A randomized controlled trial of a standardized educational intervention for patients with cancer pain

Nursing Support for Pain in Patients With Cancer: A Scoping Review

Pain is subjective, warranting tailored responses in pharmacotherapy and nursing support. Despite this, the evidence for suitable nursing support for pain is not well established in terminally ill patients such as those with cancer; therefore, it is necessary to provide support in consideration of changes in physical symptoms and quality of life. However, interventional studies for such patients are often difficult. There have been no comprehensive studies to date on non-pharmacological support that can be implemented by nurses. Therefore, with the aim of examining nursing support applicable at the end of life, this scoping review comprehensively mapped nursing support for pain in cancer patients at all stages of the disease. This study complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Arksey and O'Malley framework. All available published articles from the time of database establishment to January 31, 2022, were systematically searched for in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), CENTRAL, and the Ichushi Web database of the Japanese Society of Medical Abstracts. Overall, 10,385 articles were screened, and 72 were finally included. Both randomized controlled trials (RCTs) (n = 62) and non-RCTs (n = 10) were included. Twenty-two types of nursing support were identified. Eighteen of them showed positive results; five of them were provided only to terminally ill patients, three of which were effective, namely, comfort care, foot bath, and combined therapy. It is important to examine the applicability of types of nursing support in clinical practice in the future.

Randomized controlled study of pain education in patients receiving radiotherapy for painful bone metastases

BACKGROUND

Although short-course radiotherapy is an effective treatment for patients with painful bone metastases, pain is not always sufficiently controlled. We therefore investigated the additional effect of a nurse-led pain education program on pain control and quality of life (QoL).

PATIENTS AND METHODS

In this multicenter study, patients with solid tumor bone metastases and a worst pain intensity of ≥5 on a 0-10 numeric rating scale (NRS) were randomized between care as usual (control-group) and care as usual plus the Pain Education Program (PEP-group). PEP consisted of a structured interview and personalized education with follow-up phone calls. Patients completed the Brief Pain Inventory, EORTC QLQ-C15-PAL and BM22 at week 0, 1, 4, 8 and 12. The primary outcome was pain control, defined as the number of patients whose worst pain intensity was <5 on a 0-10 NRS after 12 weeks. Secondary outcomes were time to reach control of pain (NRS < 5), mean worst pain and average pain, and QoL at weeks 1, 4, 8 and 12.

RESULTS

Of 308 included patients, 182 (92 PEP-group) completed 12 weeks follow-up. At 12 weeks, more patients in the PEP-group (71%) compared to the control-group (52%) reported pain control (P =.008). In the PEP-group, pain control was reached earlier than in the control-group (median 29 days versus 56 days; P =.003). Mean worst and average pain decreased in both groups but decreased more in the PEP-group. QoL did not differ between the groups.

CONCLUSION

The addition of PEP to care as usual for patients treated with radiotherapy for painful bone metastases resulted in less pain and faster pain control.

Effect of Educational Tools on the use of Patient-Controlled Analgesia Devices

Objective

In the literature, there are confusing data about educational tools and device use. Therefore, it is not clear which method is superior to the other. The aim of this study was to evaluate the effects of educational tools on patient-controlled analgesia (PCA) usage in patients undergoing hysterectomy.

Methods

Ninety-six patients undergoing hysterectomy were enrolled in the study. Patients were randomly assigned to a group (verbal, brochure, or video) consisting of 32 patients each using the closed envelope method. After operations, all patients were sent to the ward and evaluated with numerical rating scale score for pain at 15^th min., 2^nd, 4^th, 6^th, 12^th, 18^th, 2^nd, 4^th, 6^th, 12^th, 18^th, 24^th hours. Given dose, the number of button presses, presence of nausea and vomiting, and static and dynamic pain scores were recorded. During visits, patients who had a pain score ≥4 were administered paracetamol 1 g IV. Ondansetron 8 mg IV was injected into patients who had nausea and vomiting.

Results

No significant differences were determined in resting and dynamic pain scores, number of button presses, and given doses between groups at 15^th min., 2^nd, 4^th, 6^th, 12^th, 18^th, 24^th hours.

Conclusion

In this study, education type did not affect PCA device use. We believe that whatever method the infrastructure of hospitals is suitable for, should be used for PCA device education.

Pain experience of cancer patients receiving care in a multidisciplinary pain management clinic

BACKGROUND

Few longitudinal studies have focused on patients' cancer pain experience when receiving care in a multidisciplinary pain management clinic (MPMC). This study aimed to evaluate the experiences of a cohort of cancer patients newly engaged in a MPMC.

METHODS

This study was based on a longitudinal approach in which data were collected over a 6 months period at the King Hussein Cancer Centre in Jordan. The study adopted the Arabic version of the Brief Pain Inventory to identify the level and prevalence of cancer pain, and to identify the impact of receiving care at the MPMC on patients' pain experience. Data were collected over four time points, and the period between these points ranged from 2 to 3 weeks.

RESULTS

The majority of patients demonstrated improvement in their pain after receiving treatment at the MPMC, while a third still experienced severe pain. Significant improvement was reported at T1, and no further decline in pain was noted after this point. This indicates that exposure to the intervention provided by the MPMC generated, on average, an improvement in patients' pain experience.

CONCLUSION

The MPMC may be an effective pain management strategy in the treatment of cancer pain.

A systematic review and meta-analysis of digital application use in clinical research in pain medicine

IMPORTANCE

Pain is a silent global epidemic impacting approximately a third of the population. Pharmacological and surgical interventions are primary modes of treatment. Cognitive/behavioural management approaches and interventional pain management strategies are approaches that have been used to assist with the management of chronic pain. Accurate data collection and reporting treatment outcomes are vital to addressing the challenges faced. In light of this, we conducted a systematic evaluation of the current digital application landscape within chronic pain medicine.

OBJECTIVE

The primary objective was to consider the prevalence of digital application usage for chronic pain management. These digital applications included mobile apps, web apps, and chatbots.

DATA SOURCES

We conducted searches on PubMed and ScienceDirect for studies that were published between 1st January 1990 and 1st January 2021.

STUDY SELECTION

Our review included studies that involved the use of digital applications for chronic pain conditions. There were no restrictions on the country in which the study was conducted. Only studies that were peer-reviewed and published in English were included. Four reviewers had assessed the eligibility of each study against the inclusion/exclusion criteria. Out of the 84 studies that were initially identified, 38 were included in the systematic review.

DATA EXTRACTION AND SYNTHESIS

The AMSTAR guidelines were used to assess data quality. This assessment was carried out by 3 reviewers. The data were pooled using a random-effects model.

MAIN OUTCOMES AND MEASURES

Before data collection began, the primary outcome was to report on the standard mean difference of digital application usage for chronic pain conditions. We also recorded the type of digital application studied (e.g., mobile application, web application) and, where the data was available, the standard mean difference of pain intensity, pain inferences, depression, anxiety, and fatigue.

RESULTS

38 studies were included in the systematic review and 22 studies were included in the meta-analysis. The digital interventions were categorised to web and mobile applications and chatbots, with pooled standard mean difference of 0.22 (95% CI: -0.16, 0.60), 0.30 (95% CI: 0.00, 0.60) and -0.02 (95% CI: -0.47, 0.42) respectively. Pooled standard mean differences for symptomatologies of pain intensity, depression, and anxiety symptoms were 0.25 (95% CI: 0.03, 0.46), 0.30 (95% CI: 0.17, 0.43) and 0.37 (95% CI: 0.05, 0.69), respectively. A sub-group analysis was conducted on pain intensity due to the heterogeneity of the results (I ² = 82.86%; p = 0.02). After stratifying by country, we found that digital applications were more likely to be effective in some countries (e.g., United States, China) than others (e.g., Ireland, Norway).

CONCLUSIONS AND RELEVANCE

The use of digital applications in improving pain-related symptoms shows promise, but further clinical studies would be needed to develop more robust applications.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier: CRD42021228343.

mHealth Self-Management System to Supporting Children with a Acute Lymphocytic Leukemia (ALL) and their caregivers in low-middle income country: Qualitative Co-Design Study (Preprint)

Background

The unique features of smartphones have extended their use in different fields, especially in the health care domain. These features offer new opportunities to support patients with chronic conditions by providing them with information, education, and self-management skills. We developed a digital self-management system to support children with cancer and their caregivers in Iran (low- and middle-income country).

Objective

This study is aimed at the development and preliminary evaluation of a cancer self-management system (CanSelfMan) tailored to the needs of children with cancer and their parents or caregivers.

Methods

This study was conducted in collaboration with a multidisciplinary team between January and February 2020 at MAHAK’s Pediatric Cancer Treatment and Research Center. We developed a self-management system in six stages: requirement analysis, conformity assessment, preparation of educational content, app prototyping, preliminary evaluation, and developing the final version.

Results

A total of 35 people (n=24, 69% parents and n=11, 31% children) volunteered to participate in the study. However, only 63% (15/24) of parents and 73% (8/11) of children were eligible to participate. By adopting a user-centered design approach, we developed a mobile app, CanSelfMan, that includes five main modules (knowledge base, self-management tips, self-assessment report, ask a question, and reminders) that provide access to reliable information about acute lymphocytic leukemia and the self-management skills required for side effect measurement and reporting. A web-based dashboard was also developed for oncologists and included a dashboard to monitor users’ symptoms and answer their questions.

Conclusions

The CanSelfMan app can support these groups by providing access to reliable information about cancer, facilitating communication between children or parents and health care providers, and helping promote medication adherence through a reminder function. The active participation of the target group can help identify their needs. Therefore, through the involvement of stakeholders such as patients, caregivers, and oncologists in the design process, we improved usability and ensured that the final product was useful. This app is now ready to proceed with feasibility studies.

A living systematic review to assess the analgesic undertreatment in cancer patients

This living, systematic review aims to provide an updated summary of the available evidence on pain undertreatment prevalence in patients with cancer; correlations with some potential determinants and confounders were also carried out. We updated a systematic review published in 2014, including observational and experimental studies reporting the use of the pain management index (PMI) in adults with cancer and pain, from 2014 to 2020. We conducted searches in PubMed/MEDLINE, Embase, and Google Scholar. We performed univariate and multivariable regression analyses to describe the relationship between PMI and a list of potential explanatory variables. Twenty new papers were identified, yielding a total sample size of 66 studies. The proportion of patients classified as undertreated according to the year of study publication shows a higher decrease from 1994 to 2013 (-13% as relative change) than the most recent years 2014-2020 (-11%). The quality of the included studies has increased over the years (from 80% to 93%). At the multivariable analysis, a statistically significant relationship was confirmed between undertreatment and the year of the publication of the study and with a low-medium economic level of the countries where the studies were conducted. Despite the improvement when compared to the period 1994-2000,-still about 40% of the cases identified received an analgesic treatment inadequate to the intensity of pain, according to the PMI. Despite its intrinsic limitations, PMI continues to be widely used and it could allow a continuous monitoring of pain management across a different mix of studies and patients.

Video Education Reduces Pain and Anxiety Levels in Cancer Patients Who First Use Fentanyl Transdermal Patch: A Randomized Controlled Trial

Objective

We sought to evaluate the efficacy of using a quick response (QR) code within video education to guide proper use of fentanyl transdermal patches and control pain, depression, and anxiety levels in cancer patients.

Methods

Patients using a fentanyl transdermal patch for the first time were enrolled in the study and then given an information leaflet as well as an informed consent form. We asked them to complete the first questionnaire (Q1) prior to first use of the fentanyl transdermal patch, and then used a random number table to randomize those who completed it into two groups. Participants in group A received a QR code (to make it easier for them to obtain additional video information) and a traditional information leaflet, whereas those in group B (control group) only received a traditional information leaflet. Thereafter, we requested all participants to complete standard questionnaires, which comprised a Numeric Rating Scale (NRS), a Spielberger State-Trait Anxiety Inventory (STAI), as well as a Hospital Anxiety and Depression Scale (HADS). The resulting continuous (with a normal distribution) and categorical data were analyzed using Student’s t- and chi-square tests, respectively. We also recorded parameters such as NRS, STAI, and HADS, as well as the frequency of rescue medication in both groups.

Results

A total of 154 cancer patients who first used a fentanyl transdermal patch were recruited during the study period, from April to May 2020. Among these, 138 completed follow-up, with 70 and 68 in group A and B, respectively. Participants in both groups had similar baseline and clinical characteristics, whereas significant differences were observed between the groups with regard to the other parameters. Specifically, participants in group A recorded a lower STAI state (38.2 vs 38.9, P=0.027) and HADS (3.9 vs 4.2, P=0.001) anxiety scores, as well as NRS (2.1 vs 2.4, P=0.025) and frequency of rescue medication (0.4 vs 1.4, P<0.001) than those in group B, following 14 days of using a fentanyl transdermal patch.

Conclusion

Our results indicated that incorporating a QR code within additional video education leads to proper use of a fentanyl transdermal patch and relieves pain and anxiety levels in patients with cancer. Based on this, we recommend a new style of education during care of cancer patients who first use a fentanyl transdermal patch.

An evaluation of cancer patients' opinions about use of opioid analgesics and the role of clinical pharmacist in patient education in Turkey

Background Patients' potential misconceptions and concerns about using opioids are among the primary causes of patient-related barriers that may lead to failure in pain management. These barriers can be eliminated through educational interventions, thus achieving better pain management. Objective The aim of this study was to assess patients' beliefs about opioids, reduce the impact of patient-related barriers through educational intervention by a clinical pharmacist, and improve patients' adherence to opioid analgesic treatment. Setting The study was conducted in the Hacettepe University Training and Research Oncology Hospital, Department of Algology in Ankara, Turkey. Method A prospective study conducted between September, 2018 and May, 2019. Patients were included who had been diagnosed with cancer, had been prescribed opioid analgesics, and who attended the pain unit during the period this study was conducted. Patients' beliefs about opioids were assessed using the Beliefs about Medicine Questionnaire (BMQ) right before and 1 month after an educational intervention was provided by a clinical pharmacist. Also, patients' adherence to the opioid regimen was assessed using a validated Self-Report Measure of Adherence questions in Turkish. Main outcome measure The mean scores of the BMQ Necessity Subscale and Concern Subscale, and a level of adherence to opioid treatment. Results Sixty patients who met the inclusion criteria were included and follow-up was completed with 38 patients. Although an increase was detected in the total score of the Necessity subscale after provision of education (p = 0.398), a statistically significant (p < 0.001) decrease was found in the total score of the 'Concern' subscale, which suggests that patients believe the benefits of opioids outweigh the risks. The patients' pain scores were decreased (p = 0.004); furthermore a significant increase was found in the adherence scores (3.16-3.55) (p = 0.027), and a high level of adherence was observed among the patients in the post-education assessment (p = 0.021). Conclusion The integration of a clinical pharmacist into the pain management team may have a positive impact on the patients' knowledge, concerns and misconceptions about opioids, which may improve adherence and effective pain management in cancer treatment.

Long-term sustainability of a quality improvement program on cancer pain management: a complex intervention in an inpatient setting

Background:

Several approaches towards pain control for admitted cancer patients have been suggested by the literature without achieving satisfactory results. In this quality improvement project, we proposed a multicomponent intervention.

Measures:

A set of indicators was established for each component of the project. The feasibility of both the intervention and its evaluation system was measured. According to the literature review and the analysis of the local context, 5 active components were identified, piloted, and assessed: training of ward professionals, education of patients and nonprofessional caregivers, regular pain assessment, specialist-level pain consultation procedures, and involvement of hospital management.

Results:

Multiprofessional training programs with daily discussions, daily pain assessment, and a readily available specialized palliative care service seem to be the active components of this complex intervention. The quality improvement project achieved 2 years sustainability.

Conclusion:

Consolidated educational and organizational methodologies support the feasibility of this complex intervention.

Psychosocial interventions for advanced cancer patients: A systematic review

OBJECTIVE

Psychosocial care for advanced cancer encompasses a wide range of interventions that help patients make life-changing decisions, manage debilitating symptoms, confront impending mortality, and improve other patient outcomes. Psychosocial care is becoming increasingly available to advanced cancer patients; however, an overview of the various types of interventions is lacking.

METHODS

The current review systematically examined randomised-controlled trials of psychosocial interventions for advanced cancer patients from January 2007 to June 2018. MEDLINE, CINAHL Plus, PsycINFO, and Scopus databases were searched, and a total of 68 studies were included in the review.

RESULTS

We found a range of psychosocial interventions studies and grouped them based on six theoretical/clinical approaches: cognitive behavioural therapy based; meaning enhancing; dignity, life review, and narrative; other counselling; education only; and music, writing, and others. The different psychosocial interventions had significantly varied characteristics (eg, format, duration, and resources used) to address issues faced by advanced cancer patients. There is compelling evidence for the use of meaning-centred psychotherapy to improve meaning and quality of life and use of question prompt lists and communication skills training to improve communication with health care providers.

CONCLUSIONS

Some psychosocial interventions are further along in establishing evidence for effectiveness. Our findings demonstrate a growing capacity within the field to meet the psychosocial needs of advanced cancer patients. Lessons and direction in clinical practice and future research endeavours are discussed.

Development of a cancer pain self-management resource to address patient, provider, and health system barriers to care

OBJECTIVE

The majority of self-management interventions are designed with a narrow focus on patient skills and fail to consider their potential as "catalysts" for improving care delivery. A project was undertaken to develop a patient self-management resource to support evidence-based, person-centered care for cancer pain and overcome barriers at the levels of the patient, provider, and health system.

METHOD

The project used a mixed-method design with concurrent triangulation, including the following: a national online survey of current practice; two systematic reviews of cancer pain needs and education; a desktop review of online patient pain diaries and other related resources; consultation with stakeholders; and interviews with patients regarding acceptability and usefulness of a draft resource.

RESULT

Findings suggested that an optimal self-management resource should encourage pain reporting, build patients' sense of control, and support communication with providers and coordination between services. Each of these characteristics was identified as important in overcoming established barriers to cancer pain care. A pain self-management resource was developed to include: (1) a template for setting specific, measureable, achievable, relevant and time-bound goals of care, as well as identifying potential obstacles and ways to overcome these; and (2) a pain management plan detailing exacerbating and alleviating factors, current strategies for management, and contacts for support.

SIGNIFICANCE OF RESULTS

Self-management resources have the potential for addressing barriers not only at the patient level, but also at provider and health system levels. A cluster randomized controlled trial is under way to test effectiveness of the resource designed in this project in combination with pain screening, audit and feedback, and provider education. More research of this kind is needed to understand how interventions at different levels can be optimally combined to overcome barriers and improve care.

Effectiveness of nursing interventions among patients with cancer: An overview of systematic reviews

AIMS AND OBJECTIVES

To explore nursing interventions used among patients with cancer and summarise the results of their effectiveness. The ultimate goal was to improve the quality of care and provide best evidence for clinicians to refer to while developing effective nursing interventions.

BACKGROUND

Nursing interventions refer to actions that nurses take with the aim of improving the well-being of people with cancer-related health and care needs. A plethora of systematic reviews has been conducted in this research area, although with scattered results. We conducted a comprehensive review to identify and summarise the existing evidence.

METHODS

This overview of systematic reviews adheres to the PRISMA guidelines. The PubMed, CINAHL, MEDLINE and Scopus databases were searched. Nine reviews reporting findings from 112 original studies published 2007-2017 met the selection criteria. The results of intervention effectiveness were analysed using descriptive quantification and a narrative summary of the quantitative data.

RESULTS

The effectiveness of educational nursing interventions was inconsistent on quality of life (QoL), attitudes, anxiety and distress, but positive on level of knowledge, symptom severity, sleep and uncertainty. Psychosocial nursing interventions had a significant effect on spiritual well-being, meaning of life, fatigue and sleep. Psychological nursing interventions reduced cancer-related fatigue. Nursing interventions supporting patients' coping had a significant impact on anxiety, distress, fatigue, sleep, dyspnoea and functional ability. Activity-based interventions may prevent cancer-related fatigue.

CONCLUSIONS

Nursing interventions achieved significant physical and psychological effects on the lives of patients with cancer. Multidimensional nature of interventions by combining different elements reinforces the effect. Priorities for future research include identifying the most beneficial components of these interventions.

RELEVANCE TO CLINICAL PRACTICE

Implementation of these nursing interventions into clinical practice is important to improve patients' knowledge and QoL as well as reducing various symptoms and side effects related to cancer and its treatment.

Protocol for a phase III pragmatic stepped wedge cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of screening and guidelines with, versus without, implementation strategies for improving pain in adults with cancer attending outpatient oncology and palliative care services: the Stop Cancer PAIN trial

BACKGROUND

Pain is a common and distressing symptom in people with cancer, but is under-recognised and under-treated. Australian guidelines for 'Cancer Pain Management in Adults' are available on the Cancer Council Australia Cancer Guideline Wiki. This study aims to evaluate the effectiveness and cost-effectiveness of a suite of guideline implementation strategies for improving pain outcomes in adults with cancer in oncology and palliative care outpatient settings.

METHODS

The study will use a stepped-wedge cluster randomised controlled design, with oncology and palliative care outpatient services as the clusters. Patients will be eligible if they are adults with cancer and pain presenting to participating services during the study period. During an initial control arm, services will routinely screen patients for average and worst pain over the past 24 h using a 0-10 numerical rating scale (NRS) and have unfettered access to online guidelines. During the intervention arm, staff at each service will be encouraged to use: 1) a patient education booklet and self-management resource; 2) an online spaced learning cancer pain education module for clinicians from different disciplines; and 3) audit and feedback of service performance on key indices of cancer pain screening, assessment and management. Service-based clinical change champions will lead implementation of these strategies. The trial's primary outcome will be the probability that patients initially screened as having moderate-severe (≥5/10 NRS) worst pain experience a clinically important improvement one week later, defined as  ≥ 30% reduction. Secondary outcomes will include patient empowerment and quality of life, carer experience, and cost-effectiveness. For the main analysis, linear mixed models will be used, accounting for clustering and the longitudinal design. Eighty-two patients per service at six services (N = 492) will provide > 90% power. A qualitative sub-study and analyses of structural and process factors will explore opportunities for further refinement and tailoring of the intervention.

DISCUSSION

This pragmatic trial will inform implementation of guidelines across a range of oncology and palliative care outpatient service contexts. If found effective, the implementation strategies will be made freely available on the Wiki alongside the guidelines.

TRIAL REGISTRATION

Registered 23/01/2015 on the Australian New Zealand Clinical Trials Registry ( ACTRN12615000064505 ).

A Randomized, Single-Blind Study Evaluating the Effect of a Bone Pain Education Video on Reported Bone Pain in Patients with Breast Cancer Receiving Chemotherapy and Pegfilgrastim

BACKGROUND

Mild-to-moderate bone pain is the most commonly reported adverse event associated with pegfilgrastim.

AIMS

To investigate the effect of bone pain education on pegfilgrastim-related bone pain in patients with breast cancer receiving chemotherapy and pegfilgrastim.

DESIGN

Randomized, single-blind study.

SETTINGS

Forty-eight community oncology clinics throughout the United States.

PARTICIPANTS

Three hundred women ≥18 years of age with newly diagnosed stage I -III breast cancer, who were planning ≥4 cycles of neoadjuvant or adjuvant chemotherapy with pegfilgrastim support starting in cycle 1.

METHODS

Patients were randomized 1:1 to view a general education DVD on chemotherapy side effects (GE-DVD) or a DVD on bone pain following chemotherapy and pegfilgrastim (BP-DVD). Patients recorded severity of bone pain on a scale of 0-10, location of pain, and use of bone pain medications (i.e., analgesics, antihistamines, and nonsteroidal anti-inflammatory drugs) for 5 days, beginning on the day of pegfilgrastim administration, in each of the first four chemotherapy cycles.

RESULTS

Patient-reported maximum bone pain was similar in the two groups (GE-DVD vs BP-DVD: cycle 1, 3.2 vs. 3.5, p = .3479; across all cycles, 4.1 vs. 4.6, p = .2196). Other measures of bone pain were also similar between the groups. Bone pain was highest in cycle 1 but decreased and then remained stable in subsequent cycles. Bone pain medication use was similar in both groups and was highest in cycle 1.

CONCLUSIONS

The bone pain-specific education evaluated here did not improve perceptions of bone pain reported in this patient population.

Nonpharmacologic Pain Interventions: A Review of Evidence-Based Practices for Reducing Chronic Cancer Pain

BACKGROUND

Pain is a common issue for patients with cancer and can be challenging to manage effectively. Healthcare professionals need to be knowledgeable about evidence-based nonpharmacologic interventions.
.

OBJECTIVES

This systematic review critically appraises the strength and quality of the empirical evidence for nonpharmacologic interventions in reducing chronic cancer pain.
.

METHODS

Intervention studies were critically appraised and summarized by an Oncology Nursing Society Putting Evidence Into Practice team of RNs, advanced practice nurses, and nurse scientists. A level of evidence and a practice recommendation was assigned to each intervention.
.

FINDINGS

Based on evidence, recommended interventions to reduce chronic cancer pain are celiac plexus block for pain related to pancreatic and abdominal cancers and radiation therapy for bone pain. Although psychoeducational interventions are considered likely to be effective, the effective components of these interventions and their dose and duration need to be determined through additional research.

Video-based patient decision aids: A scoping review

OBJECTIVE

This study reviews the published literature on the use of video-based decision aids (DA) for patients. The authors describe the areas of medicine in which video-based patient DA have been evaluated, the medical decisions targeted, their reported impact, in which countries studies are being conducted, and publication trends.

METHOD

The literature review was conducted systematically using Medline, Embase, CINAHL, PsychInfo, and Pubmed databases from inception to 2016. References of identified studies were reviewed, and hand-searches of relevant journals were conducted.

RESULTS

488 studies were included and organized based on predefined study characteristics. The most common decisions addressed were cancer screening, risk reduction, advance care planning, and adherence to provider recommendations. Most studies had sample sizes of fewer than 300, and most were performed in the United States. Outcomes were generally reported as positive. This field of study was relatively unknown before 1990s but the number of studies published annually continues to increase.

CONCLUSION

Videos are largely positive interventions but there are significant remaining knowledge gaps including generalizability across populations.

PRACTICE IMPLICATIONS

Clinicians should consider incorporating video-based DA in their patient interactions. Future research should focus on less studied areas and the mechanisms underlying effective patient decision aids.

A Systematic Review of the Patient- and Carer-Related Factors Affecting the Experience of Pain for Advanced Cancer Patients Cared for at Home

CONTEXT

Effective pain management is a priority in the palliative care of advanced cancer patients. A body of research is emerging examining the factors that influence the management and experience of pain for such individuals. Identifying such factors should allow for the development of targeted interventions to improve pain management in the home while ultimately reducing unnecessary suffering for the patient.

OBJECTIVES

The objective of this study was to identify relevant patient- and carer-related factors which have an effect on the pain experienced by advanced cancer patients cared for at home.

METHOD

This is a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement guidelines. Studies were retrieved from the CINAHL, MEDLINE, and Web of Science and assessed independently by two reviewers with discrepancies assessed by a third before quality assessment and data extraction. A narrative synthesis was produced.

RESULTS

Our search strategy produced 720 hits, of which 10 studies were retained for the final analysis. The factors identified included carer knowledge of cancer pain management, carer burden, carer and patient distress, pain rating disparity, patient well-being, patient depression, patient affective experience, patient body image, and satisfaction with palliative/medical care. All factors identified are supported by only some evidence with many having only been explored in single studies.

CONCLUSIONS

There is a lack of quantitative research in the area of factors influencing the experience of pain for advanced cancer patients cared for at home. Such findings would be useful in developing theories of change that would underpin interventions aimed at improving pain outcomes for this population.

How Do Hospital Palliative Care Teams Use the WHO Guidelines to Manage Unrelieved Cancer Pain? A 1-Year, Multicenter Audit in Japan

It has been reported that pain relief for patients with cancer is suboptimal in Japan. This has been mainly attributed to inadequate dissemination of the World Health Organization (WHO) guidelines for cancer pain management. To better understand this problem, we reviewed how 6 hospital palliative care teams (HPCTs) used the WHO guidelines for unrelieved pain in a 1-year audit that included 534 patients. The HPCT interventions were classified according to the contents of the WHO guidelines. In our study, HPCT interventions involved opioid prescriptions in >80% of referred patients, and “For the Individual” and “Attention to Detail” were the 2 most important principles. Our study indicates which parts of the WHO guidelines should be most heavily emphasized, when disseminating them in Japan.

Clinicians' Perspectives on Managing Symptom Clusters in Advanced Cancer: A Semistructured Interview Study

CONTEXT

Managing symptom clusters or multiple concurrent symptoms in patients with advanced cancer remains a clinical challenge. The optimal processes constituting effective management of symptom clusters remain uncertain.

OBJECTIVES

To describe the attitudes and strategies of clinicians in managing multiple co-occurring symptoms in patients with advanced cancer.

METHODS

Semistructured interviews were conducted with 48 clinicians (palliative care physicians [n = 10], oncologists [n = 6], general practitioners [n = 6], nurses [n = 12], and allied health providers [n = 14]), purposively recruited from two acute hospitals, two palliative care centers, and four community general practices in Sydney, Australia. Transcripts were analyzed using thematic analysis and adapted grounded theory.

RESULTS

Six themes were identified: uncertainty in decision making (inadequacy of scientific evidence, relying on experiential knowledge, and pressure to optimize care); attunement to patient and family (sensitivity to multiple cues, prioritizing individual preferences, addressing psychosocial and physical interactions, and opening Pandora's box); deciphering cause to guide intervention (disaggregating symptoms and interactions, flexibility in assessment, and curtailing investigative intrusiveness); balancing complexities in medical management (trading off side effects, minimizing mismatched goals, and urgency in resolving severe symptoms); fostering hope and empowerment (allaying fear of the unknown, encouraging meaning making, championing patient empowerment, and truth telling); and depending on multidisciplinary expertise (maximizing knowledge exchange, sharing management responsibility, contending with hierarchical tensions, and isolation and discontinuity of care).

CONCLUSION

Management of symptom clusters, as both an art and a science, is currently fraught with uncertainty in decision making. Strengthening multidisciplinary collaboration, continuity of care, more pragmatic planning of clinical trials to address more than one symptom, and training in symptom cluster management are required.

Cancer pain management: Implications for psychologists

Aim

Pain is a common and a complex experience among patients with cancer. The purpose of this review is to provide a rational for a psychologist’s role in cancer pain management and a guide for doing so based on an examination of the current cancer pain literature.

Method

A literature review was conducted using the search terms: “cancer pain” AND “nonpharmacological interventions”, “cancer pain”, and “pain management” AND “cancer pain”. Peer-reviewed articles (published between 2000-2015) in which the authors had access to the full-linked text, books, and websites were included.

Results

A total of 451 hits were returned of which 53 were relevant and considered for this review. These were then organized into the following topics: complex cancer pain syndromes, current cancer physiological therapies, the multifactorial model of cancer pain, psychosocial assessment and interventions, barriers to treatment, and clinical implications that impact the future of behavioural interventions as part of cancer treatment.

Conclusion

Each patient with cancer has a unique pain experience that is shaped by biopsychosocial factors. Because of this, using a multidimensional and multidisciplinary approach is needed to optimize treatment outcomes. To maximize their role, psychologists need to help facilitate this process and to address any attitude and/or knowledge shortcomings they may have.

Therapeutic Education in Improving Cancer Pain Management: A Synthesis of Available Studies

This literature review aims to synthesize available studies and to update findings in order to obtain a current, comprehensive estimate of the benefits of pain education. Forty-four original articles obtained from the PubMed database were analyzed to investigate which protocols could be most effective in improving pain management. Recent studies indicate a growing interest in evaluating patients' skills and attitudes; these include satisfaction with cancer pain treatment, patient-reported improvement, and patient participation-all of which could be dependable benchmarks for evaluating the effectiveness of educational programs. Besides pain measurement, recent studies advance support for the importance of assessing newly developed outcome criteria. In this sense, patients' active participation and decision making in their pain management are probably the most relevant goals of pain education.

Educational interventions for cancer pain. A systematic review of systematic reviews with nested narrative review of randomized controlled trials

OBJECTIVES

Educational interventions are one approach to improving cancer pain management. This review aims to determine whether educational interventions can improve cancer pain management and to characterize components of cancer pain educational interventions.

METHODS

Medline, EMBASE, CINAHL, and Cochrane databases were searched. Systematic reviews that assessed educational interventions to improve cancer pain management were included. Randomized controlled trials (RCTs) were identified from each review. A narrative approach was taken to summarizing the nature and components of interventions.

RESULTS

Eight systematic reviews and 34 randomized controlled trials (RCTs) were reviewed. Interventions targeting patients can achieve small to moderate reductions in pain intensity. Interventions targeting professionals can improve their knowledge but most trials have not assessed for resultant patient benefits. All interventions included at least one of seven core components: improving knowledge about the nature of cancer pain; aiding communication about cancer pain; enhancing pain assessment; improving analgesic prescribing; tackling barriers to analgesic non-adherence; teaching non-pharmacological pain management strategies; and promoting re-assessment.

CONCLUSIONS

Cancer pain educational interventions can improve pain outcomes. They are complex heterogeneous interventions which often contain a combination of active components.

PRACTICE IMPLICATIONS

Suggestions are made to aid the development of future interventions.

Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer

PURPOSE

Pain is a frequent symptom in patients with cancer, with substantial impact. Despite the availability of opioids and updated guidelines from reliable leading societies, undertreatment is still frequent.

METHODS

We updated a systematic review published in 2008, which showed that according to the Pain Management Index (PMI), 43.4% of patients with cancer were undertreated. This review included observational and experimental studies reporting negative PMI scores for adults with cancer and pain published from 2007 to 2013 and retrieved through MEDLINE, Embase, and Google Scholar. To detect any temporal trend and identify potential determinants of undertreatment, we compared articles published before and after 2007 with univariable, multivariable, and sensitivity analyses.

RESULTS

In the new set of 20 articles published from 2007 to 2013, there was a decrease in undertreatment of approximately 25% (from 43.4 to 31.8%). In the whole sample, the proportion of undertreated patients fell from 2007 to 2013, and an association was confirmed between negative PMI score, economic level, and nonspecific setting for cancer pain. Sensitivity analysis confirmed the robustness of results.

CONCLUSION

Analysis of 46 articles published from 1994 to 2013 using the PMI to assess the adequacy of analgesic therapy suggests the quality of pharmacologic pain management has improved. However, approximately one third of patients still do not receive pain medication proportional to their pain intensity.

Pain medication management processes used by oncology outpatients and family caregivers part II: home and lifestyle contexts

CONTEXT

Despite the increasing complexity of medication regimens for persistent cancer pain, little is known about how oncology outpatients and their family caregivers manage pain medications at home.

OBJECTIVES

To describe the day-to-day management of pain medications from the perspectives of oncology outpatients and their family caregivers who participated in a randomized clinical trial of a psychoeducational intervention called the Pro-Self(©) Plus Pain Control Program. In this article, we focus on pain medication management in the context of highly individualized home environments and lifestyles.

METHODS

This qualitative study was conducted as part of a randomized clinical trial, in which an embedded mixed methods research design was used. Audio-recorded dialogue among patients, family caregivers, and intervention nurses was analyzed using qualitative research methods.

RESULTS

Home and lifestyle contexts for managing pain medications included highly individualized home environments, work and recreational activities, personal routines, and family characteristics. Pain medication management processes particularly relevant in these contexts included understanding, organizing, storing, scheduling, remembering, and taking the medications. With the exception of their interactions with the intervention nurses, most study participants had little involvement with clinicians as they worked through these processes.

CONCLUSION

Pain medication management is an ongoing multidimensional process, each step of which has to be mastered by patients and their family caregivers when cancer treatment and supportive care are provided on an outpatient basis. Realistic patient- and family-centered skill-building interventions are needed to achieve effective and safe pain medication management in the contexts of individual home environments and lifestyles.

Optimal patient education for cancer pain: a systematic review and theory-based meta-analysis

PURPOSE

Previous systematic reviews have found patient education to be moderately efficacious in decreasing the intensity of cancer pain, but variation in results warrants analysis aimed at identifying which strategies are optimal.

METHODS

A systematic review and meta-analysis was undertaken using a theory-based approach to classifying and comparing educational interventions for cancer pain. The reference lists of previous reviews and MEDLINE, PsycINFO, and CENTRAL were searched in May 2012. Studies had to be published in a peer-reviewed English language journal and compare the effect on cancer pain intensity of education with usual care. Meta-analyses used standardized effect sizes (ES) and a random effects model. Subgroup analyses compared intervention components categorized using the Michie et al. (Implement Sci 6:42, 2011) capability, opportunity, and motivation behavior (COM-B) model.

RESULTS

Fifteen randomized controlled trials met the criteria. As expected, meta-analysis identified a small-moderate ES favoring education versus usual care (ES, 0.27 [-0.47, -0.07]; P = 0.007) with substantial heterogeneity (I² = 71 %). Subgroup analyses based on the taxonomy found that interventions using "enablement" were efficacious (ES, 0.35 [-0.63, -0.08]; P = 0.01), whereas those lacking this component were not (ES, 0.18 [-0.46, 0.10]; P = 0.20). However, the subgroup effect was nonsignificant (P = 0.39), and heterogeneity was not reduced. Factoring in the variable of individualized versus non-individualized influenced neither efficacy nor heterogeneity.

CONCLUSIONS

The current meta-analysis follows a trend in using theory to understand the mechanisms of complex interventions. We suggest that future efforts focus on interventions that target patient self-efficacy. Authors are encouraged to report comprehensive details of interventions and methods to inform synthesis, replication, and refinement.

Pharmacist-led medication education in cancer pain control: A multicentre randomized controlled study in Guangzhou, China

Objective

To evaluate clinical pharmacist-led pain-medication education in patients with cancer.

Methods

A controlled study was conducted prospectively at six tertiary hospitals in China. In-patients with cancer were randomized to receive conventional treatment plus medication education or no education (controls). Education consisted of access to information booklets and eight 30-min face-to-face counselling sessions given by clinical pharmacists over 4 weeks. Patients completed pain- and analgesic-knowledge assessments and a Brief Pain Inventory, pre- and post-study.

Results

A total of 123 and 114 patients in the education and control groups, respectively, completed follow-up. At the end of the study, patient knowledge regarding cancer pain and pain control was significantly increased in both groups; pain and analgesic knowledge scores were significantly higher in the education group compared with controls. In the control group, the increase in total pain-related knowledge was significantly greater in analgesic-naïve patients compared with those who were using/had used analgesics. Pain intensity scores and pain interference of daily activities were significantly reduced in the education group compared with controls.

Conclusions

Clinical pharmacist-led medication education resulted in improved pain control in patients with cancer.

An educational intervention to reduce pain and improve pain management for Malawian people living with HIV/AIDS and their family carers: study protocol for a randomised controlled trial

Background

Many HIV/AIDS patients experience pain often due to advanced HIV/AIDS infection and side effects of treatment. In sub-Saharan Africa, pain management for people with HIV/AIDS is suboptimal. With survival extended as a direct consequence of improved access to antiretroviral therapy, the prevalence of HIV/AIDS related pain is increasing. As most care is provided at home, the management of pain requires patient and family involvement. Pain education is an important aspect in the management of pain in HIV/AIDS patients. Studies of the effectiveness of pain education interventions for people with HIV/AIDS have been conducted almost exclusively in western countries.

Methods/design

A randomised controlled trial is being conducted at the HIV and palliative care clinics of two public hospitals in Malawi. To be eligible, patient participants must have a diagnosis of HIV/AIDS (stage III or IV). Carer participants must be the individual most involved in the patient’s unpaid care. Eligible participants are randomised to either: (1) a 30-minute face-to-face educational intervention covering pain assessment and management, augmented by a leaflet and follow-up telephone call at two weeks; or (2) usual care. Those allocated to the usual care group receive the educational intervention after follow-up assessments have been conducted (wait-list control group). The primary outcome is pain severity measured by the Brief Pain Inventory. Secondary outcomes are pain interference, patient knowledge of pain management, patient quality of life, carer knowledge of pain management, caregiver motivation and carer quality of life. Follow-up assessments are conducted eight weeks after randomisation by palliative care nurses blind to allocation.

Discussion

This randomised controlled trial conducted in sub-Saharan Africa among people living with HIV/AIDS and their carers will assess whether a pain education intervention is effective in reducing pain and improving pain management, quality of life and carer motivation.

Trial registration

Current Controlled Trials ISRCTN72861423.

Experience of barriers to pain management in patients receiving outpatient palliative care

BACKGROUND

Patient-reported barriers are an important obstacle to cancer pain management. For effective pain management, exploring patient-reported barriers and related factors is important.

OBJECTIVES

The study's objective is to determine factors associated with patient-reported barriers to cancer pain management.

METHOD

We conducted a secondary analysis of data from a prospective observational study examining opioid adherence in palliative care outpatients. We evaluated the association between high score on patient-reported barriers to cancer pain management, on the Barriers Questionnaire II (BQ-II), and patients' race, sex, smoking history, pain intensity, opioid dose, and depression.

RESULTS

Of 196 patients evaluated (median age 55 years), 147 (75%) were white, 41 (21%) had gastrointestinal cancer, and 121 (62%) were receiving anticancer treatment when data were collected. The median pain score was 4 (interquartile range [IQR] 3-7); 98% were receiving strong opioids; and 63% were satisfied with their pain medication. The median Edmonton symptom assessment scale (ESAS) depression score was 1 (IQR 0-3). Mean (SD) BQ-II scores were 1.8 (0.9) for physiologic effects, 1.6 (0.9) for fatalism, 0.9 (0.9) for communication, 2.3 (1.1) for harmful effects, and 1.7 (0.8) in total. Only racial differences were associated with high total BQ-II score in multivariable analysis (R2=0.05, overall F test significance=0.02). Pain related factors including opioids dose, pain intensity, and satisfaction were not associated with high BQ-II score.

CONCLUSION

Patients receiving palliative care expressed low barriers to pain control. There were minimal associations of BQ-II score with demographics and clinical factors.

Multimedia educational interventions for consumers about prescribed and over-the-counter medications

BACKGROUND

Health consumers increasingly want access to accurate, evidence-based information about their medications. Currently, education about medications (that is, information that is designed to achieve health or illness related learning) is provided predominantly via spoken communication between the health provider and consumer, sometimes supplemented with written materials. There is evidence, however, that current educational methods are not meeting consumer needs. Multimedia educational programs offer many potential advantages over traditional forms of education delivery.

OBJECTIVES

To assess the effects of multimedia patient education interventions about prescribed and over-the-counter medications in people of all ages, including children and carers.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2011, Issue 6), MEDLINE (1950 to June 2011), EMBASE (1974 to June 2011), CINAHL (1982 to June 2011), PsycINFO (1967 to June 2011), ERIC (1966 to June 2011), ProQuest Dissertation & Theses Database (to June 2011) and reference lists of articles.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and quasi-RCTs of multimedia-based patient education about prescribed or over-the-counter medications in people of all ages, including children and carers, if the intervention had been targeted for their use.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the risk of bias of included studies. Where possible, we contacted study authors to obtain missing information.

MAIN RESULTS

We identified 24 studies that enrolled a total of 8112 participants. However, there was significant heterogeneity in the comparators used and the outcomes measured, which limited the ability to pool data. Many of the studies did not report sufficient information in their methods to allow judgment of their risk of bias. From the information that was reported, three of the studies had a high risk of selection bias and one was at high risk of bias due to lack of blinding of the outcome assessors. None of the included studies reported the minimum clinically important difference for the outcomes that were measured. We have therefore reported results from the studies but have been unable to interpret whether differences were of clinical importance.The main findings of the review are as follows.Knowledge: There is low quality evidence that multimedia education was more effective than usual care (non-standardised education provided as part of usual clinical care) or no education (standardised mean difference (SMD) 1.04, 95% confidence interval (CI) 0.49 to 1.58, six studies with 817 participants). There was considerable statistical heterogeneity (I(2) = 89%), however, all but one of the studies favoured the multimedia group. There is moderate quality evidence that multimedia education was not more effective at improving knowledge than control multimedia interventions (i.e. multimedia programs that do not provide information about the medication) (mean difference (MD) of knowledge scores 2.78%, 95% CI -1.48 to 7.0, two studies with 568 participants). There is moderate quality evidence that multimedia education was more effective when added to a co-intervention (written information or brief standardised instructions provided by a health professional) compared with the co-intervention alone (MD of knowledge scores 24.59%, 95% CI 22.34 to 26.83, two studies with 381 participants).Skill acquisition: There is moderate quality evidence that multimedia education was more effective than usual care or no education (MD of inhaler technique score 18.32%, 95% CI 11.92 to 24.73, two studies with 94 participants) and written education (risk ratio (RR) of improved inhaler technique 2.14, 95% CI 1.33 to 3.44, two studies with 164 participants). There is very low quality evidence that multimedia education was equally effective as education by a health professional (MD of inhaler technique score -1.01%, 95% CI -15.75 to 13.72, three studies with 130 participants).Compliance with medications: There is moderate quality evidence that there was no difference between multimedia education and usual care or no education (RR of complying 1.02, 95% CI 0.96 to 1.08, two studies with 4552 participants).We could not determine the effect of multimedia education on other outcomes, including patient satisfaction, self-efficacy and health outcomes, due to an inadequate number of studies from which to draw conclusions.

AUTHORS' CONCLUSIONS

This review provides evidence that multimedia education about medications is more effective than usual care (non-standardised education provided by health professionals as part of usual clinical care) or no education, in improving both knowledge and skill acquisition. It also suggests that multimedia education is at least equivalent to other forms of education, including written education and education provided by a health professional. However, this finding is based on often low quality evidence from a small number of trials. Multimedia education about medications could therefore be considered as an adjunct to usual care but there is inadequate evidence to recommend it as a replacement for written education or education by a health professional. Multimedia education may be considered as an alternative to education provided by a health professional, particularly in settings where provision of detailed education by a health professional is not feasible. More studies evaluating multimedia educational interventions are required in order to increase confidence in the estimate of effect of the intervention.Conclusions regarding the effect of multimedia education were limited by the lack of information provided by study authors about the educational interventions, and variability in their content and quality. Studies testing educational interventions should provide detailed information about the interventions and comparators. Research is required to establish a framework that is specific for the evaluation of the quality of multimedia educational programs. Conclusions were also limited by the heterogeneity in the outcomes reported and the instruments used to measure them. Research is required to identify a core set of outcomes which should be measured when evaluating patient educational interventions. Future research should use consistent, reliable and validated outcome measures so that comparisons can be made between studies.

A systematic review of health care interventions for pain in patients with advanced cancer

PURPOSE

Poorly controlled pain is common in advanced cancer. The objective of this article was to synthesize the evidence on the effectiveness of pain-focused interventions in this population.

METHODS

We searched MEDLINE, CINAHL, PsycINFO, Cochrane, and DARE from 2000 through December 2011. We included prospective, controlled health care intervention studies in advanced cancer populations, focusing on pain.

RESULTS

Nineteen studies met the inclusion criteria; most focused on nurse-led patient-centered interventions. In all, 9 (47%) of the 19 studies found a significant effect on pain. The most common intervention type was patient/caregiver education, in 17 (89%) of 19 studies, 7 of which demonstrated a significant decrease in pain.

CONCLUSIONS

We found moderate strength of evidence that pain in advanced cancer can be improved using health care interventions, particularly nurse-led patient-centered interventions.

Randomized controlled trial of standardized education and telemonitoring for pain in outpatients with advanced solid tumors

Purpose

Previous studies have not defined the role of telemonitoring with educational tools in outpatients with advanced cancers. We tested the effectiveness of standardized education and telemonitoring for improving pain, distress, anxiety, depression, quality of life (QoL), and performance in outpatients with advanced cancers.

Methods

A total of 108 patients were randomly assigned to receive pain education alone (control arm) or pain education plus telemonitoring (experimental arm). Nursing specialists provided video-assisted educational material in both arms and daily telemonitoring for the first week in the experimental arm. Assessment was performed at baseline and 1 week and included evaluations of pain (Brief Pain Inventory, BPI), distress (Distress Thermometer, DT), anxiety, and depression (Hospital Anxiety and Depression Scale, HADS), QoL (QLQ-C30), and a Karnofsky score.

Results

Overall (n = 108), pain intensity was significantly improved at 1 week, including worst pain (7.3 to 5.7, P < 0.01) and average pain (4.6 to 3.8, P < 0.01). Additionally, anxiety (HADS score ≥ 11, 75 % to 56 %, P < 0.01), depression (HADS score ≥ 11, 73 % to 51 %, P < 0.01), QoL (fatigue and insomnia), and the Karnofsky score (32 to 66, P < 0.01) were also significantly improved at 1 week. However, the level of distress did not improve. The telemonitoring plus standardized education group showed more significant improvement in portion of pain >4 on VAS scale (35 % vs. 19 %, P = 0.02).

Conclusions

Standardized pain education using nursing specialists is an efficient way to improve not only pain itself but also anxiety, depression, performance, and QoL. The addition of telemonitoring helps to improve pain management in the outpatient setting.

Developing effective cancer pain education programs

Pain is prevalent, burdensome, and undertreated in individuals with cancer across the disease trajectory. Providing patients and family caregivers with psychosocial support and education to manage cancer pain is a core component of quality care that can result in significant clinical benefit. In this review, we: (1) outline an approach for developing and assessing the effectiveness of education programs for adults with cancer pain; (2) discuss considerations for tailoring programs to the needs of diverse populations and those with limited health literacy skills; (3) describe the resource needs and costs of developing a program; (4) highlight innovative approaches to cancer pain education. We conclude with recommendations for future research and the next generation of educational interventions.

A systematic evaluation of content, structure, and efficacy of interventions to improve patients' self-management of cancer pain

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.

Psychosocial issues in cancer pain

Cancer pain is a complex and multidimensional experience that affects and is affected by psychological and social factors. This article reviews recent research that points to a number of key psychosocial factors associated with pain, including psychological distress, coping, and social support, as well as the impact of socioeconomic factors on barriers to pain management. We also review recent research suggesting that psychosocial interventions, including education, coping-skills training, and hypnosis, may be useful adjuncts to medical management of pain. Clinical implications and recommendations for future research are discussed.

Do educational interventions improve cancer patients' quality of life and reduce pain intensity? Quantitative systematic review

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.

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 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.