
- Melanie R. Lovell and Meera Agar, HammondCare; Melanie R. Lovell and Frances M. Boyle, University of Sydney; Melanie R. Lovell, Tim Luckett, Jane Phillips, Meera Agar, and Patricia M. Davidson, ImPaCCT (New South Wales Palliative Care Trials Group); Tim Luckett and Patricia M. Davidson, University of Technology Sydney; Jane Phillips, University of Notre Dame; and Meera Agar, University of New South Wales, Sydney, New South Wales, Australia
| | - Tim Luckett
- Melanie R. Lovell and Meera Agar, HammondCare; Melanie R. Lovell and Frances M. Boyle, University of Sydney; Melanie R. Lovell, Tim Luckett, Jane Phillips, Meera Agar, and Patricia M. Davidson, ImPaCCT (New South Wales Palliative Care Trials Group); Tim Luckett and Patricia M. Davidson, University of Technology Sydney; Jane Phillips, University of Notre Dame; and Meera Agar, University of New South Wales, Sydney, New South Wales, Australia
| | - Frances M. Boyle
- Melanie R. Lovell and Meera Agar, HammondCare; Melanie R. Lovell and Frances M. Boyle, University of Sydney; Melanie R. Lovell, Tim Luckett, Jane Phillips, Meera Agar, and Patricia M. Davidson, ImPaCCT (New South Wales Palliative Care Trials Group); Tim Luckett and Patricia M. Davidson, University of Technology Sydney; Jane Phillips, University of Notre Dame; and Meera Agar, University of New South Wales, Sydney, New South Wales, Australia
| | - Jane Phillips
- Melanie R. Lovell and Meera Agar, HammondCare; Melanie R. Lovell and Frances M. Boyle, University of Sydney; Melanie R. Lovell, Tim Luckett, Jane Phillips, Meera Agar, and Patricia M. Davidson, ImPaCCT (New South Wales Palliative Care Trials Group); Tim Luckett and Patricia M. Davidson, University of Technology Sydney; Jane Phillips, University of Notre Dame; and Meera Agar, University of New South Wales, Sydney, New South Wales, Australia
| | - Meera Agar
- Melanie R. Lovell and Meera Agar, HammondCare; Melanie R. Lovell and Frances M. Boyle, University of Sydney; Melanie R. Lovell, Tim Luckett, Jane Phillips, Meera Agar, and Patricia M. Davidson, ImPaCCT (New South Wales Palliative Care Trials Group); Tim Luckett and Patricia M. Davidson, University of Technology Sydney; Jane Phillips, University of Notre Dame; and Meera Agar, University of New South Wales, Sydney, New South Wales, Australia
| | - Patricia M. Davidson
- Melanie R. Lovell and Meera Agar, HammondCare; Melanie R. Lovell and Frances M. Boyle, University of Sydney; Melanie R. Lovell, Tim Luckett, Jane Phillips, Meera Agar, and Patricia M. Davidson, ImPaCCT (New South Wales Palliative Care Trials Group); Tim Luckett and Patricia M. Davidson, University of Technology Sydney; Jane Phillips, University of Notre Dame; and Meera Agar, University of New South Wales, Sydney, New South Wales, Australia
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122
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te Boveldt N, Vernooij-Dassen M, Leppink I, Samwel H, Vissers K, Engels Y. Patient empowerment in cancer pain management: an integrative literature review. Psychooncology 2014; 23:1203-11. [DOI: 10.1002/pon.3573] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 02/04/2014] [Accepted: 04/16/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Nienke te Boveldt
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Center (Radboudumc); Nijmegen The Netherlands
| | - Myrra Vernooij-Dassen
- Department of IQ Healthcare, Department of Primary and Community Care; Radboud University Nijmegen Medical Center (Radboudumc); Nijmegen The Netherlands
- Kalorama Foundation; Beek-Ubbergen The Netherlands
| | - Irene Leppink
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Center (Radboudumc); Nijmegen The Netherlands
| | - Han Samwel
- Department of Medical Psychology; Radboud University Nijmegen Medical Center (Radboudumc); Nijmegen The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Center (Radboudumc); Nijmegen The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Center (Radboudumc); Nijmegen The Netherlands
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Abstract
Pain is a devastating symptom of cancer that affects the quality of life of patients, families, and caregivers. It is a multidimensional symptom that includes physical, psychosocial, emotional, and spiritual components. Despite the development of novel analgesics and updated pain guidelines, cancer pain remains undermanaged, and some patients with moderate to severe pain do not receive adequate pain treatment. Inadequate pain management can be attributed to barriers related to health care professionals, patients, and the health care system. Common professional-related barriers include poor pain assessment, lack of knowledge and skill, and the reluctance of physicians to prescribe opioids. Patient-related barriers include cognitive factors, affective factors, and adherence to analgesic regimens. System-related barriers such as limits on access to opioids and the availability of pain and palliative care specialists present additional challenges, particularly in resource-poor regions. Given the multidimensional nature of cancer pain and the multifaceted barriers involved, effective pain control mandates multidisciplinary interventions from interprofessional teams. Educational interventions for patients and health care professionals may improve the success of pain management.
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Affiliation(s)
- Jung Hye Kwon
- From Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea.
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124
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Ryan R, Santesso N, Lowe D, Hill S, Grimshaw J, Prictor M, Kaufman C, Cowie G, Taylor M. Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev 2014; 2014:CD007768. [PMID: 24777444 PMCID: PMC6491214 DOI: 10.1002/14651858.cd007768.pub3] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Many systematic reviews exist on interventions to improve safe and effective medicines use by consumers, but research is distributed across diseases, populations and settings. The scope and focus of such reviews also vary widely, creating challenges for decision-makers seeking to inform decisions by using the evidence on consumers' medicines use.This is an update of a 2011 overview of systematic reviews, which synthesises the evidence, irrespective of disease, medicine type, population or setting, on the effectiveness of interventions to improve consumers' medicines use. OBJECTIVES To assess the effects of interventions which target healthcare consumers to promote safe and effective medicines use, by synthesising review-level evidence. SEARCH METHODS We included systematic reviews published on the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects. We identified relevant reviews by handsearching databases from their start dates to March 2012. SELECTION CRITERIA We screened and ranked reviews based on relevance to consumers' medicines use, using criteria developed for this overview. DATA COLLECTION AND ANALYSIS We used standardised forms to extract data, and assessed reviews for methodological quality using the AMSTAR tool. We used standardised language to summarise results within and across reviews; and gave bottom-line statements about intervention effectiveness. Two review authors screened and selected reviews, and extracted and analysed data. We used a taxonomy of interventions to categorise reviews and guide syntheses. MAIN RESULTS We included 75 systematic reviews of varied methodological quality. Reviews assessed interventions with diverse aims including support for behaviour change, risk minimisation and skills acquisition. No reviews aimed to promote systems-level consumer participation in medicines-related activities. Medicines adherence was the most frequently-reported outcome, but others such as knowledge, clinical and service-use outcomes were also reported. Adverse events were less commonly identified, while those associated with the interventions themselves, or costs, were rarely reported.Looking across reviews, for most outcomes, medicines self-monitoring and self-management programmes appear generally effective to improve medicines use, adherence, adverse events and clinical outcomes; and to reduce mortality in people self-managing antithrombotic therapy. However, some participants were unable to complete these interventions, suggesting they may not be suitable for everyone.Other promising interventions to improve adherence and other key medicines-use outcomes, which require further investigation to be more certain of their effects, include:· simplified dosing regimens: with positive effects on adherence;· interventions involving pharmacists in medicines management, such as medicines reviews (with positive effects on adherence and use, medicines problems and clinical outcomes) and pharmaceutical care services (consultation between pharmacist and patient to resolve medicines problems, develop a care plan and provide follow-up; with positive effects on adherence and knowledge).Several other strategies showed some positive effects, particularly relating to adherence, and other outcomes, but their effects were less consistent overall and so need further study. These included:· delayed antibiotic prescriptions: effective to decrease antibiotic use but with mixed effects on clinical outcomes, adverse effects and satisfaction;· practical strategies like reminders, cues and/or organisers, reminder packaging and material incentives: with positive, although somewhat mixed effects on adherence;· education delivered with self-management skills training, counselling, support, training or enhanced follow-up; information and counselling delivered together; or education/information as part of pharmacist-delivered packages of care: with positive effects on adherence, medicines use, clinical outcomes and knowledge, but with mixed effects in some studies;· financial incentives: with positive, but mixed, effects on adherence.Several strategies also showed promise in promoting immunisation uptake, but require further study to be more certain of their effects. These included organisational interventions; reminders and recall; financial incentives; home visits; free vaccination; lay health worker interventions; and facilitators working with physicians to promote immunisation uptake. Education and/or information strategies also showed some positive but even less consistent effects on immunisation uptake, and need further assessment of effectiveness and investigation of heterogeneity.There are many different potential pathways through which consumers' use of medicines could be targeted to improve outcomes, and simple interventions may be as effective as complex strategies. However, no single intervention assessed was effective to improve all medicines-use outcomes across all diseases, medicines, populations or settings.Even where interventions showed promise, the assembled evidence often only provided part of the picture: for example, simplified dosing regimens seem effective for improving adherence, but there is not yet sufficient information to identify an optimal regimen.In some instances interventions appear ineffective: for example, the evidence suggests that directly observed therapy may be generally ineffective for improving treatment completion, adherence or clinical outcomes.In other cases, interventions may have variable effects across outcomes. As an example, strategies providing information or education as single interventions appear ineffective to improve medicines adherence or clinical outcomes, but may be effective to improve knowledge; an important outcome for promoting consumers' informed medicines choices.Despite a doubling in the number of reviews included in this updated overview, uncertainty still exists about the effectiveness of many interventions, and the evidence on what works remains sparse for several populations, including children and young people, carers, and people with multimorbidity. AUTHORS' CONCLUSIONS This overview presents evidence from 75 reviews that have synthesised trials and other studies evaluating the effects of interventions to improve consumers' medicines use.Systematically assembling the evidence across reviews allows identification of effective or promising interventions to improve consumers' medicines use, as well as those for which the evidence indicates ineffectiveness or uncertainty.Decision makers faced with implementing interventions to improve consumers' medicines use can use this overview to inform decisions about which interventions may be most promising to improve particular outcomes. The intervention taxonomy may also assist people to consider the strategies available in relation to specific purposes, for example, gaining skills or being involved in decision making. Researchers and funders can use this overview to identify where more research is needed and assess its priority. The limitations of the available literature due to the lack of evidence for important outcomes and important populations, such as people with multimorbidity, should also be considered in practice and policy decisions.
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Affiliation(s)
- Rebecca Ryan
- Centre for Health Communication and Participation, School of Public Health and Human Biosciences, La Trobe University, Bundoora, VIC, Australia, 3086
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Bao Y, Kong X, Yang L, Liu R, Shi Z, Li W, Hua B, Hou W. Complementary and alternative medicine for cancer pain: an overview of systematic reviews. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:170396. [PMID: 24817897 PMCID: PMC4003746 DOI: 10.1155/2014/170396] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 02/25/2014] [Accepted: 03/07/2014] [Indexed: 12/22/2022]
Abstract
Background and Objective. Now with more and more published systematic reviews of Complementary and Alternative Medicine (CAM) on adult cancer pain, it is necessary to use the methods of overview of systematic review to summarize available evidence, appraise the evidence level, and give suggestions to future research and practice. Methods. A comprehensive search (the Cochrane Library, PubMed, Embase, and ISI Web of Knowledge) was conducted to identify all systematic reviews or meta-analyses of CAM on adult cancer pain. And the evidence levels were evaluated using GRADE approach. Results. 27 systematic reviews were included. Based on available evidence, we could find that psychoeducational interventions, music interventions, acupuncture plus drug therapy, Chinese herbal medicine plus cancer therapy, compound kushen injection, reflexology, lycopene, TENS, qigong, cupping, cannabis, Reiki, homeopathy (Traumeel), and creative arts therapies might have beneficial effects on adult cancer pain. No benefits were found for acupuncture (versus drug therapy or shame acupuncture), and the results were inconsistent for massage therapy, transcutaneous electric nerve stimulation (TENS), and Viscum album L plus cancer treatment. However, the evidence levels for these interventions were low or moderate due to high risk of bias and/or small sample size of primary studies. Conclusion. CAM may be beneficial for alleviating cancer pain, but the evidence levels were found to be low or moderate. Future large and rigor randomized controlled studies are needed to confirm the benefits of CAM on adult cancer pain.
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Affiliation(s)
- Yanju Bao
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing 100053, China
| | - Xiangying Kong
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Nanxiaojie, Dongzhimennei Avenue, Beijing 100700, China
| | - Liping Yang
- Department of Nephrology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing 100053, China
| | - Rui Liu
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing 100053, China
| | - Zhan Shi
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing 100053, China
| | - Weidong Li
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing 100053, China
| | - Baojin Hua
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing 100053, China
| | - Wei Hou
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing 100053, China
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Does a regional comprehensive palliative care program improve pain in outpatient cancer patients? Support Care Cancer 2014; 22:2445-55. [PMID: 24705857 DOI: 10.1007/s00520-014-2232-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
CONTEXT Pain is still a major problem for cancer patients, and the effect of a population-based approach on patients' experience of pain is not fully understood. AIMS The primary aim of this study was to clarify the changes in pain intensity in outpatients before and after a regional palliative care program. The secondary aim was to clarify the prevalence of patients who had unmet needs for pain treatment and to clarify the reasons for not wanting pain treatment. SUBJECTS AND METHODS A regional palliative care program was implemented in four regions of Japan. A region-representative sample of metastatic/locally advanced cancer patients in outpatient settings took part in questionnaire surveys before and after the regional intervention. Responses were obtained from 859 from 1,880 and 857 from 2,123 in the preintervention and postintervention surveys, respectively. RESULTS After a regional palliative care program, neither worst, average, nor least pain levels in outpatients changed significantly. A total of 134 patients (16 %) reported that they needed more pain treatment. There were various reasons for not wanting pain treatment, namely, minimum interference with daily life, general nonpreference for medicines, longstanding symptoms before the diagnosis of cancer, concerns about tolerance and addiction, and experienced neuropsychiatric symptoms under current medications. CONCLUSION The regional palliative care program failed to demonstrate improvement of the pain intensity of cancer outpatients. One possible interpretation is that they are less likely to be regarded as target populations and that the study population experienced generally well-controlled pain. Future study including patients with more severe pain is needed, but to improve pain levels of cancer outpatients, intensive, patient-directed intervention seems to be more promising than region-based intervention.
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Abstract
Pain is the most feared symptom of cancer. New oncological cancer treatments are improving survival, but advanced cancer presents challenges that have not been seen before, often with pain that is very difficult to manage because of a recurrent tumour that is invading the central nervous system. In some of the older interventional techniques of destroying nerve pathways, expertise has diminished or has been deemed unnecessary with the development of specialist palliative care. Not all pain is managed adequately with the analgesic ladder. Knowledge of pain mechanisms, careful assessment and selection of the right technique at the right time will enhance cancer pain management. New techniques include intrathecal drug therapy, vertebroplasty, cordotomy, ultra-sound guided nerve blocks, neuromodulation and advances in drug therapies.
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Affiliation(s)
- James Wilson
- Department of AnaestheticsSt George's Hospital, Blackshaw Road, Tooting, London SW17 0QTUK
| | - Catherine Stack
- Department of AnaestheticsKing's College Hospital, Denmark Hill, London SE5 9RSUK
| | - Joan Hester
- Department of AnaestheticsKing's College Hospital, Denmark Hill, London SE5 9RSUK
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128
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Improvement of pain-related self-management for cancer patients through a modular transitional nursing intervention: a cluster-randomized multicenter trial. Pain 2014; 155:746-754. [PMID: 24434732 DOI: 10.1016/j.pain.2014.01.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 12/10/2013] [Accepted: 01/10/2014] [Indexed: 11/23/2022]
Abstract
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 > or = 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.
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129
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Ospina MB, Taenzer P, Rashiq S, MacDermid JC, Carr E, Chojecki D, Harstall C, Henry JL. A systematic review of the effectiveness of knowledge translation interventions for chronic noncancer pain management. Pain Res Manag 2013; 18:e129-41. [PMID: 24308029 PMCID: PMC3917804 DOI: 10.1155/2013/120784] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Reliable evidence detailing effective treatments and management practices for chronic noncancer pain exists. However, little is known about which knowledge translation (KT) interventions lead to the uptake of this evidence in practice. OBJECTIVES To conduct a systematic review of the effectiveness of KT interventions for chronic noncancer pain management. METHODS Comprehensive searches of electronic databases, the gray literature and manual searches of journals were undertaken. Randomized controlled trials, controlled clinical trials and controlled before-and-after studies of KT interventions were included. Data regarding interventions and primary outcomes were categorized using a standard taxonomy; a risk-of-bias approach was adopted for study quality. A narrative synthesis of study results was conducted. RESULTS More than 8500 titles and abstracts were screened, with 230 full-text articles reviewed for eligibility. Nineteen studies were included, of which only a small proportion were judged to be at low risk of bias. Interactive KT education for health care providers has a positive effect on patients' function, but its benefits for other health provider- and patient-related outcomes are inconsistent. Interactive education for patients leads to improvements in knowledge and function. Little research evidence supports the effectiveness of structural changes in health systems and quality improvement processes or coordination of care. CONCLUSIONS KT interventions incorporating interactive education in chronic noncancer pain led to positive effects on patients' function and knowledge about pain. Future studies should provide implementation details and use consistent theoretical frameworks to better estimate the effectiveness of such interventions.
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Affiliation(s)
| | - Paul Taenzer
- Departments of Psychiatry, Medicine and Oncology, Faculty of Medicine, University of Calgary, Calgary
| | - Saifee Rashiq
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta
| | - Joy C MacDermid
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario
| | - Eloise Carr
- Faculty of Nursing, University of Calgary, Calgary, Alberta
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130
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Baker TA, O'Connor ML, Krok JL. Experience and knowledge of pain management in patients receiving outpatient cancer treatment: what do older adults really know about their cancer pain? PAIN MEDICINE 2013; 15:52-60. [PMID: 24118873 DOI: 10.1111/pme.12244] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE An individual's ability to effectively manage their cancer pain is influenced by knowledge and perceptions regarding the pain experience. While significance of the physician's knowledge of cancer pain management has been reported, much less is known how a patient's knowledge may influence their ability to optimally manage their pain. The purpose of this study is to determine the influence health and social factors have on the knowledge and experience of cancer pain among older adults. DESIGN A prospective cross-sectional study of older Black and White patients presenting for outpatient cancer treatment. METHODS Participants were surveyed on questions assessing pain severity, knowledge and experience of pain, self-efficacy for pain treatment, satisfaction with pain treatment, and additional social, health, and demographic characteristics. A series of hierarchical regression models were specified to examine predictors of cancer pain knowledge and experience. RESULTS Education, race, and trust were significant predictors of pain knowledge, whereas self-efficacy for pain, pain interference, and pain severity were indicators of the experience of cancer pain. CONCLUSIONS Knowledge and experience of (cancer) pain are contingent upon a myriad of social and clinical factors that are not exclusive but rather coexisting determinants of health. Understanding older adults' knowledge of pain may begin to diminish the imparities in the diagnosis and treatment of pain among this growing diverse population of older adults. It may similarly allow for programs to be tailored to fit the specific needs of the patient in the treatment and management of their cancer pain.
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Affiliation(s)
- Tamara A Baker
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
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131
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Marie N, Luckett T, Davidson PM, Lovell M, Lal S. Optimal patient education for cancer pain: a systematic review and theory-based meta-analysis. Support Care Cancer 2013; 21:3529-37. [PMID: 24085650 DOI: 10.1007/s00520-013-1995-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 09/22/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Previous systematic reviews have found patient education to be moderately efficacious in decreasing the intensity of cancer pain, but variation in results warrants analysis aimed at identifying which strategies are optimal. METHODS A systematic review and meta-analysis was undertaken using a theory-based approach to classifying and comparing educational interventions for cancer pain. The reference lists of previous reviews and MEDLINE, PsycINFO, and CENTRAL were searched in May 2012. Studies had to be published in a peer-reviewed English language journal and compare the effect on cancer pain intensity of education with usual care. Meta-analyses used standardized effect sizes (ES) and a random effects model. Subgroup analyses compared intervention components categorized using the Michie et al. (Implement Sci 6:42, 2011) capability, opportunity, and motivation behavior (COM-B) model. RESULTS Fifteen randomized controlled trials met the criteria. As expected, meta-analysis identified a small-moderate ES favoring education versus usual care (ES, 0.27 [-0.47, -0.07]; P = 0.007) with substantial heterogeneity (I² = 71 %). Subgroup analyses based on the taxonomy found that interventions using "enablement" were efficacious (ES, 0.35 [-0.63, -0.08]; P = 0.01), whereas those lacking this component were not (ES, 0.18 [-0.46, 0.10]; P = 0.20). However, the subgroup effect was nonsignificant (P = 0.39), and heterogeneity was not reduced. Factoring in the variable of individualized versus non-individualized influenced neither efficacy nor heterogeneity. CONCLUSIONS The current meta-analysis follows a trend in using theory to understand the mechanisms of complex interventions. We suggest that future efforts focus on interventions that target patient self-efficacy. Authors are encouraged to report comprehensive details of interventions and methods to inform synthesis, replication, and refinement.
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Affiliation(s)
- N Marie
- School of Medical and Molecular Biosciences, University of Technology Sydney, Ultimo, Australia,
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132
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Wang Y, Huang H, Zeng Y, Wu J, Wang R, Ren B, Xu F. Pharmacist-led medication education in cancer pain control: A multicentre randomized controlled study in Guangzhou, China. J Int Med Res 2013; 41:1462-72. [PMID: 23975860 DOI: 10.1177/0300060513491170] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate clinical pharmacist-led pain-medication education in patients with cancer. Methods A controlled study was conducted prospectively at six tertiary hospitals in China. In-patients with cancer were randomized to receive conventional treatment plus medication education or no education (controls). Education consisted of access to information booklets and eight 30-min face-to-face counselling sessions given by clinical pharmacists over 4 weeks. Patients completed pain- and analgesic-knowledge assessments and a Brief Pain Inventory, pre- and post-study. Results A total of 123 and 114 patients in the education and control groups, respectively, completed follow-up. At the end of the study, patient knowledge regarding cancer pain and pain control was significantly increased in both groups; pain and analgesic knowledge scores were significantly higher in the education group compared with controls. In the control group, the increase in total pain-related knowledge was significantly greater in analgesic-naïve patients compared with those who were using/had used analgesics. Pain intensity scores and pain interference of daily activities were significantly reduced in the education group compared with controls. Conclusions Clinical pharmacist-led medication education resulted in improved pain control in patients with cancer.
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Affiliation(s)
- Yan Wang
- Department of Pharmacy, Sixth People’s Hospital South Campus, Shanghai Jiaotong University, Shanghai, China
- Department of Pharmacy, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hongbing Huang
- Department of Pharmacy, Sun Yat-sen University Cancer Centre, Guangzhou, China
| | - Yingtong Zeng
- Department of Pharmacy, Guangdong General Hospital, Guangzhou, China
| | - Junyan Wu
- Department of Pharmacy, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruolun Wang
- Department of Pharmacy, Second Affiliated Hospital, Guangzhou Medical College, Guangzhou, China
| | - Bin Ren
- Department of Pharmacy, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Feng Xu
- Department of Pharmacy, Sixth People’s Hospital South Campus, Shanghai Jiaotong University, Shanghai, China
- Department of Pharmacy, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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133
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Luckett T, Davidson PM, Green A, Boyle F, Stubbs J, Lovell M. Assessment and management of adult cancer pain: a systematic review and synthesis of recent qualitative studies aimed at developing insights for managing barriers and optimizing facilitators within a comprehensive framework of patient care. J Pain Symptom Manage 2013; 46:229-53. [PMID: 23159681 DOI: 10.1016/j.jpainsymman.2012.07.021] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 07/23/2012] [Accepted: 07/28/2012] [Indexed: 11/26/2022]
Abstract
CONTEXT Cancer pain is a common, burdensome problem, which is not well managed despite evidence-based guidelines. OBJECTIVES To develop insights for managing barriers and optimizing facilitators to adult cancer pain assessment and management within a comprehensive framework of patient care. METHODS We undertook a systematic review and synthesis of qualitative studies. Medline, PsycINFO, Embase, AMED, CINAHL, and Sociological Abstracts were searched from May 20 to 26, 2011. To be included, the articles had to be published in a peer-reviewed journal since 2000; written in English; and report original qualitative studies on the perspectives of patients, their significant others, or health care providers. Article quality was rated using the checklist of Kitto et al. Thematic synthesis followed a three-stage approach using Evidence for Policy and Practice Information and Co-ordinating Centre-Reviewer 4 software: 1) free line-by-line coding of "Results," 2) organization into "descriptive" themes, and 3) development of "analytical" themes informative to our objective. At Stage 3, a conceptual framework was selected from the peer-reviewed literature according to prima facie "fit" for descriptive themes. RESULTS Of 659 articles screened, 70 met the criteria, reporting 65 studies with 48 patient, 19 caregiver, and 21 health care provider samples. Authors rarely reported reflexivity or negative cases. Mead and Bower's model of patient-centered care accommodated 85% of the descriptive themes; 12% more related to the caregiver and service/system factors. Three themes could not be accommodated. CONCLUSION Findings highlight the need to integrate patient/family education within improved communication, individualize care, use more nonpharmacological strategies, empower patients/families to self-manage pain, and reorganize multidisciplinary roles around patient-centered care and outcomes. These conclusions require validation via consensus and intervention trials.
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Affiliation(s)
- Tim Luckett
- Improving Palliative Care through Clinical Trials, New South Wales Palliative Care Clinical Trials Collaborative, Sydney, NSW 2007, Australia.
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134
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Nkhoma K, Seymour J, Arthur A. An educational intervention to reduce pain and improve pain management for Malawian people living with HIV/AIDS and their family carers: study protocol for a randomised controlled trial. Trials 2013; 14:216. [PMID: 23849502 PMCID: PMC3717041 DOI: 10.1186/1745-6215-14-216] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 07/03/2013] [Indexed: 11/29/2022] Open
Abstract
Background Many HIV/AIDS patients experience pain often due to advanced HIV/AIDS infection and side effects of treatment. In sub-Saharan Africa, pain management for people with HIV/AIDS is suboptimal. With survival extended as a direct consequence of improved access to antiretroviral therapy, the prevalence of HIV/AIDS related pain is increasing. As most care is provided at home, the management of pain requires patient and family involvement. Pain education is an important aspect in the management of pain in HIV/AIDS patients. Studies of the effectiveness of pain education interventions for people with HIV/AIDS have been conducted almost exclusively in western countries. Methods/design A randomised controlled trial is being conducted at the HIV and palliative care clinics of two public hospitals in Malawi. To be eligible, patient participants must have a diagnosis of HIV/AIDS (stage III or IV). Carer participants must be the individual most involved in the patient’s unpaid care. Eligible participants are randomised to either: (1) a 30-minute face-to-face educational intervention covering pain assessment and management, augmented by a leaflet and follow-up telephone call at two weeks; or (2) usual care. Those allocated to the usual care group receive the educational intervention after follow-up assessments have been conducted (wait-list control group). The primary outcome is pain severity measured by the Brief Pain Inventory. Secondary outcomes are pain interference, patient knowledge of pain management, patient quality of life, carer knowledge of pain management, caregiver motivation and carer quality of life. Follow-up assessments are conducted eight weeks after randomisation by palliative care nurses blind to allocation. Discussion This randomised controlled trial conducted in sub-Saharan Africa among people living with HIV/AIDS and their carers will assess whether a pain education intervention is effective in reducing pain and improving pain management, quality of life and carer motivation. Trial registration Current Controlled Trials ISRCTN72861423.
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Affiliation(s)
- Kennedy Nkhoma
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
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135
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Nobis HG, Pielsticker A. Ärztliche Edukation und Kommunikation in der primären Schmerzbehandlung. Schmerz 2013; 27:317-24. [DOI: 10.1007/s00482-012-1289-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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137
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Jho HJ, Myung SK, Chang YJ, Kim DH, Ko DH. Efficacy of pain education in cancer patients: a meta-analysis of randomized controlled trials. Support Care Cancer 2013; 21:1963-71. [PMID: 23430013 DOI: 10.1007/s00520-013-1756-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 02/04/2013] [Indexed: 01/13/2023]
Abstract
PURPOSE Patient education has been considered as one of the important strategies to improve cancer pain control. However, randomized controlled trials (RCTs) have reported inconsistent findings on this issue. This study aims to evaluate the overall efficacy of pain education on improving pain management in cancer patients by using a meta-analysis of RCTs. METHODS We searched PubMed, EMBASE, and the Cochrane Library in February 2012. Two evaluators independently reviewed and selected trials based on the predetermined selection criteria. Out of 213 articles meeting initial criteria, 12 RCTs involving 2,169 participants (1,069 intervention group and 1,100 control group), were included in the final analysis. RESULTS In the meta-analysis of all 12 RCTs, compared with the control group, the intervention group showed a small significant lower pain intensity (standardized mean difference [SMD], -0.11; 95 % confidence interval [CI], -0.20 to -0.02). In the subgroup meta-analysis by various factors, a beneficial effect of pain education was observed for patients with an estimated prognosis of at least 3 months, a follow-up within 2 weeks after pain education, multiple sessions, measured worst pain, tailored education, general pain management, education by medical staff, and usual care for a control group. However, in the subgroup meta-analyses of trials using attention control as a control group and high-quality trials, there was no significant effect of pain education. CONCLUSIONS Further large, high-quality RCTs using a placebo control such as attention control are required to investigate whether pain education has a true efficacy on pain control or is a placebo effect.
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Affiliation(s)
- Hyun Jung Jho
- Department of Family Medicine, Hospital, National Cancer Center, Goyang, South Korea
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138
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Martinez KA, Aslakson RA, Wilson RF, Apostol CC, Fawole OA, Lau BD, Vollenweider D, Bass EB, Dy SM. A systematic review of health care interventions for pain in patients with advanced cancer. Am J Hosp Palliat Care 2013; 31:79-86. [PMID: 23408371 DOI: 10.1177/1049909113476129] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Poorly controlled pain is common in advanced cancer. The objective of this article was to synthesize the evidence on the effectiveness of pain-focused interventions in this population. METHODS We searched MEDLINE, CINAHL, PsycINFO, Cochrane, and DARE from 2000 through December 2011. We included prospective, controlled health care intervention studies in advanced cancer populations, focusing on pain. RESULTS Nineteen studies met the inclusion criteria; most focused on nurse-led patient-centered interventions. In all, 9 (47%) of the 19 studies found a significant effect on pain. The most common intervention type was patient/caregiver education, in 17 (89%) of 19 studies, 7 of which demonstrated a significant decrease in pain. CONCLUSIONS We found moderate strength of evidence that pain in advanced cancer can be improved using health care interventions, particularly nurse-led patient-centered interventions.
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Affiliation(s)
- Kathryn A Martinez
- 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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139
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Kim HS, Shin SJ, Kim SC, An S, Rha SY, Ahn JB, Cho BC, Choi HJ, Sohn JH, Kim HS, Chung HC, Kim JH, Roh JK, Lee S. Randomized controlled trial of standardized education and telemonitoring for pain in outpatients with advanced solid tumors. Support Care Cancer 2013; 21:1751-9. [PMID: 23338230 PMCID: PMC3641298 DOI: 10.1007/s00520-013-1722-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 01/09/2013] [Indexed: 12/04/2022]
Abstract
Purpose Previous studies have not defined the role of telemonitoring with educational tools in outpatients with advanced cancers. We tested the effectiveness of standardized education and telemonitoring for improving pain, distress, anxiety, depression, quality of life (QoL), and performance in outpatients with advanced cancers. Methods A total of 108 patients were randomly assigned to receive pain education alone (control arm) or pain education plus telemonitoring (experimental arm). Nursing specialists provided video-assisted educational material in both arms and daily telemonitoring for the first week in the experimental arm. Assessment was performed at baseline and 1 week and included evaluations of pain (Brief Pain Inventory, BPI), distress (Distress Thermometer, DT), anxiety, and depression (Hospital Anxiety and Depression Scale, HADS), QoL (QLQ-C30), and a Karnofsky score. Results Overall (n = 108), pain intensity was significantly improved at 1 week, including worst pain (7.3 to 5.7, P < 0.01) and average pain (4.6 to 3.8, P < 0.01). Additionally, anxiety (HADS score ≥ 11, 75 % to 56 %, P < 0.01), depression (HADS score ≥ 11, 73 % to 51 %, P < 0.01), QoL (fatigue and insomnia), and the Karnofsky score (32 to 66, P < 0.01) were also significantly improved at 1 week. However, the level of distress did not improve. The telemonitoring plus standardized education group showed more significant improvement in portion of pain >4 on VAS scale (35 % vs. 19 %, P = 0.02). Conclusions Standardized pain education using nursing specialists is an efficient way to improve not only pain itself but also anxiety, depression, performance, and QoL. The addition of telemonitoring helps to improve pain management in the outpatient setting.
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Affiliation(s)
- Han Sang Kim
- Yonsei Cancer Center, Division of Medical Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Luckett T, Davidson PM, Boyle F, Liauw W, Agar M, Green A, Lovell M. Australian survey of current practice and guideline use in adult cancer pain assessment and management: perspectives of oncologists. Asia Pac J Clin Oncol 2012; 10:e99-107. [PMID: 23253101 DOI: 10.1111/ajco.12040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2012] [Indexed: 12/01/2022]
Abstract
AIMS Cancer pain continues to be undertreated in up to half of cases, despite the availability of evidence-based guidelines. This study aimed to: (i) identify barriers and facilitators to adult cancer pain assessment and management, as perceived by Australian health professionals; (ii) establish the perceived need for new Australian guidelines and implementation strategy; (iii) identify which guidelines are used; (iv) identify barriers and facilitators to guideline use. This article focuses on the perceptions of responding oncologists. METHODS A cross-sectional survey was administered online. Invitations were circulated via peak bodies and clinical leaders. Comments were coded independently by two researchers. RESULTS In all 76 oncologists self-reported high concordance with evidence-based recommendations, except validated pain scales. Perceived barriers to pain management included insufficient non-pharmacological interventions, access to /coordination between services, and time. Only 22 percent of respondents reported using pain guidelines. Perceived barriers to guideline use included lack of access, awareness and any single standard. Respondents were generally supportive of new Australian guidelines and especially an implementation strategy. CONCLUSION Barriers to evidence-based practice and guideline use identified by our survey might be addressed via a clinical pathway that gives step-by-step guidance on evidence-based practice along with a framework for evaluation. Particular attention should be paid to promoting use of validated scales, patient education and non-pharmacological interventions, training of an appropriately skilled workforce and improving care coordination. Challenges are discussed.
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Affiliation(s)
- Tim Luckett
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Morris LD, Grimmer-Somers KA, Louw QA, Sullivan MJ. Cross-cultural adaptation and validation of the South African Pain Catastrophizing Scale (SA-PCS) among patients with fibromyalgia. Health Qual Life Outcomes 2012; 10:137. [PMID: 23173637 PMCID: PMC3548716 DOI: 10.1186/1477-7525-10-137] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 11/09/2012] [Indexed: 01/03/2023] Open
Abstract
Background Pain catastrophization has recently been recognized as a barrier to the healthy development of physical functioning among chronic pain patients. Levels of pain catastrophization in chronic pain patients are commonly measured using the Pain Catastrophizing Scale (PCS). Objective To cross-culturally adapt and validate the South African PCS (SA-PCS) among English-, Afrikaans- and Xhosa-speaking patients with fibromyalgia living in the Cape Metropole area, Western Cape, South Africa. Methods The original PCS was cross-culturally adapted in accordance with international standards to develop an English, Afrikaans and Xhosa version of the SA-PCS using a repeated measures study design. Psychometric testing included face/content validity, internal consistency (Cronbach’s alpha-α), test-retest reliability (intraclass coefficient correlations-ICC), sensitivity-to-change and cross-sectional convergent validity (by comparing the adapted SA-PCS to related constructs). Results The cross-culturally adapted English, Afrikaans and Xhosa SA-PCS showed good face and content validity, excellent internal consistency (with Chronbach’s α = 0.98, 0.98 and 0.97 for the English, Afrikaans and Xhosa SA-PCS, as a whole, respectively), excellent test-retest reliability (with ICC’s of 0.90, 0.91 and 0.89 for the English, Afrikaans and Xhosa SA-PCS, respectively); as well as satisfactory sensitivity-to-change (with a minimum detectable change of 8.8, 9.0 and 9.3 for the English, Afrikaans and Xhosa SA-PCS, respectively) and cross-sectional convergent validity (when compared to pain severity as well as South African versions of the Tampa scale for Kinesiophobia and the revised Fibromyalgia Impact Questionnaire). Conclusion The SA-PCS can therefore be recommended as simple, efficient, valid and reliable tool which shows satisfactory sensitivity-to-change and cross-sectional convergent validity, for use among English, Afrikaans and Xhosa-speaking patients with fibromyalgia attending the public health sector in the Western Cape area of South Africa.
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Affiliation(s)
- Linzette D Morris
- Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Faculty of Medical and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
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142
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Abstract
Pain is prevalent, burdensome, and undertreated in individuals with cancer across the disease trajectory. Providing patients and family caregivers with psychosocial support and education to manage cancer pain is a core component of quality care that can result in significant clinical benefit. In this review, we: (1) outline an approach for developing and assessing the effectiveness of education programs for adults with cancer pain; (2) discuss considerations for tailoring programs to the needs of diverse populations and those with limited health literacy skills; (3) describe the resource needs and costs of developing a program; (4) highlight innovative approaches to cancer pain education. We conclude with recommendations for future research and the next generation of educational interventions.
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143
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Wells NL, Sandlin V. Expectations of pain and accompanying symptoms during cancer treatment. Curr Pain Headache Rep 2012; 16:292-9. [PMID: 22580764 DOI: 10.1007/s11916-012-0272-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Patients' experience of cancer pain varies throughout the course of the disease. It is important to recognize that patients may experience more than one type of pain, and pain often occurs in the presence of other symptoms. Controlling pain requires a multi-faceted approach to assessing and treating the underlying mechanisms. This article reviews the pain mechanisms responsible for pain during cancer treatment and how expectations of pain and associated symptoms contribute to the pain experience.
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Affiliation(s)
- Nancy L Wells
- Vanderbilt University Medical Center, Nashville, TN 37232-2424, USA.
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144
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Savage I, Blenkinsopp A, Closs SJ, Bennett MI. 'Like doing a jigsaw with half the parts missing': community pharmacists and the management of cancer pain in the community. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2012; 21:151-60. [PMID: 23418926 DOI: 10.1111/j.2042-7174.2012.00245.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 06/17/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim was to explore and describe community pharmacists' current and potential place in the cancer pain pathway. Objectives were to describe pharmacists' role in advising patients and their carers on optimum use of opioid drugs for pain relief, identify elements of medicines management that could be modified and identify opportunities for improved communication with patients and other professionals. METHODS Semi-structured interviews were conducted with 25 community pharmacists in three areas of England. Data were analysed using the Framework method. KEY FINDINGS Pharmacists had no reliable method to identify patients with cancer and no access to disease stage and treatment plan information. There was little evidence of any routine communication with other professionals about patient care. Contact with patients was limited. Access to palliative care medicines could be problematic for patients and medicines use reviews (MURs) were rarely done. Interview data suggested variable levels of knowledge about optimal opioid use in cancer pain or awareness of patients' priorities. For some pharmacists, proactive involvement appeared to be inhibited by fear of discussing emotional and wider social aspects and accounts showed that a wide range of issues and concerns were raised by family members, indicating considerable unmet need. Pharmacists tended to assume information had already been provided by others and felt isolated from other care team members. Many felt that their potential contribution to cancer pain management was constrained but aspired to do more. CONCLUSIONS There is significant scope for improving access to and interaction with, community pharmacists by people with cancer pain and their families. Finding ways to embed pharmacists within palliative care teams could provide a starting point for a greater contribution to cancer pain management.
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Affiliation(s)
- Imogen Savage
- School of Pharmacy, University of London, London, UK
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145
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Koller A, Miaskowski C, De Geest S, Opitz O, Spichiger E. Results of a randomized controlled pilot study of a self-management intervention for cancer pain. Eur J Oncol Nurs 2012; 17:284-91. [PMID: 22959603 DOI: 10.1016/j.ejon.2012.08.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 07/31/2012] [Accepted: 08/03/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE OF THE RESEARCH This paper reports findings from a randomized controlled pilot study evaluating the PRO-SELF Plus Pain Control Program, a U.S.-developed cancer pain self-management intervention, regarding feasibility and effect sizes in a German patient sample. METHODS AND SAMPLE Thirty-nine German oncology outpatients were randomized to intervention (n = 19) and control (n = 20) groups. The intervention group received the PRO-SELF Plus Pain Control Program in 6 visits and 4 phone calls a 10-week period. The control group received standard education and care. The intervention employed three key strategies: information provision, skills building, and nurse coaching. Primary outcomes were changes in average and worst pain intensity. Secondary outcomes included changes in pain-related knowledge, opioid intake, and self-efficacy. Data were collected at enrollment, then at 6, 10, 14, and 22 weeks. KEY RESULTS The group-by-time effect showed a statistically significant increase in knowledge (week 10: p = 0.04; week 22: p < 0.01). Despite slight reductions in average and worst pain, no statistically significant changes were found for pain, opioid intake, or self-efficacy. CONCLUSIONS This study is the first to evaluate and demonstrate the feasibility of a U.S.-developed cancer pain self-management intervention in a German patient population. Pain self-management related knowledge improved significantly and effect sizes for pain reduction were determined. Findings from this pilot RCT provide the basis for planning a larger RCT. CLINICAL TRIAL REGISTRATION NUMBER NCT00920504.
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Affiliation(s)
- Antje Koller
- Institute of Nursing Science, Faculty of Medicine, University of Basel, Switzerland
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146
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Rustøen T, Valeberg BT, Kolstad E, Wist E, Paul S, Miaskowski C. The PRO-SELF(©) Pain Control Program improves patients' knowledge of cancer pain management. J Pain Symptom Manage 2012; 44:321-30. [PMID: 22704056 DOI: 10.1016/j.jpainsymman.2011.09.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 09/13/2011] [Accepted: 09/14/2011] [Indexed: 11/17/2022]
Abstract
CONTEXT Inadequate knowledge is one barrier to effective cancer pain management. OBJECTIVES This study's aim was to evaluate the effects of a psychoeducational intervention (the Norwegian version of the PRO-SELF(©) Pain Control Program) compared with a control group in increasing patients' knowledge of cancer pain management. METHODS Adult oncology outpatients with pain from bone metastasis of 2.5 or greater on a 0 to 10 numeric rating scale were randomized into the PRO-SELF (n=87) or control (n=92) groups. Patients completed a demographic questionnaire and the Pain Experience Scale (PES) at the beginning and end of the study to assess their knowledge and attitudes. The six-week intervention consisted of education, skills building, and nurse coaching. Mixed-model analyses with tests of a group×time interaction were done for each of the individual items and total PES scores to evaluate between-group differences in changes in knowledge over time. RESULTS Except for functional status, no differences were found between the PRO-SELF and control groups on any baseline demographic, clinical, or pain characteristics. Significant group×time interactions were found for all the single item and total PES scores. Compared with the control group, patients in the PRO-SELF group had significant increases in knowledge scores. CONCLUSION The use of a knowledge and attitude survey, like the PES, as part of a psychoeducational intervention provides an effective foundation for patient education in cancer pain management. This individualized approach to education about pain management may save staff time and improve patient outcomes.
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Affiliation(s)
- Tone Rustøen
- Department of Research and Development, Oslo University Hospital, Ullevål, Oslo, Norway.
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147
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Koller A, Miaskowski C, De Geest S, Opitz O, Spichiger E. A systematic evaluation of content, structure, and efficacy of interventions to improve patients' self-management of cancer pain. J Pain Symptom Manage 2012; 44:264-84. [PMID: 22871509 DOI: 10.1016/j.jpainsymman.2011.08.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 08/05/2011] [Accepted: 09/01/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT 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. OBJECTIVES 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. METHODS 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). RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Antje Koller
- Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland
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148
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Gardiner C, Gott M, Ingleton C, Hughes P, Winslow M, Bennett MI. Attitudes of health care professionals to opioid prescribing in end-of-life care: a qualitative focus group study. J Pain Symptom Manage 2012; 44:206-14. [PMID: 22672918 DOI: 10.1016/j.jpainsymman.2011.09.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 09/02/2011] [Accepted: 09/05/2011] [Indexed: 11/27/2022]
Abstract
CONTEXT Opioid therapy is central to the management of pain in the field of generalist palliative and end-of-life care, and international guidelines highlight the need for opioids to be used as part of a comprehensive strategy to treat pain. However, evidence suggests that the use of opioids in palliative care is suboptimal, and many patients do not receive adequate pain control at the end of life. OBJECTIVES This study aimed to explore the attitudes of health care professionals to opioid prescribing in generalist end-of-life care. METHODS Thirty-one health and allied health professionals participated in four focus groups. Two focus groups took place in general practitioner practices and two in hospices. RESULTS Findings revealed that significant barriers exist to the appropriate use of opioids in end-of-life care. Particular barriers exist for professionals working in primary care and include concerns about giving high doses and having insufficient training in opioid use. Working partnerships between specialist and generalist palliative care providers are important for increasing generalist confidence in prescribing. Patients and their families often have concerns about initiating opioids, and specialist nursing staff are crucial to managing and alleviating these concerns. CONCLUSION Significant barriers exist to the appropriate use of opioids in end-of-life care. If international priorities on improving pain management at the end of life are to be achieved, educational opportunities for generalists need to be enhanced, and effective interprofessional working models need to be developed so that pain management for patients at the end of life is optimized.
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Affiliation(s)
- Clare Gardiner
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
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149
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Laufenberg-Feldmann R, Schwab R, Rolke R, Weber M. [Cancer pain in palliative medicine]. Anaesthesist 2012; 61:457-67; quiz 468-9. [PMID: 22665134 DOI: 10.1007/s00101-012-2022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
During the course of cancer progression up to 90% of the patients suffer from pain of nociceptive, neuropathic or mixed nociceptive/neuropathic origin. Psychological, social or existential factors may additionally affect the intensity of pain (concept of "total pain"). The WHO "analgesic ladder" provides a large variety of effective drugs that can be used according to the specific pain type. Parenteral or peridural opioid therapy as well as neurodestructive methods can effectively support the analgesic treatment in selected cases.
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Affiliation(s)
- R Laufenberg-Feldmann
- Klinik für Anästhesiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstrasse 1, 55131 Mainz, Deutschland.
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150
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Thomas ML, Elliott JE, Rao SM, Fahey KF, Paul SM, Miaskowski C. A randomized, clinical trial of education or motivational-interviewing-based coaching compared to usual care to improve cancer pain management. Oncol Nurs Forum 2012; 39:39-49. [PMID: 22201654 DOI: 10.1188/12.onf.39-49] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To test the effectiveness of two interventions compared to usual care in decreasing attitudinal barriers to cancer pain management, decreasing pain intensity, and improving functional status and quality of life (QOL). DESIGN Randomized clinical trial. SETTING Six outpatient oncology clinics (three Veterans Affairs [VA] facilities, one county hospital, and one community-based practice in California, and one VA clinic in New Jersey)Sample: 318 adults with various types of cancer-related pain. METHODS Patients were randomly assigned to one of three groups: control, standardized education, or coaching. Patients in the education and coaching groups viewed a video and received a pamphlet on managing cancer pain. In addition, patients in the coaching group participated in four telephone sessions with an advanced practice nurse interventionist using motivational interviewing techniques to decrease attitudinal barriers to cancer pain management. Questionnaires were completed at baseline and six weeks after the final telephone calls. Analysis of covariance was used to evaluate for differences in study outcomes among the three groups. MAIN RESEARCH VARIABLES Pain intensity, pain relief, pain interference, attitudinal barriers, functional status, and QOL. FINDINGS Attitudinal barrier scores did not change over time among groups. Patients randomized to the coaching group reported significant improvement in their ratings of pain-related interference with function, as well as general health, vitality, and mental health. CONCLUSIONS Although additional evaluation is needed, coaching may be a useful strategy to help patients decrease attitudinal barriers toward cancer pain management and to better manage their cancer pain. IMPLICATIONS FOR NURSING By using motivational interviewing techniques, advanced practice oncology nurses can help patients develop an appropriate plan of care to decrease pain and other symptoms.
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