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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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102
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Aubin M, Giguère A, Martin M, Verreault R, Fitch MI, Kazanjian A, Carmichael PH. Interventions to improve continuity of care in the follow-up of patients with cancer. Cochrane Database Syst Rev 2012:CD007672. [PMID: 22786508 DOI: 10.1002/14651858.cd007672.pub2] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Care from the family physician is generally interrupted when patients with cancer come under the care of second-line and third-line healthcare professionals who may also manage the patient's comorbid conditions. This situation may lead to fragmented and uncoordinated care, and results in an increased likelihood of not receiving recommended preventive services or recommended care. OBJECTIVES To classify, describe and evaluate the effectiveness of interventions aiming to improve continuity of cancer care on patient, healthcare provider and process outcomes. SEARCH METHODS We searched the Cochrane Effective Practice and Organization of Care Group (EPOC) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, CINAHL, and PsycINFO, using a strategy incorporating an EPOC Methodological filter. Reference lists of the included study reports and relevant reviews were also scanned, and ISI Web of Science and Google Scholar were used to identify relevant reports having cited the studies included in this review. SELECTION CRITERIA Randomised controlled trials (including cluster trials), controlled clinical trials, controlled before and after studies and interrupted time series evaluating interventions to improve continuity of cancer care were considered for inclusion. We included studies that involved a majority (> 50%) of adults with cancer or healthcare providers of adults with cancer. Primary outcomes considered for inclusion were the processes of healthcare services, objectively measured healthcare professional, informal carer and patient outcomes, and self-reported measures performed with scales deemed valid and reliable. Healthcare professional satisfaction was included as a secondary outcome. DATA COLLECTION AND ANALYSIS Two reviewers described the interventions, extracted data and assessed risk of bias. The authors contacted several investigators to obtain missing information. Interventions were regrouped by type of continuity targeted, model of care or interventional strategy and were compared to usual care. Given the expected clinical and methodological diversity, median changes in outcomes (and bootstrap confidence intervals) among groups of studies that shared specific features of interest were chosen to analyse the effectiveness of included interventions. MAIN RESULTS Fifty-one studies were included. They used three different models, namely case management, shared care, and interdisciplinary teams. Six additional interventional strategies were used besides these models: (1) patient-held record, (2) telephone follow-up, (3) communication and case discussion between distant healthcare professionals, (4) change in medical record system, (5) care protocols, directives and guidelines, and (6) coordination of assessments and treatment.Based on the median effect size estimates, no significant difference in patient health-related outcomes was found between patients assigned to interventions and those assigned to usual care. A limited number of studies reported psychological health, satisfaction of providers, or process of care measures. However, they could not be regrouped to calculate median effect size estimates because of a high heterogeneity among studies. AUTHORS' CONCLUSIONS Results from this Cochrane review do not allow us to conclude on the effectiveness of included interventions to improve continuity of care on patient, healthcare provider or process of care outcomes. Future research should evaluate interventions that target an improvement in continuity as their primary objective and describe these interventions with the categories proposed in this review. Also of importance, continuity measures should be validated with persons with cancer who have been followed in various settings.
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Affiliation(s)
- Michèle Aubin
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec city, Canada.
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Weingart SN, Cleary A, Stuver SO, Lynch M, Brandoff D, Schaefer KG, Zhu J, Berry DL, Block S, Weeks JC. Assessing the quality of pain care in ambulatory patients with advanced stage cancer. J Pain Symptom Manage 2012; 43:1072-81. [PMID: 22651950 DOI: 10.1016/j.jpainsymman.2011.06.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 06/19/2011] [Accepted: 06/28/2011] [Indexed: 11/28/2022]
Abstract
CONTEXT Pain is common among patients with advanced cancer despite the dissemination of clinical pain care guidelines. OBJECTIVES We sought to assess the quality of pain care among patients with advanced disease. METHODS We reviewed the records of 85 adult ambulatory patients with advanced breast, lung, and gastrointestinal cancer treated in 2004-2006. Patients' screening pain intensity scores were at least 7 of 10. Nurse reviewers completed medical record reviews of care rendered at the index visit and over the subsequent 30 days based on the 2004 National Comprehensive Cancer Network pain guideline. An expert panel then rated the quality of the evaluation, treatment, and overall pain care. We used a multivariable model to analyze guideline compliance and resolution of severe pain. RESULTS Among advanced cancer patients with severe pain, clinicians adjusted pain medications only half the time and made few timely referrals for pain-related consultations. By 30 days after the index visit, 34% of patients continued to report severe pain. The expert panel judged the overall quality of pain care as "fair" or "poor" in about two-thirds of cases because more timely and effective intervention could have reduced the severity and duration of pain. Resolution of severe pain was associated with adjustment of pain medications at the index visit (adjusted odds ratio 3.8, 95% CI 1.3-10.6). CONCLUSION There is room for improvement in the pain care of patients with advanced cancer. Additional research is needed to understand the reasons for poor performance.
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Affiliation(s)
- Saul N Weingart
- Center for Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA.
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Henselmans I, de Haes HCJM, Smets EMA. Enhancing patient participation in oncology consultations: a best evidence synthesis of patient-targeted interventions. Psychooncology 2012; 22:961-77. [DOI: 10.1002/pon.3099] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 03/16/2012] [Accepted: 04/06/2012] [Indexed: 01/08/2023]
Affiliation(s)
- Inge Henselmans
- Department of Medical Psychology, Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - Hanneke C. J. M. de Haes
- Department of Medical Psychology, Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - Ellen M. A. Smets
- Department of Medical Psychology, Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
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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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Sheinfeld Gorin S, Krebs P, Badr H, Janke EA, Jim HS, Spring B, Mohr DC, Berendsen MA, Jacobsen PB. Meta-analysis of psychosocial interventions to reduce pain in patients with cancer. J Clin Oncol 2012; 30:539-47. [PMID: 22253460 PMCID: PMC6815997 DOI: 10.1200/jco.2011.37.0437] [Citation(s) in RCA: 191] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 11/08/2011] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Pain is one of the most common, burdensome, and feared symptoms experienced by patients with cancer. American Pain Society standards for pain management in cancer recommend both pharmacologic and psychosocial approaches. To obtain a current, stable, and comprehensive estimate of the effect of psychosocial interventions on pain-an important clinical topic-we conducted a meta-analysis of randomized controlled studies among adult patients with cancer published between 1966 and 2010. METHODS Three pairs of raters independently reviewed 1,681 abstracts, with a systematic process for reconciling disagreement, yielding 42 papers, of which 37 had sufficient data for meta-analysis. Studies were assessed for quality using a modified seven-item Physiotherapy Evidence Database (PEDro) coding scheme. Pain severity and interference were primary outcome measures. RESULTS Study participants (N = 4,199) were primarily women (66%) and white (72%). The weighted averaged effect size across studies for pain severity (38 comparisons) was 0.34 (95% CI, 0.23 to 0.46; P < .001), and the effect size for pain interference (four comparisons) was 0.40 (95% CI, 0.21 to 0.60; P < .001). Studies that monitored whether treatment was delivered as intended had larger effects than those that did not (P = .04). CONCLUSION Psychosocial interventions had medium-size effects on both pain severity and interference. These robust findings support the systematic implementation of quality-controlled psychosocial interventions as part of a multimodal approach to the management of pain in patients with cancer.
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Affiliation(s)
- Sherri Sheinfeld Gorin
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Paul Krebs
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Hoda Badr
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Elizabeth Amy Janke
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Heather S.L. Jim
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Bonnie Spring
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - David C. Mohr
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Mark A. Berendsen
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Paul B. Jacobsen
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
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Armijo-Olivo S, Stiles CR, Hagen NA, Biondo PD, Cummings GG. Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. J Eval Clin Pract 2012; 18:12-8. [PMID: 20698919 DOI: 10.1111/j.1365-2753.2010.01516.x] [Citation(s) in RCA: 1013] [Impact Index Per Article: 84.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Cochrane Collaboration is strongly encouraging the use of a newly developed tool, the Cochrane Collaboration Risk of Bias Tool (CCRBT), for all review groups. However, the psychometric properties of this tool to date have yet to be described. Thus, the objective of this study was to add information about psychometric properties of the CCRBT including inter-rater reliability and concurrent validity, in comparison with the Effective Public Health Practice Project Quality Assessment Tool (EPHPP). METHODS Both tools were used to assess the methodological quality of 20 randomized controlled trials included in our systematic review of the effectiveness of knowledge translation interventions to improve the management of cancer pain. Each study assessment was completed independently by two reviewers using each tool. We analysed the inter-rater reliability of each tool's individual domains, as well as final grade assigned to each study. RESULTS The EPHPP had fair inter-rater agreement for individual domains and excellent agreement for the final grade. In contrast, the CCRBT had slight inter-rater agreement for individual domains and fair inter-rater agreement for final grade. Of interest, no agreement between the two tools was evident in their final grade assigned to each study. Although both tools were developed to assess 'quality of the evidence', they appear to measure different constructs. CONCLUSIONS Both tools performed quite differently when evaluating the risk of bias or methodological quality of studies in knowledge translation interventions for cancer pain. The newly introduced CCRBT assigned these studies a higher risk of bias. Its psychometric properties need to be more thoroughly validated, in a range of research fields, to understand fully how to interpret results from its application.
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Affiliation(s)
- Susan Armijo-Olivo
- Research Center, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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108
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te Boveldt N, Engels Y, Besse K, Vissers K, Vernooij-Dassen M. Rationale, design, and implementation protocol of the Dutch clinical practice guideline pain in patients with cancer: a cluster randomised controlled trial with Short Message Service (SMS) and Interactive Voice Response (IVR). Implement Sci 2011; 6:126. [PMID: 22142327 PMCID: PMC3248867 DOI: 10.1186/1748-5908-6-126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 12/06/2011] [Indexed: 11/23/2022] Open
Abstract
Background One-half of patients with cancer have pain. In nearly one out of two cancer patients with pain, this was undertreated. Inadequate pain control still remains an important problem in this group of patients. Therefore, in 2008 a national, evidence-based multidisciplinary clinical practice guideline 'pain in patients with cancer' has been developed. Yet, publishing a guideline is not enough. Implementation is needed to improve pain management. An innovative implementation strategy, Short Message Service with Interactive Voice Response (SVS-IVR), has been developed and pilot tested. This study aims to evaluate on effectiveness of this strategy to improve pain reporting, pain measurement and adequate pain therapy. In addition, whether the active role of the patient and involvement of caregivers in pain management may change. Methods/design A cluster randomised controlled trial with two arms will be performed in six oncology outpatient clinics of hospitals in the Southeastern region of the Netherlands, with three hospitals in the intervention and three in the control condition. Follow-up measurements will be conducted in all hospitals to study the long-term effect of the intervention. The intervention includes training of professionals (medical oncologists, nurses, and general practitioners) and SMS-IVR to report pain in patients with cancer to improve pain reporting by patients, pain management by medical oncologists, nurses, and general practitioners, and decrease pain intensity. Discussion This innovative implementation strategy with technical tools and the involvement of patients, may enhance the use of the guideline 'pain in patients with cancer' for pain management. Short Message Service alerts may serve as a tool to support self-management of patients. Therefore, the SMS-IVR intervention may increase the feeling of having control over one's life. Trail registration Netherlands Trial Register (NTR): NTR2739
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Affiliation(s)
- Nienke te Boveldt
- Department Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre (RUNMC), Nijmegen, 6500 HB, The Netherlands.
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109
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Ling CC, Lui LYY, So WKW. Do educational interventions improve cancer patients' quality of life and reduce pain intensity? Quantitative systematic review. J Adv Nurs 2011; 68:511-20. [PMID: 21999358 DOI: 10.1111/j.1365-2648.2011.05841.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS This paper reports a quantitative systematic review of the effects of educational interventions on quality of life, pain intensity and pain interference in cancer patients. BACKGROUND Cancer pain has a marked negative impact on quality of life, and this has become an important issue in discussions of treatment options. Patient education seems to be effective in pain management, but no review has been published with quality of life as an outcome measure. DATA SOURCES Relevant publications from 2000 to 2010 were identified in six databases (Medline, CIHAHL, PubMed, EMBASE, PsycINFO and DARE) and by means of hand-searches. All randomized controlled trial studies of pain-education programmes for cancer patients were considered, and a quantitative review of effectiveness carried out. REVIEW METHODS Studies were critically appraised by three independent reviewers, and the Jadad score was used to assess the quality of those included. RESULTS Four studies meeting the inclusion criteria were used, after methodological quality assessment. Pain intensity and pain interference were significantly reduced after education, but statistical change in quality of life was not found in any of the studies. CONCLUSIONS Pain and quality of life are complex matters, and quality of life might not be a sensitive indicator of the effectiveness of pain education. To improve quality of life and reduce the severity of pain in cancer patients, individualized care, recognition of variations in patient experience, and a multi-disciplinary approach are required. Further research is recommended into patients' preferences of any educational intervention, and into the quality of existing education programmes and the expertise of the healthcare professionals concerned.
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Affiliation(s)
- Cheuk-chi Ling
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
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A combined pain consultation and pain education program decreases average and current pain and decreases interference in daily life by pain in oncology outpatients: a randomized controlled trial. Pain 2011; 152:2632-2639. [PMID: 21906879 DOI: 10.1016/j.pain.2011.08.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 06/30/2011] [Accepted: 08/05/2011] [Indexed: 11/23/2022]
Abstract
Pain education programs (PEP) and pain consultations (PC) have been studied to overcome patient-related and professional-related barriers in cancer pain management. These interventions were studied separately, not in combination, and half of the studies reported a significant improvement in pain. Moreover, most PEP studies did not mention the adequacy of pain treatment. We studied the effect of PC combined with PEP on pain and interference by pain with daily functioning in comparison to standard care (SC). Patients were randomly assigned to SC (n=37) or PC-PEP (n=35). PEP consisted of patient-tailored pain education and weekly monitoring of pain and side effects. We measured overall reduction in pain intensity and daily interference over an 8-week period as well as adequacy of pain treatment and adherence. The overall reduction in pain intensity and daily interference was significantly greater after randomization to PC-PEP than to SC (average pain 31% vs 20%, P=.03; current pain 30% vs 16%, P=.016; interference 20% vs 2.5%, P=.01). Adequacy of pain management did not differ between the groups. Patients were more adherent to analgesics after randomization to PC-PEP than to SC (P=.03). In conclusion, PC-PEP improves pain, daily interference, and patient adherence in oncology outpatients.
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111
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Johnston BM, Milligan S, Foster C, Kearney N. Self-care and end of life care—patients’ and carers’ experience a qualitative study utilising serial triangulated interviews. Support Care Cancer 2011; 20:1619-27. [DOI: 10.1007/s00520-011-1252-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 08/09/2011] [Indexed: 10/17/2022]
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McDonald DD, Gifford T, Walsh S. Effect of a virtual pain coach on older adults' pain communication: a pilot study. Pain Manag Nurs 2011; 12:50-6. [PMID: 21349449 DOI: 10.1016/j.pmn.2009.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 10/07/2009] [Accepted: 10/15/2009] [Indexed: 12/31/2022]
Abstract
A randomized posttest-only double blind design was used to pilot test the effect of a virtual practitioner pain communication coach on older adults' communication of their osteoarthritis pain. Baseline pain intensity and pain interference with activities were measured using the Brief Pain Inventory Short Form. Thirty older adults watched a video of a practitioner describing important osteoarthritis pain information followed by either a virtual practitioner coach, a video practitioner coach, or no coach. Participants were next asked, via a videotaped health care practitioner, to orally describe their pain as if speaking to their own practitioner. The amount of important distinctive pain information described by the older adults was audiotaped, transcribed, content analyzed, and summed using a priori criteria from the American Pain Society osteoarthritis pain management guidelines. Older adults described M=6.3 (SD=3.17), M=3.0 (SD=2.08), and M=5.2 (SD=2.40) items of important pain information as a result of the virtual coach, video coach, and no coach conditions, respectively; F(2,25)=3.17, p=.06, η²=.01. Older adults who practiced talking with the virtual coach described more than one additional item of important pain information. The clinically significant group difference supports the need to test the intervention in a randomized clinical trial. The virtual coaching and education intervention might enable older adults to communicate their pain management information more effectively to their practitioners.
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113
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Patients' stories provide insights. Cancer Nurs 2011; 34:340-1. [PMID: 21677551 DOI: 10.1097/ncc.0b013e31822389f6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sobko T, Svensson V, Ek A, Ekstedt M, Karlsson H, Johansson E, Cao Y, Hagströmer M, Marcus C. A randomised controlled trial for overweight and obese parents to prevent childhood obesity--Early STOPP (STockholm Obesity Prevention Program). BMC Public Health 2011; 11:336. [PMID: 21592388 PMCID: PMC3121630 DOI: 10.1186/1471-2458-11-336] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 05/18/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overweight and obesity have a dramatic negative impact on children's health not only during the childhood but also throughout the adult life. Preventing the development of obesity in children is therefore a world-wide health priority. There is an obvious urge for sustainable and evidenced-based interventions that are suitable for families with young children, especially for families with overweight or obese parents. We have developed a prevention program, Early STOPP, combating multiple obesity-promoting behaviors such unbalanced diet, physical inactivity and disturbed sleeping patterns. We also aim to evaluate the effectiveness of the early childhood obesity prevention in a well-characterized population of overweight or obese parents. This protocol outlines methods for the recruitment phase of the study. DESIGN AND METHODS This randomized controlled trial (RCT) targets overweight and/or obese parents with infants, recruited from the Child Health Care Centers (CHCC) within the Stockholm area. The intervention starts when infants are one year of age and continues until they are six and is regularly delivered by a trained coach (dietitian, physiotherapist or a nurse). The key aspects of Early STOPP family intervention are based on Swedish recommendations for CHCC, which include advices on healthy food choices and eating patterns, increasing physical activity/reducing sedentary behavior and regulating sleeping patterns. DISCUSSION The Early STOPP trial design addresses weaknesses of previous research by recruiting from a well-characterized population, defining a feasible, theory-based intervention and assessing multiple measurements to validate and interpret the program effectiveness. The early years hold promise as a time in which obesity prevention may be most effective. To our knowledge, this longitudinal RCT is the first attempt to demonstrate whether an early, long-term, targeted health promotion program focusing on healthy eating, physical activity/reduced sedentary behaviors and normalizing sleeping patterns could be effective. If proven so, Early STOPP may protect children from the development of overweight and obesity. TRIAL REGISTRATION The protocol for this study is registered with the clinical trials registry clinicaltrials.gov, ID: ES-2010).
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Affiliation(s)
- Tanja Sobko
- Department of Clinical Science, Intervention and Technology, Division of Paediatrics, Endocrine Research Unit B62, Karolinska Institutet, S-141 86 Stockholm, Sweden.
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Cummings GG, Olivo SA, Biondo PD, Stiles CR, Yurtseven O, Fainsinger RL, Hagen NA. Effectiveness of knowledge translation interventions to improve cancer pain management. J Pain Symptom Manage 2011; 41:915-39. [PMID: 21398088 DOI: 10.1016/j.jpainsymman.2010.07.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 07/25/2010] [Accepted: 07/29/2010] [Indexed: 10/18/2022]
Abstract
CONTEXT Cancer pain is prevalent, yet patients do not receive best care despite widely available evidence. Although national cancer control policies call for education, effectiveness of such programs is unclear and best practices are not well defined. OBJECTIVES To examine existing evidence on whether knowledge translation (KT) interventions targeting health care providers, patients, and caregivers improve cancer pain outcomes. METHODS A systematic review and meta-analysis were undertaken to evaluate primary studies that examined effects of KT interventions on providers and patients. RESULTS Twenty-six studies met the inclusion criteria. Five studies reported interventions targeting health care providers, four focused on patients or their families, one study examined patients and their significant others, and 16 studies examined patients only. Seven quantitative comparisons measured the statistical effects of interventions. A significant difference favoring the treatment group in least pain intensity (95% confidence interval [CI]: 0.44, 1.42) and in usual pain/average pain (95% CI: 0.13, 0.74) was observed. No other statistical differences were observed. However, most studies were assessed as having high risk of bias and failed to report sufficient information about the intervention dose, quality of educational material, fidelity, and other key factors required to evaluate effectiveness of intervention design. CONCLUSION Trials that used a higher dose of KT intervention (characterized by extensive follow-up, comprehensive educational program, and higher resource allocation) were significantly more likely to have positive results than trials that did not use this approach. Further attention to methodological issues to improve educational interventions and research to clarify factors that lead to better pain control are urgently needed.
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Affiliation(s)
- Greta G Cummings
- CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Alberta, Canada.
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Abstract
The experience of pain in cancer is widely accepted as a major threat to quality of life, and the relief of pain has emerged as a priority in oncology care. Pain is associated with both the disease as well as treatment, and management is essential from the onset of early disease through long-term survivorship or end-of-life care. Effective relief of pain is contingent upon a comprehensive assessment to identify physical, psychological, social, and spiritual aspects and as a foundation for multidisciplinary interventions. Fortunately, advances in pain treatment and in the field of palliative care have provided effective treatments encompassing pharmacological, cognitive-behavioral, and other approaches. The field of palliative care has emphasized that attention to symptoms such as pain is integral to quality cancer care.
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Affiliation(s)
- Judith A Paice
- Division of Hematology-Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Spichiger E, Müller-Fröhlich C, Denhaerynck K, Stoll H, Hantikainen V, Dodd M. Symptom prevalence and changes of symptoms over ten days in hospitalized patients with advanced cancer: A descriptive study. Eur J Oncol Nurs 2011; 15:95-102. [DOI: 10.1016/j.ejon.2010.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 06/22/2010] [Accepted: 06/24/2010] [Indexed: 11/15/2022]
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Kravitz RL, Tancredi DJ, Grennan T, Kalauokalani D, Street RL, Slee CK, Wun T, Oliver JW, Lorig K, Franks P. Cancer Health Empowerment for Living without Pain (Ca-HELP): effects of a tailored education and coaching intervention on pain and impairment. Pain 2011; 152:1572-1582. [PMID: 21439726 DOI: 10.1016/j.pain.2011.02.047] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 01/25/2011] [Accepted: 02/23/2011] [Indexed: 11/15/2022]
Abstract
We aimed to determine the effectiveness of a lay-administered tailored education and coaching (TEC) intervention (aimed at reducing pain misconceptions and enhancing self-efficacy for communicating with physicians) on cancer pain severity, pain-related impairment, and quality of life. Cancer patients with baseline "worst pain" of ≥4 on a 0-10 scale or at least moderate functional impairment due to pain were randomly assigned to TEC or enhanced usual care (EUC) during a telephone interview conducted in advance of a planned oncology office visit (265 patients randomized to TEC or EUC; 258 completed at least one follow-up). Patients completed questionnaires before and after the visit and were interviewed by telephone at 2, 6, and 12 weeks. Mixed effects regressions were used to evaluate the intervention adjusting for patient, practice, and site characteristics. Compared to EUC, TEC was associated with increased pain communication self-efficacy after the intervention (P<.001); both groups showed significant (P<.0001), similar, reductions in pain misconceptions. At 2 weeks, assignment to TEC was associated with improvement in pain-related impairment (-0.25 points on a 5-point scale, 95% confidence interval -0.43 to -0.06, P=.01) but not in pain severity (-0.21 points on an 11-point scale, -0.60 to 0.17, P=.27). The improvement in pain-related impairment was not sustained at 6 and 12 weeks. There were no significant intervention by subgroup interactions (P>.10). We conclude that TEC, compared with EUC, resulted in improved pain communication self-efficacy and temporary improvement in pain-related impairment, but no improvement in pain severity.
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Affiliation(s)
- Richard L Kravitz
- Department of Internal Medicine and Center for Healthcare Policy and Research, University of California at Davis, USA Department of Pediatrics and Center for Healthcare Policy and Research, University of California at Davis, USA Kaiser Permanente, Northern California, USA Department of Anesthesiology and Pain Management and Center for Healthcare Policy and Research, University of California at Davis, USA Department of Communication, Texas A&M University and Houston Center for Quality and Utilization Studies, Baylor College of Medicine, USA Center for Healthcare Policy and Research, University of California at Davis, USA Division of Hematology-Oncology, University of California at Davis and the Northern California VA Health Care System, USA Oliver Consulting, USA Department of Medicine, Stanford University, USA Department of Family and Community Medicine and Center for Healthcare Policy and Research, University of California at Davis, USA
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Trajectories of pain and analgesics in oncology outpatients with metastatic bone pain during participation in a psychoeducational intervention study to improve pain management. THE JOURNAL OF PAIN 2011; 12:652-66. [PMID: 21429811 DOI: 10.1016/j.jpain.2010.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 11/27/2010] [Accepted: 12/08/2010] [Indexed: 01/22/2023]
Abstract
UNLABELLED A large number of oncology patients with bone metastasis report significant and often unrelieved pain that is associated with reduced quality of life and impaired functional status. Our research team previously assessed the efficacy of a tailored self-care psychoeducational intervention to improve pain management in these patients. Samplewide analyses demonstrated improvements in pain intensity and analgesic prescriptions. However, substantial interindividual variability was observed within the intervention group. In the current paper, hierarchical linear modeling (HLM) was used to determine factors that contributed to variability in pain intensity and analgesic prescription and intake in the sample of patients who participated in the intervention. Specifically, HLM analyses identified demographic, clinical, and psychological characteristics that predicted variation in pain intensity and analgesic prescription and intake at baseline (intercepts) and over the course of the 6-week study (trajectories). Awareness of these predictors may be particularly useful for the identification of patients who would benefit most from this type of intervention. Furthermore, these findings highlight specific aspects of the intervention that may be modified in order to further improve pain management in these patients. PERSPECTIVE This paper describes the application of HLM to explain interindividual variability in pain and analgesic outcomes among oncology outpatients with metastatic bone pain who participated in a psychoeducational intervention to improve pain management. Findings identify particularly responsive subgroups, areas for improvement to the intervention, and targets for future intervention.
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120
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Jorge J, McDonald DD. Hispanic older adults' osteoarthritis pain communication. Pain Manag Nurs 2011; 12:173-9. [PMID: 21893306 DOI: 10.1016/j.pmn.2010.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Revised: 12/24/2010] [Accepted: 12/28/2010] [Indexed: 10/18/2022]
Abstract
Better understanding of how Hispanic older adults describe their chronic pain might suggest ways to support Hispanic older adults to talk about important pain information with their practitioner. The study aim was to describe how Hispanic older adults communicate pain information, including the amount of pain information and communication processes employed. A secondary analysis with a descriptive design was used. The data were from a larger primary study that tested the effect of practitioner pain question phrasing on the amount of pain information described by older adults with osteoarthritis pain. The sample for this secondary analysis was composed of the 24 Hispanic older adults with chronic osteoarthritis pain. In the primary study older adults watched and orally responded to a videotape of a practitioner asking about their pain. Pain content from the patient responses was content analyzed by two independent raters. Communication processes were also content analyzed by two independent raters using a priori criteria from communication accommodation theory (clarity, syntax, complexity, explicitness, and staying on topic). Participants described a mean of 5.5 (SD 3.39) items of pain information. The majority stayed on topic, and one-half spoke clearly and explicitly. Hispanic older adults with osteoarthritis pain concisely describe clinically important pain information when given the opportunity to do so.
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Affiliation(s)
- Jennifer Jorge
- Yale New Haven Medical Center, New Haven, Connecticutt, USA
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Trajectories of pain and analgesics in oncology outpatients with metastatic bone pain. THE JOURNAL OF PAIN 2011; 12:495-507. [PMID: 21310669 DOI: 10.1016/j.jpain.2010.10.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 09/27/2010] [Accepted: 10/26/2010] [Indexed: 11/20/2022]
Abstract
UNLABELLED A large proportion of oncology outpatients with bone metastasis report unrelieved pain that significantly interferes with daily functioning and quality of life. However, little is known about the longitudinal pattern of pain intensity and analgesic prescriptions or use. Moreover, despite considerable advantages, the use of sophisticated statistical techniques, such as hierarchical linear modeling (HLM) has not been applied to the study of pain and analgesic outcomes. In a prospective longitudinal study, HLM was used to explore predictors of pain intensity and analgesic prescription and intake at the time of enrollment into the study (intercept) and over the course of 6 weeks (trajectory) in a sample of oncology outpatients with bone metastasis who received standard care for pain. In addition to corroborating known predictors of pain intensity, previously unrecognized variables were found that appear to affect both pain and analgesic outcomes. Importantly, some of the predictors of the trajectories of pain intensity and analgesic use (ie, pain-related distress and Pain Management Index (PMI) scores) are particularly amenable to interventions. Findings from this study suggest that sophisticated statistical modeling can be used in pain research to identify individual risk factors and propose novel targets that can be used to improve pain management in oncology outpatients with bone metastasis. PERSPECTIVE Findings from this study suggest that a large amount of inter-individual variability exists in patients' experiences with cancer pain and analgesic use. Future studies need to elucidate the mechanisms that underlie these differences.
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Hematologic patients' clinical and psychosocial experiences with implanted long-term central venous catheter: self-management versus professionally controlled care. Cancer Nurs 2011; 33:426-35. [PMID: 20562617 DOI: 10.1097/ncc.0b013e3181dc1908] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A significant decrease in catheter-related infections was demonstrated in our earlier randomized controlled trial of central venous catheter (CVC) care in hematologic patients. OBJECTIVE This article focuses on patients' clinical and psychosocial experiences with CVC self-care compared with professionally controlled CVC care. METHODS Eighty-two patients with tunneled CVCs were enrolled in the randomized controlled trial. The intervention group (n = 42) was trained to perform CVC self-care. The control group (n = 40) followed standard CVC procedure provided by nurses. Eighteen patients were selected for semistructured interviews focusing on patients' clinical and psychosocial experiences with CVCs. RESULTS Methods of CVC care have different influences on the patients' clinical and psychosocial outcomes, depending on whether they were hospitalized or outpatients. Central venous catheter was viewed as important because it was the main port of treatment toward a cure, although patients constantly fear complications. Central venous catheter self-care increased patients' independence from health professionals and supported perceived self-efficacy and control. Central venous catheters cause psychosocial problems including altered body perception, sexual activity avoidance, and feeling stigmatized. CONCLUSIONS Patients experience increased perceived self-control and independence when individually supervised and trained in CVC self-management. Assuming ownership of CVC care can encourage patients to feel less inhibited about sexual activity and socialization. IMPLICATIONS FOR PRACTICE Placement of a tunneled CVC should engage nurses to organize individualized structured and supervised patient education. Stigma originating from CVCs should be carefully considered by health professionals when maintaining CVC insertion for longer periods. Central venous catheters should be removed whenever the potential risks exceed the catheter's functional necessity.
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Strohbuecker B, Gaertner J, Stock S. Informing Severely III Patients: Needs, Shortcomings and Strategies for Improvement. ACTA ACUST UNITED AC 2011; 6:8-13. [PMID: 21547020 DOI: 10.1159/000324563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
SUMMARY: The scope of palliative care has expanded gradually over the last decade. Provision of palliative care is not restricted to the last months of life as in some out-dated concepts. It addresses the needs of severely ill patients in all care settings (in- and outpatients, home care, hospices). Particularly in the last years, the value of integrating palliative care early in the disease trajectory of life-threatening and incurable diseases has become increasingly acknowledged. In order for patients to fully benefit from the concept of early integration of palliative care, they need to be provided with information tailored to their disease trajectory. For example, patients and relatives need to know how symptoms such as pain, depression, fatigue, breathlessness, or anxiety can be alleviated. The patients' knowledge and understanding will support the coping process, improve comfort and enhance patient participation and autonomy. Since information needs are highly individual and vary throughout the course of the disease, an interactive approach of assessing the patients' needs and responding to them adequately is mandatory. In this article, the information needs of advanced cancer patients and their families are explained, shortcomings of the present information concepts are discussed, and an integrative approach to responding to patients' information needs throughout the care pathway is advocated.
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Affiliation(s)
- Barbara Strohbuecker
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne, Germany
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Borneman T, Koczywas M, Sun V, Piper BF, Smith-Idell C, Laroya B, Uman G, Ferrell B. Effectiveness of a clinical intervention to eliminate barriers to pain and fatigue management in oncology. J Palliat Med 2011; 14:197-205. [PMID: 21271872 PMCID: PMC3037802 DOI: 10.1089/jpm.2010.0268] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2010] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pain and fatigue are recognized as critical symptoms that impact quality of life (QOL) in cancer, particularly in palliative care settings. Barriers to pain and fatigue relief have been classified into three categories: patient, professional, and system barriers. The overall objective of this study was to test the effects of a clinical intervention on reducing barriers to pain and fatigue management in oncology. METHODS This longitudinal, three-group, quasi-experimental study was conducted in three phases: phase 1 (usual care), phase 2 (intervention), and phase 3 (dissemination). A sample of 280 patients with breast, lung, colon, or prostate cancers, stage III and IV disease (80%), and a pain and/or fatigue of 4 or more (moderate to severe) were recruited. The intervention group received four educational sessions on pain/fatigue assessment and management, whereas the control group received usual care. Pain and fatigue barriers and patient knowledge were measured at baseline, 1 month, and 3 months post-accrual for all phases. A 3 × 2 repeated measures statistical design was utilized to derive a priori tests of immediate effects (baseline to 1 month) and sustained effects (baseline or 1 month to 3 months) for each major outcome variable, subscale, and/or scale score. RESULTS There were significant immediate and sustained effects of the intervention on pain and fatigue barriers as well as knowledge. Measurable improvements in QOL were found in physical and psychological well-being only. CONCLUSION A clinical intervention was effective in reducing patient barriers to pain and fatigue management, increasing patient knowledge regarding pain and fatigue, and is feasible and acceptable to patients.
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Affiliation(s)
- Tami Borneman
- Nursing Research & Education, Department of Population Sciences, City of Hope, Duarte, California, USA.
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McCorkle R, Ercolano E, Lazenby M, Schulman-Green D, Schilling LS, Lorig K, Wagner EH. Self-management: Enabling and empowering patients living with cancer as a chronic illness. CA Cancer J Clin 2011; 61:50-62. [PMID: 21205833 PMCID: PMC3058905 DOI: 10.3322/caac.20093] [Citation(s) in RCA: 611] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
With recent improvements in the early detection, diagnosis, and treatment of cancer, people with cancer are living longer, and their cancer may be managed as a chronic illness. Cancer as a chronic illness places new demands on patients and families to manage their own care, and it challenges old paradigms that oncology's work is done after treatment. As a chronic illness, however, cancer care occurs on a continuum that stretches from prevention to the end of life, with early detection, diagnosis, treatment, and survivorship in between. In this article, self-management interventions that enable patients and families to participate in managing their care along this continuum are reviewed. Randomized controlled trials of self-management interventions with cancer patients and families in the treatment, survivorship, and end-of-life phases of the cancer care continuum are reviewed, and the Chronic Care Model is presented as a model of care that oncology practices can use to enable and empower patients and families to engage in self-management. It is concluded that the need for a common language with which to speak about self-management and a common set of self-management actions for cancer care notwithstanding, oncology practices can now build strong relationships with their patients and formulate mutually agreed upon care plans that enable and empower patients to care for themselves in the way they prefer.
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Affiliation(s)
- Ruth McCorkle
- School of Nursing, Yale University, New Haven, CT, USA.
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126
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Ise Y, Morita T, Maehori N, Kutsuwa M, Shiokawa M, Kizawa Y. Role of the community pharmacy in palliative care: a nationwide survey in Japan. J Palliat Med 2010; 13:733-7. [PMID: 20597706 DOI: 10.1089/jpm.2009.0362] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The role of the community pharmacy in palliative care may become increasingly important in Japan. There has been however no investigation to date of community pharmacies in Japan that takes into account their role in enabling palliative care in the home. The aims of the present study were thus to evaluate (1) the availability of narcotics through community pharmacies and the experience of pharmacists in prescribing narcotics; (2) availability of patient counseling provided by pharmacists; (3) pharmacist-perceived difficulties in treating cancer patients with narcotics; and (4) useful strategies to make narcotics more easily available to patients. METHODS We sent 3000 questionnaires to community pharmacies as a representative national sample, and 1036 responses were analyzed (response rate: 34.5%). RESULTS We found that 77% of community pharmacies had a narcotics retailer license, and that approximately 50% received prescriptions for and prepared narcotics each month. Approximately 70% of community pharmacies received however only 3 narcotics prescriptions each month. Half of the pharmacists reported that they did not counsel patients, primarily because they lacked information about the patient. The most common area reported by pharmacists as being extremely difficult was communicating with terminally ill cancer patients. To make narcotics more easily available to patients, 76% of community pharmacists felt it was important to be able to return narcotics to wholesalers. CONCLUSION The present study suggests that there are many problems in community pharmacy that need to be addressed to improve access to palliative care in the home, including (1) increased sharing of patient information; (2) increasing community pharmacists' communication skills; and (3) changing current regulations regarding the distribution of narcotics. If these issues are addressed, palliative care in the home could become more widely accepted.
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Affiliation(s)
- Yuya Ise
- Department of Pharmaceutical Services, Nippon Medical School Hospital, Sendagi Bunkyo-ku, Tokyo, Japan.
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127
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Smith MY, DuHamel KN, Egert J, Winkel G. Impact of a brief intervention on patient communication and barriers to pain management: results from a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2010; 81:79-86. [PMID: 20036097 DOI: 10.1016/j.pec.2009.11.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Revised: 11/15/2009] [Accepted: 11/24/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This study examined the impact of a brief pain communication/education intervention on patient outcomes in breast cancer. We hypothesized that our intervention would improve patient communication and reduce misconceptions ("Barriers") concerning pain management, and that patients with lower Barriers, or who perceived their physician as being more facilitative and receptive, would report better outcomes. METHODS Female breast cancer patients with persistent pain (n=89) were randomly assigned to either a 30-min in-person pain education/communication intervention or control condition and followed for 12 weeks. RESULTS Intervention group patients reported a significant decrease in pain Barriers but not in other outcomes. Overall, patients with lower barrier scores reported less distress and better emotional well-being. Patients who scored higher in active communication (e.g., asking questions, giving information) reported fewer Barriers and better pain relief. Individuals who perceived their physicians as being more receptive reported better pain management while those who perceived their physicians as being both more receptive and facilitative were more satisfied with their health care. CONCLUSION A brief education/communication intervention reduced patients' Barriers to pain management but did not impact other patient outcomes. PRACTICAL IMPLICATIONS Pain outcomes may be improved by addressing patients' pain misconceptions and emphasizing a receptive and responsive communication style.
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Affiliation(s)
- Meredith Y Smith
- Cancer Prevention and Control Division, Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY, USA.
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128
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Pai YC. The need for nursing instruction in patients receiving steroid pulse therapy for the treatment of autoimmune diseases and the effect of instruction on patient knowledge. BMC Musculoskelet Disord 2010; 11:217. [PMID: 20858234 PMCID: PMC2954988 DOI: 10.1186/1471-2474-11-217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 09/21/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many patients who receive steroid pulse therapy go home the same day or the day after steroid administration. Nursing instructions are important for improving patient knowledge related to their diseases and treatments, but the short hospital stay often prevents complete education and guidance regarding the given therapy. The purpose of this study was to investigate the need for nursing instruction in patients receiving steroid pulse therapy for the treatment of autoimmune diseases and the effect of instruction on patient knowledge of their disease and treatment. METHODS Patients with systemic lupus erythematosus (SLE) and systemic sclerosis receiving steroid pulse therapy (N = 63) were recruited from a medical center in Taipei. A structured questionnaire was used for data collection before and after nursing instruction, and 1 week as well as 2 weeks after therapy. The need for nursing instruction and knowledge levels were validated using Cronbach's α reliability test. RESULTS There was a significant difference (P < 0.001) in the need for nursing instruction among the 4 time points. There was a positive correlation between the need for nursing instruction and body weight change, frequency of treatment, and distress, but there was a negative correlation with knowledge level (β = -0.012, P = 0.003) regarding symptoms. The knowledge level of subjects after nursing instruction was significantly higher than before nursing instruction (80 ± 14.31 vs. 70.06 ± 17.23, P < 0.001). CONCLUSIONS This study indicates that nursing instruction is needed by patients receiving steroid pulse therapy, and that by designing and administering nursing instructions according to the priority of patient symptoms, nurses can improve patient knowledge related to their diseases and treatments. In addition, the need for nursing instruction can be affected by patient characteristics.
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Affiliation(s)
- Yu-Chu Pai
- Nursing Department, Taipei Veterans General Hospital, Taiwan.
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129
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Capewell C, Gregory W, Closs S, Bennett M. Brief DVD-based educational intervention for patients with cancer pain: feasibility study. Palliat Med 2010; 24:616-22. [PMID: 20558433 DOI: 10.1177/0269216310371704] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient attitudes and knowledge regarding cancer pain and strong opioid analgesia can sometimes be a barrier to good pain control. Educational interventions that address these barriers are effective in oncology outpatients but have not been evaluated in patients with more advanced disease. We assessed the feasibility of a randomized, controlled clinical trial evaluating a brief DVD-based educational intervention for cancer pain in palliative care patients. Participants were shown DVD at baseline (V1) and at 1 week (V2). Outcomes were assessed using Brief Pain Inventory (BPI) and Patient Pain Questionnaire (PPQ) before intervention, and at V2 and V3 (4 weeks later). Fifteen patients and 10 carers were recruited. Between V1 and V2, total BPI and PPQ scores improved significantly by 9.6% (p = 0.02) and 17% (p = 0.04) respectively with no further improvements at V3. Our findings suggest that this intervention is feasible and potentially effective between 7-30 days follow up. A multicentre clinical trial is now needed to evaluate this intervention further.
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Affiliation(s)
- Cmr Capewell
- St John's Hospice, Slyne Road, Lancaster, LA2 6ST, UK
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Lovell MR, Forder PM, Stockler MR, Butow P, Briganti EM, Chye R, Goldstein D, Boyle FM. A randomized controlled trial of a standardized educational intervention for patients with cancer pain. J Pain Symptom Manage 2010; 40:49-59. [PMID: 20619212 DOI: 10.1016/j.jpainsymman.2009.12.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 12/10/2009] [Accepted: 12/14/2009] [Indexed: 11/22/2022]
Abstract
CONTEXT Published literature has not defined the effectiveness of standardized educational tools that can be self-administered in the general oncology population with pain. OBJECTIVES We sought to determine if an educational intervention consisting of a video and/or booklet for adults with cancer pain could improve knowledge and attitudes about cancer pain management, pain levels, pain interference, anxiety, quality of life, and analgesic use. METHODS Eligible participants had advanced cancer, a pain score >/=2 of 10 in the last week, English proficiency, an estimated prognosis of more than one month, and were receiving outpatient cancer treatment at participating hospitals. Participants completed baseline assessments and then were randomly allocated to receive a booklet, a video, both, or neither, in addition to standard care. Outcome measures at two and four weeks included the Barriers Questionnaire (BQ), Brief Pain Inventory, Global Quality of Life Scale, and Hospital Anxiety and Depression Scale. Adequacy of analgesia and severity of pain were assessed with the Pain Management Index and a daily pain diary. RESULTS One hundred fifty-eight participants were recruited from 21 sites over 42 months. Baseline mean barriers scores were lower than reported in previous Australian studies at 1.33 (standard deviation: 0.92). Mean average pain and worst pain scores improved significantly in patients receiving both the video and booklet by 1.17 (standard error [SE]: 0.51, P=0.02) and 1.12 (SE: 0.57, P=0.05), respectively, on a 0-10 scale. The addiction subscale of the BQ score was improved by 0.44 (SE: 0.19) for participants receiving any part of the intervention (P=0.03). CONCLUSION Provision of a video and/or booklet for people with cancer pain was a feasible and effective adjunct to the management of cancer pain.
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Street RL, Slee C, Kalauokalani DK, Dean DE, Tancredi DJ, Kravitz RL. Improving physician-patient communication about cancer pain with a tailored education-coaching intervention. PATIENT EDUCATION AND COUNSELING 2010; 80:42-7. [PMID: 19962845 PMCID: PMC2891619 DOI: 10.1016/j.pec.2009.10.009] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 10/16/2009] [Accepted: 10/26/2009] [Indexed: 05/02/2023]
Abstract
OBJECTIVE This study examined the effect of a theoretically grounded, tailored education-coaching intervention to help patients more effectively discuss their pain-related questions, concerns, and preferences with physicians. METHODS Grounded in social-cognitive and communication theory, a tailored education-coaching (TEC) intervention was developed to help patients learn pain management and communication skills. In a RCT, 148 cancer patients agreed to have their consultations audio-recorded and were assigned to the intervention or a control group. The recordings were used to code for patients' questions, acts of assertiveness, and expressed concerns and to rate the quality of physicians' communication. RESULTS Patients in the TEC group discussed their pain concerns more than did patients in the control group. More active patients also had more baseline pain and interacted with physicians using participatory decision-making. Ratings of physicians' information about pain were higher when patients talked more about their pain concerns. CONCLUSIONS The study demonstrates the efficacy of a theoretically grounded, coaching intervention to help cancer patients talk about pain control. PRACTICE IMPLICATIONS Coaching interventions can be effective resources for helping cancer patients communicate about their pain concerns if they are theoretically grounded, can be integrated within clinical routines, and lead to improve health outcomes.
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Affiliation(s)
- Richard L Street
- Department of Communication, Texas A&M University, College Station, TX 77843-4234, USA.
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132
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Wilkie D, Berry D, Cain K, Huang HY, Mekwa J, Lewis F, Gallucci B, Lin YC, Chen ACC, Ko NY. Effects of coaching patients with lung cancer to report cancer pain. West J Nurs Res 2010; 32:23-46. [PMID: 20164474 DOI: 10.1177/0193945909348009] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors have examined the effects of coaching sensory self-monitoring and reporting on pain-related variables in patients with lung cancer. Randomly assigned to coached or not-coached groups, 215 patients have their interactions with their providers audiotaped and complete study measures pre- and postintervention. Of the 151 patients who complete the 4-week study, those coached are more likely than those not coached to give their providers unsolicited sensory pain information and to mention it before their providers ask for it. The mean number of pain parameters discussed during the audiotaped clinic visit is statistically larger at study end for the coached group. Scores for analgesic adequacy, all pain indices except one, anxiety, depression, and catastrophizing coping are not significantly different. Although coaching increases the amount of pain data communicated to providers by patients with lung cancer, the magnitude is small and does not lead to improved adequacy of analgesics prescribed for each patient's pain level.
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133
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Jahn P, Kitzmantel M, Renz P, Kukk E, Kuss O, Thoke-Colberg A, Horn I, Landenberger M. Improvement of pain related self management for oncologic patients through a trans institutional modular nursing intervention: protocol of a cluster randomized multicenter trial. Trials 2010; 11:29. [PMID: 20307262 PMCID: PMC2855560 DOI: 10.1186/1745-6215-11-29] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 03/22/2010] [Indexed: 11/29/2022] Open
Abstract
Background Pain is one of the most frequent and distressing symptoms in cancer patients. For the majority of the patients, sufficient pain relief can be obtained if adequate treatment is provided. However, pain remains often undertreated due to institutional, health care professional and patient related barriers. Patients self management skills are affected by the patients' knowledge, activities and attitude to pain management. This trial protocol is aimed to test the SCION-PAIN program, a multi modular structured intervention to improve self management in cancer patients with pain. Methods 240 patients with diagnosed malignancy and pain > 3 days and average pain ≥ 3/10 will participate in a cluster randomized trial on 18 wards in 2 German university hospitals. Patients from the intervention wards will receive, additionally to standard pain treatment, the SCION-PAIN program consisting of 3 modules: pharmacologic pain management, nonpharmacologic pain management and discharge management. The intervention will be conducted by specially trained oncology nurses and includes components of patient education, skills training and counseling to improve self care regarding pain management beginning with admission followed by booster session every 3rd day and one follow up telephone counseling within 2 to 3 days after discharge. Patients in the control group will receive standard care. Primary endpoint is the group difference in patient related barriers to management of cancer pain (BQII), 7 days after discharge. Secondary endpoints are: pain intensity & interference, adherence, coping and HRQoL. Discussion The study will determine if the acquired self management skills of the patients continue to be used after discharge from hospital. It is hypothesized that patients who receive the multi modular structured intervention will have less patient related barriers and a better self management of cancer pain. Trial Registration ClinicalTrials NCT00779597
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Affiliation(s)
- Patrick Jahn
- Institute for Health and Nursing Science, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Germany.
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134
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Borneman T, Koczywas M, Sun VCY, Piper BF, Uman G, Ferrell B. Reducing patient barriers to pain and fatigue management. J Pain Symptom Manage 2010; 39:486-501. [PMID: 20303026 PMCID: PMC2844345 DOI: 10.1016/j.jpainsymman.2009.08.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 08/18/2009] [Accepted: 08/29/2009] [Indexed: 10/19/2022]
Abstract
CONTEXT Pain and fatigue are recognized as critical symptoms that impact the quality of life of cancer patients. The barriers to pain and fatigue relief have been classified into three categories: patient, professional, and system barriers. OBJECTIVES The overall objective of this trial as to test the effects of the "Passport to Comfort" intervention on reducing barriers to pain and fatigue management for ambulatory care cancer patients. METHODS This quasi-experimental, comparative study uses a Phase 1 control group of usual care followed sequentially by a Phase 2 intervention group in which educational and system-change efforts were directed toward improved pain and fatigue management. A sample of 187 cancer patients with breast, lung, colon, or prostate cancers, and a pain and/or fatigue rating of 4 or more (moderate to severe), were recruited. Patients in the intervention group received four educational sessions on pain/fatigue assessment and management, whereas patients in the control group received usual care. Pain and fatigue barriers and patient knowledge were measured at baseline, one month, and three months post-accrual. RESULTS Patients in the intervention group experienced significant improvements in pain and fatigue measures immediately postintervention, and these improvements were sustained over time. CONCLUSION The "Passport to Comfort" intervention was effective in reducing patient barriers to pain and fatigue management as well as in increasing patient knowledge regarding pain and fatigue. This intervention demonstrates innovation by translating the evidence-based guidelines for pain and fatigue as developed by the National Comprehensive Cancer Network into practice.
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Affiliation(s)
- Tami Borneman
- Division of Nursing Research & Education, Department of Population Sciences, City of Hope, Duarte, California 91010, USA.
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135
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Bertsche T, Askoxylakis V, Habl G, Laidig F, Kaltschmidt J, Schmitt SP, Ghaderi H, Bois AZD, Milker-Zabel S, Debus J, Bardenheuer HJ, Haefeli WE. Multidisciplinary pain management based on a computerized clinical decision support system in cancer pain patients. Pain 2009; 147:20-8. [DOI: 10.1016/j.pain.2009.07.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 07/06/2009] [Accepted: 07/13/2009] [Indexed: 11/25/2022]
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Kravitz RL, Tancredi DJ, Street RL, Kalauokalani D, Grennan T, Wun T, Slee C, Evans Dean D, Lewis L, Saito N, Franks P. Cancer Health Empowerment for Living without Pain (Ca-HELP): study design and rationale for a tailored education and coaching intervention to enhance care of cancer-related pain. BMC Cancer 2009; 9:319. [PMID: 19737424 PMCID: PMC2745433 DOI: 10.1186/1471-2407-9-319] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 09/09/2009] [Indexed: 12/03/2022] Open
Abstract
Background Cancer-related pain is common and under-treated. This article describes a study designed to test the effectiveness of a theory-driven, patient-centered coaching intervention to improve cancer pain processes and outcomes. Methods/Design The Cancer Health Empowerment for Living without Pain (Ca-HELP) Study is an American Cancer Society sponsored randomized trial conducted in Sacramento, California. A total of 265 cancer patients with at least moderate pain severity (Worst Pain Numerical Analog Score >=4 out of 10) or pain-related impairment (Likert score >= 3 out of 5) were randomly assigned to receive tailored education and coaching (TEC) or educationally-enhanced usual care (EUC); 258 received at least one follow-up assessment. The TEC intervention is based on social-cognitive theory and consists of 6 components (assess, correct, teach, prepare, rehearse, portray). Both interventions were delivered over approximately 30 minutes just prior to a scheduled oncology visit. The majority of visits (56%) were audio-recorded for later communication coding. Follow-up data including outcomes related to pain severity and impairment, self-efficacy for pain control and for patient-physician communication, functional status and well-being, and anxiety were collected at 2, 6, and 12 weeks. Discussion Building on social cognitive theory and pilot work, this study aims to test the hypothesis that a brief, tailored patient activation intervention will promote better cancer pain care and outcomes. Analyses will focus on the effects of the experimental intervention on pain severity and impairment (primary outcomes); self-efficacy and quality of life (secondary outcomes); and relationships among processes and outcomes of cancer pain care. If this model of coaching by lay health educators proves successful, it could potentially be implemented widely at modest cost. Trial Registration [Clinical Trials Identifier: NCT00283166]
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Affiliation(s)
- Richard L Kravitz
- Department of Internal Medicine, University of California Davis, School of Medicine, Sacramento, CA, USA.
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137
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Johnston B, McGill M, Milligan S, McElroy D, Foster C, Kearney N. Self care and end of life care in advanced cancer: literature review. Eur J Oncol Nurs 2009; 13:386-98. [PMID: 19501021 DOI: 10.1016/j.ejon.2009.04.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 03/31/2009] [Accepted: 04/03/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Self care is a key feature of health care policy in the UK. It has been suggested that self care by patients with cancer improves quality of life, symptom management, and patient satisfaction. However, little is known about self care and end of life care. OBJECTIVES This review sets out to find out what is known about how people experiencing end of life care manage their illness themselves, in the advanced stages of their disease. METHODS A systematic review was conducted; searching key databases; extracting relevant literature, using RefMan, NVIVO; grading, analysing, and appraising the literature. RESULTS Eighteen articles were included in the review. Themes identified were; interventions for end of life care; self care behaviours used by patients; factors that prevent patients to self care. CONCLUSION The nurses' role in supporting self care for people with advanced cancer is important. The review identifies various ways nurses can empower patients to self care related to oncology.
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Affiliation(s)
- Bridget Johnston
- Cancer Care Research Centre, Department of Nursing and Midwifery, University of Stirling,Stirling University Innovation Park, Stirling, UK.
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138
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Reynolds MAH. Postoperative Pain Management Discharge Teaching in a Rural Population. Pain Manag Nurs 2009; 10:76-84. [DOI: 10.1016/j.pmn.2008.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 07/18/2008] [Accepted: 07/24/2008] [Indexed: 11/17/2022]
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139
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140
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McDonald DD, Shea M, Rose L, Fedo J. The effect of pain question phrasing on older adult pain information. J Pain Symptom Manage 2009; 37:1050-60. [PMID: 19500724 PMCID: PMC2694581 DOI: 10.1016/j.jpainsymman.2008.06.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Revised: 06/02/2008] [Accepted: 06/16/2008] [Indexed: 11/22/2022]
Abstract
The aim of this study was to test how practitioners' pain communication affected the pain information provided by older adults. A post-test only, double-blind experiment was used to test how the phrasing of practitioners' pain questions-open-ended and without social desirability bias; closed-ended and without social desirability bias; or open-ended and with social desirability bias-affected the pain information provided by 312 community-living older adults with osteoarthritis pain. Older adults were randomly assigned to one of the three pain phrasing conditions to watch and orally respond to a computer-displayed videotape of a practitioner asking about their pain. All responded to a second videotape of the practitioner asking if there was anything further they wanted to communicate. Lastly, all responded to a third videotape asking if there was anything further they wanted to communicate about their pain. Transcripts of the audiotaped responses were content analyzed using 16 a priori criteria from national guidelines to identify important pain information for osteoarthritis pain management. Older adults described significantly more pain information in response to the open-ended question without social desirability. The two follow-up questions elicited significant additional information for all three groups, but did not compensate for the initial reduced pain information from the closed-ended and social desirability-biased groups. Initial use of an open-ended pain question without social desirability bias and use of follow-up questions significantly increase the amount of important pain information provided by older adults with osteoarthritis pain.
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Affiliation(s)
- Deborah Dillon McDonald
- University of Connecticut, School of Nursing, 231 Glenbrook Road, Storrs, CT 06269-2026, USA.
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141
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A randomized trial of a tailored barriers intervention for Cancer Information Service (CIS) callers in pain. Pain 2009; 144:49-56. [PMID: 19406576 DOI: 10.1016/j.pain.2009.02.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 01/27/2009] [Accepted: 02/23/2009] [Indexed: 11/22/2022]
Abstract
Cancer pain management can be improved by overcoming patients' attitudinal barriers to reporting pain and using analgesics. A simple cost-effective barriers intervention designed to reach a large number of persons with cancer has not yet been tested. Such an intervention should be tested against barriers' assessment-alone, as well as no-treatment control. The purpose of this study was to test the efficacy and the cost effectiveness of a tailored barriers intervention (TBI), an educational intervention tailored to participants' attitudinal barriers toward reporting pain and using analgesics. This was a randomized three-group (TBI, assessment-alone, or control) trial with measures at baseline and 28 days later conducted at the NorthCentral and Heartland offices of the Cancer Information Service (CIS), an NCI program that provides information to persons seeking answers to cancer-related questions. Participants (1256 adult CIS callers diagnosed with cancer with moderate to severe pain in the past week) joined the study and were randomized. Of these participants, 970 (77.23%) provided follow-up data. The TBI consisted of educational messages tailored to each participant's attitudinal barriers, delivered orally over the telephone, followed by a printed mailed copy. The outcome measures were attitudinal barriers to pain management, as well as pain outcomes (duration, severity, and interference with life activities). At follow-up the TBI group had significantly lower attitudinal barriers scores compared to assessment-alone and control, but the groups did not differ on the pain outcome variables. TBI and assessment-alone had similar cost effectiveness. The TBI needs to be strengthened to achieve reductions in pain severity.
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142
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Kahana E, Kahana B, Wykle M, Kulle D. Marshalling Social Support: A "Care-Getting" Model for Persons Living with Cancer. JOURNAL OF FAMILY SOCIAL WORK 2009; 12:168-193. [PMID: 20107524 PMCID: PMC2811383 DOI: 10.1080/10522150902874834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This paper offers a stress theory based conceptual framework for understanding proactive options for care-getting for patients living with cancer that is also relevant to patients living with other chronic or life threatening illnesses. Barriers and facilitators to active efforts for obtaining responsive care from both informal and formal sources are discussed. This "Care-Getting" model explores benefits of proactive care-getting for diminishing physical discomfort/suffering, burden of illness and disability, and psychological distress. We highlight unique issues in care-getting that patients face at different stages of the life course. Implications of prior research related to the model for practice and intervention are discussed.
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Affiliation(s)
- Eva Kahana
- Department of Sociology, Case Western Reserve University, Cleveland, OH, USA
| | - Boaz Kahana
- Department of Psychology, Cleveland State University, Cleveland, OH, USA
| | - May Wykle
- Department of Sociology, Case Western Reserve University, Cleveland, OH, USA
| | - Diana Kulle
- Department of Sociology, Case Western Reserve University, Cleveland, OH, USA
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143
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Bennett MI, Bagnall AM, Closs JS. How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis. Pain 2009; 143:192-199. [PMID: 19285376 DOI: 10.1016/j.pain.2009.01.016] [Citation(s) in RCA: 172] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 01/07/2009] [Accepted: 01/13/2009] [Indexed: 01/11/2023]
Abstract
This review aimed to quantify the benefit of patient-based educational interventions in the management of cancer pain. We undertook a systematic review and meta-analysis of experimentally randomised and non-randomised controlled clinical trials identified from six databases from inception to November 2007.Two reviewers independently selected trials comparing intervention (formal instruction on cancer pain and analgesia on an individual basis using any medium) to usual care or other control in adults with cancer pain. Methodological quality was assessed, and data extraction undertaken by one reviewer with a second reviewer checking for accuracy. We used random effects model to combine the effect estimates from studies. Main outcome measures were effects on knowledge and attitudes towards cancer pain and analgesia, and pain intensity. Twenty-one trials (19 randomised) totalling 3501 patients met inclusion criteria, and 15 were included in the meta-analysis. Compared to usual care or control, educational interventions improved knowledge and attitudes by half a point on 0-5 rating scale (weighted mean difference 0.52, 95% confidence interval 0.04-1.0), reduced average pain intensity by over one point on 0-10 rating scale (WMD -1.1, -1.8 to -0.41) and reduced worst pain intensity by just under one point (WMD -0.78, -1.21 to -0.35). We found equivocal evidence for the effect of education on self-efficacy, but no significant benefit on medication adherence or on reducing interference with daily activities. Patient-based educational interventions can result in modest but significant benefits in the management of cancer pain, and are probably underused alongside more traditional analgesic approaches.
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Affiliation(s)
- Michael I Bennett
- International Observatory on End of Life Care, Institute for Health Research, Lancaster University, Lancaster LA1 4YT, UK Faculty of Health, Leeds Metropolitan University, Calverley Street, Leeds LS1 3HE, UK School of Healthcare, University of Leeds, Leeds LS2 9UT, UK
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144
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Rustøen T, Gaardsrud T, Leegaard M, Wahl AK. Nursing Pain Management—A Qualitative Interview Study of Patients with Pain, Hospitalized for Cancer Treatment. Pain Manag Nurs 2009; 10:48-55. [DOI: 10.1016/j.pmn.2008.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2008] [Revised: 09/06/2008] [Accepted: 09/23/2008] [Indexed: 10/21/2022]
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145
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Oldenmenger WH, Sillevis Smitt PAE, van Dooren S, Stoter G, van der Rijt CCD. A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: a critical appraisal. Eur J Cancer 2009; 45:1370-80. [PMID: 19201599 DOI: 10.1016/j.ejca.2009.01.007] [Citation(s) in RCA: 183] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 01/06/2009] [Indexed: 01/31/2023]
Abstract
The aim of this paper is to identify the major barriers hindering adequate pain management and critically review interventions aiming to overcome them. We searched relevant literature on PubMed published between January 1986 and April 2007. The most frequently mentioned barriers for both patients and professionals were knowledge deficits, inadequate pain assessment and misconceptions regarding pain. Four interventions were identified: patient education, professional education, pain assessment and pain consultation. These interventions were never combined in multidisciplinary study protocols. Most RCTs included small groups of patients and reported no power analysis. Studies on professional education and pain assessment did not evaluate patients' outcomes. In 5 of 11 RCTs on patient education, pain intensity decreased statistically significantly. In two RCTs on pain consultation, patients' pain decreased statistically significantly, although the adequacy of pain treatment did not change. In conclusion, international guidelines on multidisciplinary interventions in pain management are partly substantiated by clinical trials.
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Affiliation(s)
- Wendy H Oldenmenger
- Department of Medical Oncology, Erasmus MC, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands
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146
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McCorkle R, Dowd M, Ercolano E, Schulman-Green D, Williams AL, Siefert ML, Steiner J, Schwartz P. Effects of a nursing intervention on quality of life outcomes in post-surgical women with gynecological cancers. Psychooncology 2009; 18:62-70. [PMID: 18570223 PMCID: PMC4186244 DOI: 10.1002/pon.1365] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Women with gynecological cancers have reported poor health-related quality of life (QOL), with complex physical and psychological needs post-surgery and during chemotherapy treatment. There are no studies reporting interventions addressing these needs post-hospital discharge in this population. METHODS Patients were randomized into two groups. The intervention group received 6 months of specialized care by an Advanced Practice Nurse (APN); in addition, women with high distress were evaluated and monitored by a psychiatric consultation-liaison nurse (PCLN). The attention control group was assisted with symptom management by a research assistant. The effects of the 6-month intervention were evaluated using self-report questionnaires at baseline (24-48 h after surgery), 1, 3, and 6 months post- surgery. QOL assessments included the Center for Epidemiological Studies-Depression Scale , the ambiguity subscale of the Mishel Uncertainty in Illness Scale , the Symptom Distress Scale, and the Short-Form Health Survey (SF-12). The sample for the longitudinal analysis included 123 who completed QOL outcome measures across three occasions post-surgery. RESULTS The APN intervention resulted in significantly less uncertainty than the attention control intervention 6 months after surgery. When the sub-group who received the APN plus PCLN intervention was compared with the total attention control group, the sub-group had significantly less uncertainty, less symptom distress, and better SF-12 mental and physical QOL over time. CONCLUSION Nurse tailored interventions that target both physical and psychological aspects of QOL in women recovering from cancer surgery and undergoing chemotherapy produce stronger outcomes than interventions that target solely one QOL aspect.
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Affiliation(s)
- Ruth McCorkle
- Yale School of Nursing, Center for Excellence in Chronic Illness Care, New Haven, Connecticut 06536-0740, USA.
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147
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van der Peet EH, van den Beuken-van Everdingen MHJ, Patijn J, Schouten HC, van Kleef M, Courtens AM. Randomized clinical trial of an intensive nursing-based pain education program for cancer outpatients suffering from pain. Support Care Cancer 2008; 17:1089-99. [PMID: 19104843 PMCID: PMC2707949 DOI: 10.1007/s00520-008-0564-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 12/09/2008] [Indexed: 11/30/2022]
Abstract
Introduction The prevalence of pain in patients with cancer is still too high. Factors relating to ineffective pain treatment fall into three categories: the health care system, professional care providers, and patients. In patients, various barriers lead to noncompliance. Previous educational interventions have increased their knowledge of pain and decreased short-term pain levels. In this randomized controlled trial, the authors investigated how an intensive home-based education program given by nurses affected short-term and long-term pain levels. Materials and methods One hundred and twenty cancer patients were randomized to receive either the pain education program (PEP) or usual care. Pain, knowledge, quality of life, anxiety, and depression were measured at baseline and after 4 and 8 weeks. In the intervention group, effects on symptom levels were communicated to the treating physician. Results The level of pain had decreased at 4 weeks, but not at 8 weeks. Significant decreases in pain only persisted in those patients with a high pain score at baseline. Knowledge of pain significantly increased in the intervention group. No correlation was found between increased pain knowledge and decreased pain levels. Conclusions The PEP given by nurses lowered pain intensity levels in cancer patients and increased their knowledge of pain. More attention should be paid to patient education and to communication between patients and health professionals regarding pain and pain management.
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Affiliation(s)
| | | | - Jacob Patijn
- Department of Anesthesiology, Pain Management and Research Centre, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Harry C. Schouten
- Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Maarten van Kleef
- Department of Anesthesiology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Annemie M. Courtens
- Department of Transmural Care, University Hospital Maastricht, Maastricht, The Netherlands
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148
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McDonald DD, Shea M, Fedo J, Rose L, Bacon K, Noble K, Stewart J. Older Adult Pain Communication and the Brief Pain Inventory Short Form. Pain Manag Nurs 2008; 9:154-9, 159.e1-2. [DOI: 10.1016/j.pmn.2008.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 02/29/2008] [Accepted: 03/03/2008] [Indexed: 10/21/2022]
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149
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Wilson PM. The UK Expert Patients Program: lessons learned and implications for cancer survivors' self-care support programs. J Cancer Surviv 2008; 2:45-52. [PMID: 18648986 DOI: 10.1007/s11764-007-0040-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Globally, the enablement of self-care is increasingly being recognised as an essential component of chronic disease management. Within the UK a key self-care policy initiative is the Expert Patients Program. Developed from the Chronic Disease Self-Management Program, this is a 6 week self-management education program for people with different chronic diseases, facilitated by lay volunteers. As an example of a major public health initiative designed to enhance self-management in long-term conditions, this paper draws on evaluations of the EPP and CDSMP and analyzes the implications for the development of similar programs for cancer survivors. There are a number of evaluations of the CDSMP which suggest significant improvement in participants' chronic disease management self-efficacy and some evidence of healthcare utilization reduction. However, whilst the national evaluation of the EPP demonstrated similar improvements in self-efficacy and health status, there was no significant effect on healthcare utilization. Trials of such programs need to be treated with some caution as participants are often not typical of the general population, and as a complex intervention effectiveness is inherently difficult to assess. Qualitative evaluations revealed that the EPP's strength was derived mainly through peer support and learning. Nevertheless, a number of contextual problems were identified including recruitment, clinicians' lack of engagement with the program and inflexible course materials. Lay-led self-care support programs such as the EPP have a significantly positive effect on self-efficacy which could be of benefit to cancer survivors. However, a number of lessons should be learned from the EPP when developing similar initiatives for cancer survivors.
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Affiliation(s)
- Patricia M Wilson
- Centre for Research in Primary & Community Care, University of Hertfordshire, College Lane, Hatfield, AL10 9AB, UK.
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Chesla CA. Translational research: essential contributions from interpretive nursing science. Res Nurs Health 2008; 31:381-90. [PMID: 18231973 DOI: 10.1002/nur.20267] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Translating research into practice is a central priority in the National Institutes of Health Roadmap. Nurse scientists must reevaluate how proposed research fits within and contributes not only to the development of new knowledge, but to the translation of that knowledge to the care of diverse communities and populations. Key barriers to the translation of evidence based practices in health programs and initiatives have been identified in the health services and nursing literature. Contributions that interpretive research approaches enable in addressing those barriers are articulated.
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Affiliation(s)
- Catherine A Chesla
- Department of Family Health Care Nursing, University of California, San Francisco, 2 Koret Way, San Francisco, CA 94143-0606, USA
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