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Shen MJ, Stokes T, Yarborough S, Harrison J. Improving Pain Self-Management Among Rural Older Adults With Cancer. JAMA Netw Open 2024; 7:e2421298. [PMID: 39018074 PMCID: PMC11255907 DOI: 10.1001/jamanetworkopen.2024.21298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/10/2024] [Indexed: 07/18/2024] Open
Abstract
Importance Undertreated cancer pain is a major public health concern among older adults in rural communities. Interventions to improve pain management among this vulnerable population are needed. Objective To test the feasibility, acceptability, and changes in pain outcomes from exposure to an adapted intervention, Cancer Health Empowerment for Living without Pain (CA-HELP), to improve patients' communication about pain to their clinicians. Design, Setting, and Participants Older adults with cancer (aged ≥65 years) who were residing in a noninstitutional rural setting and receiving outpatient care at a rural-based clinic in Tennessee were enrolled in the study, in which everyone received the intervention, in May 2022. All patients were given assessments at baseline and 1 week after intervention. Mean score differences were analyzed using 1-tailed paired sample t tests (α = .05). Data were analyzed in June 2022. Exposure The adapted version of CA-HELP included an 18-page patient-facing workbook and a 30-minute telephone coaching call with a registered nurse to coach patients on pain education and communication techniques to discuss pain with their medical team. Main Outcomes and Measures Feasibility was examined through accrual and completion rates. Acceptability was measured by helpfulness, difficulty, and satisfaction with the intervention. Changes in outcomes were measured using mean score differences from pre-post assessments of pain self-management, self-efficacy for communicating with clinicians about pain, patient-reported pain, and misconceptions about pain. Results Among the 30 total participants, the mean (SD) age was 73.0 (5.1) years; 17 participants (56.7%) were female, 5 (16.7%) were Black or African American, 30 (100%) were non-Hispanic or non-Latino, 24 (80.0%) were White, 16 (53.3%) had less than a high school education, and 15 (50.0%) reported income less than $21 000 per year. Based on accrual and completion rates of 100%, this intervention was highly feasible. Fidelity rates for delivering intervention components (100%) and communication competence (27 participants [90%]) were also high. Regarding acceptability, all patients rated the intervention as helpful, with the majority (24 participants [80%]) rating it as "very helpful." Most patients rated the intervention as "not at all difficult" (27 participants [90%]), enjoyed participating (21 participants [70%]), and reported being "very satisfied" (25 participants [83.3%]). Pre-post changes in outcomes suggested significant improvements in pain self-management and self-efficacy for communicating with clinicians about pain, as well as significant reductions in patient-reported pain and pain misconceptions. Conclusions and Relevance In this case-series study of CA-HELP, results suggested the adapted version of CA-HELP was feasible and acceptable and showed changes in pain-related outcome measures among older adults with cancer in a rural setting.
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Affiliation(s)
- Megan J. Shen
- Division of Clinical Research, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Tammy Stokes
- Maury Regional Medical Center, Columbia, Tennessee
| | - Sarah Yarborough
- Division of Clinical Research, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Jill Harrison
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
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Shen MJ, Cho S, De Los Santos C, Yarborough S, Maciejewski PK, Prigerson HG. Planning for Your Advance Care Needs (PLAN): A Communication Intervention to Improve Advance Care Planning among Latino Patients with Advanced Cancer. Cancers (Basel) 2023; 15:3623. [PMID: 37509284 PMCID: PMC10377387 DOI: 10.3390/cancers15143623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The goal of this study was to develop and optimize an intervention designed to address barriers to engagement in advance care planning (ACP) among Latino patients with advanced cancer. The resulting intervention, titled Planning Your Advance Care Needs (PLAN), is grounded in theoretical models of communication competence and sociocultural theory. MATERIALS AND METHODS An initial version of the PLAN manual was developed based on a prior intervention, Ca-HELP, that was designed to improve communication around pain among cancer patients. PLAN uses this framework to coach patients on how to plan for and communicate their end-of-life care needs through ACP. In the present study, feedback was obtained from key stakeholders (n = 11 patients, n = 11 caregivers, n = 10 experts) on this preliminary version of the PLAN manual. Participants provided ratings of acceptability and feedback around the intervention content, format, design, modality, and delivery through quantitative survey questions and semi-structured qualitative interviews. RESULTS Results indicated that the PLAN manual was perceived to be helpful and easy to understand. All stakeholder groups liked the inclusion of explicit communication scripts and guidance for having conversations about ACP with loved ones and doctors. Specific feedback was given to modify PLAN to ensure it was optimized and tailored for Latino patients. Some patients noted reviewing the manual motivated engagement in ACP. CONCLUSIONS Feedback from stakeholders resulted in an optimized, user-centered version of PLAN tailored to Latino patients. Future research will examine the acceptability, feasibility, and potential efficacy of this intervention to improve engagement in ACP.
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Affiliation(s)
- Megan J. Shen
- Division of Clinical Research, Fred Hutchinson Cancer Center, 1100 Fairview Ave. N., Mail Stop D5-290, Seattle, WA 98109, USA; (C.D.L.S.); (S.Y.)
| | - Susie Cho
- School of Nursing, University of Washington, Seattle, WA 98195, USA;
| | - Claudia De Los Santos
- Division of Clinical Research, Fred Hutchinson Cancer Center, 1100 Fairview Ave. N., Mail Stop D5-290, Seattle, WA 98109, USA; (C.D.L.S.); (S.Y.)
| | - Sarah Yarborough
- Division of Clinical Research, Fred Hutchinson Cancer Center, 1100 Fairview Ave. N., Mail Stop D5-290, Seattle, WA 98109, USA; (C.D.L.S.); (S.Y.)
| | - Paul K. Maciejewski
- Department of Radiology, Weill Cornell Medical College, New York, NY 10065, USA;
| | - Holly G. Prigerson
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA;
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Reese JB, Zimmaro LA, Bober SL, Sorice K, Handorf E, Wittenberg E, El-Jawahri A, Beach MC, Wolff AC, Daly MB, Izquierdo B, Lepore SJ. Mobile Technology-Based (mLearning) Intervention to Enhance Breast Cancer Clinicians' Communication About Sexual Health: A Pilot Trial. J Natl Compr Canc Netw 2021; 19:1133-1140. [PMID: 34388731 PMCID: PMC8840991 DOI: 10.6004/jnccn.2021.7032] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/02/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Most breast cancer clinicians lack training to counsel patients about sexual concerns. The purpose of this study was to assess the feasibility, acceptability, and preliminary effects of a mobile learning (mLearning) intervention (improving Sexual Health and Augmenting Relationships through Education [iSHARE]) aimed at enhancing breast cancer clinicians' knowledge of, beliefs about, and comfort with discussing patients' sexual health concerns. METHODS Clinicians listened to a 2-part educational podcast series offering information on breast cancer-related sexual health concerns and effective communication on the topic, which consisted of interviews with expert guests. Intervention feasibility was assessed through rates of enrollment, retention, and intervention completion, with benchmarks of 40%, 70%, and 60%, respectively. Acceptability was assessed through program evaluations, with 75% of clinicians rating the intervention favorably (eg, relevance, satisfaction) signifying acceptability. Clinicians self-reported their knowledge about breast cancer-related sexual health concerns, beliefs (ie, self-efficacy for discussing sexual health concerns), and comfort with discussing sexual concerns measured at preintervention and postintervention. Qualitative analysis examined clinicians' perceptions of lessons learned from the intervention. RESULTS A total of 32 breast cancer clinicians enrolled (46% of those invited; 97% of those who responded and screened eligible), 30 (94%) completed both the intervention and study surveys, and 80% rated the intervention favorably, demonstrating feasibility and acceptability. Results showed positive trends for improvement in clinician knowledge, beliefs, and comfort with discussing sexual health concerns. Clinicians reported key lessons learned, including taking a proactive approach to discussing sexual health concerns, normalizing the topic, addressing vaginal health, sending the message that help is available, and assessing sexual health concerns with patients from different backgrounds. CONCLUSIONS Breast cancer clinicians were amenable to participating in the iSHARE intervention and found it useful. iSHARE showed promise for improving clinician's knowledge and comfort discussing patients' sexual health concerns. A larger trial is required to demonstrate efficacy. Future studies should also examine whether iSHARE can improve patient-clinician communication and address patients' sexual concerns.
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Affiliation(s)
| | | | - Sharon L. Bober
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute,Division of Palliative Medicine, Department of Medicine, Brigham and Women’s Hospital
| | - Kristen Sorice
- Cancer Prevention and Control Program, Fox Chase Cancer Center
| | - Elizabeth Handorf
- Cancer Prevention and Control Program, Fox Chase Cancer Center,Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center
| | - Elaine Wittenberg
- Department of Communication Studies, California State University, Los Angeles
| | - Areej El-Jawahri
- Department of Hematology/Oncology, Massachusetts General Hospital
| | | | - Antonio C. Wolff
- Women’s Malignancies Program, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | - Mary B. Daly
- Department of Clinical Genetics, Fox Chase Cancer Center
| | - Brynna Izquierdo
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University
| | - Stephen J. Lepore
- Cancer Prevention and Control Program, Fox Chase Cancer Center,Department of Social and Behavioral Sciences, College of Public Health, Temple University
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Tait RC, Chibnall JT. Community Perspectives on Patient Credibility and Provider Burden in the Treatment of Chronic Pain. PAIN MEDICINE 2021; 23:1075-1083. [PMID: 34387353 DOI: 10.1093/pm/pnab256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study examined factors influencing lay perceptions of a provider's clinical burden in providing care to a person with chronic pain. DESIGN In a between-subjects design that varied three levels of pain severity (4-6-8/10) with two levels of medical evidence (low/high), participants rated the credibility of pain reported by a hypothetical patient and psychosocial factors expected to mediate the effects of evidence and severity on a provider's burden of care. SETTING A randomized vignette study in which community participants were recruited via Amazon Mechanical Turk. SUBJECTS 337 community participants. METHODS Using a Qualtrics platform, participants read one of six vignettes describing a hypothetical patient with varying levels of medical evidence and pain severity, and then rated perceived pain severity, pain credibility, psychosocial variables, and burden. RESULTS Serial mediation models accounted for all effects of medical evidence and pain severity on burden. Low medical evidence was associated with increased burden, as mediated through lower pain credibility and greater concerns about patient depression, opioid abuse, and learning pain management. Higher levels of reported pain severity were associated with increased burden, as mediated through greater pain discounting and concerns about opioid abuse. CONCLUSIONS The lay public is skeptical of chronic pain that is not supported by medical evidence or is reported at high levels of severity, raising concerns about psychosocial complications and drug seeking and expectations of higher burden of care. Such negative stereotypes can pose obstacles to people seeking necessary care if they or others develop a chronic pain condition.
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Affiliation(s)
- Raymond C Tait
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine
| | - John T Chibnall
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine
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Chawak S, Chittem M, Maya S, Dhillon HM, Butow PN. The Question-prompt list (QPL): Why it is needed in the Indian oncology setting? Cancer Rep (Hoboken) 2021; 4:e1316. [PMID: 33295152 PMCID: PMC8451377 DOI: 10.1002/cnr2.1316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In India, caregivers are an integral part of the illness experience, especially in cancer, to the extent that they can become proxy decision-makers for the patient. Further, owing to acute resource constraints in the Indian healthcare system, it may be difficult for oncologists to assess and elicit questions from each patient/caregiver. Consequently, there is a need to address these unique aspects of oncology care in India to improve patient outcomes and understanding of their illness and treatment. This can be achieved through a Question Prompt List (QPL), a checklist used by care recipients during medical consultations. RECENT FINDINGS This narrative review will first introduce research on the development and effectiveness of the QPL, and then it will highlight current gaps in oncology care in India and explore how the QPL may aid in closing these gaps. A literature search of the empirical research focused on the development, feasibility and acceptability of the QPL in oncology settings was conducted. The final review included 40 articles pertaining to QPL research. Additionally, psycho-oncology research in India centered on information needs and experiences was reviewed. Current Indian psycho-oncology research reports patients' want to be actively involved in their cancer care and a need for more illness information. However, a high demand on physicians' resources and the family caregivers' interference can be barriers to meeting patients' information/communication needs. International research demonstrates that a QPL helps structure and decrease consultation time, improves patient satisfaction with care, and improves the quality of communication during medical encounters. CONCLUSION QPLs for Indian patients and caregivers may focus on the scope of medical consultations to address patient needs while influencing the course and content of the patient-caregiver-physician interactions. Further, it can address the resource constraints in Indian oncology care settings, thus reducing the physician's burden.
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Affiliation(s)
- Shweta Chawak
- Department of Liberal ArtsIndian Institute of Technology HyderabadHyderabadIndia
| | - Mahati Chittem
- Department of Liberal ArtsIndian Institute of Technology HyderabadHyderabadIndia
| | - Sravannthi Maya
- Department of Liberal ArtsIndian Institute of Technology HyderabadHyderabadIndia
| | - Haryana M. Dhillon
- Centre for Medical Psychology & Evidence‐based Decision‐making, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
| | - Phyllis N. Butow
- Centre for Medical Psychology & Evidence‐based Decision‐making, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
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Links MJ, Watterson L, Martin P, O'Regan S, Molloy E. Finding common ground: meta-synthesis of communication frameworks found in patient communication, supervision and simulation literature. BMC MEDICAL EDUCATION 2020; 20:45. [PMID: 32046704 PMCID: PMC7014645 DOI: 10.1186/s12909-019-1922-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Effective communication between patients-clinicians, supervisors-learners and facilitators-participants within a simulation is a key priority in health profession education. There is a plethora of frameworks and recommendations to guide communication in each of these contexts, and they represent separate discourses with separate communities of practice and literature. Finding common ground within these frameworks has the potential to minimise cognitive load and maximise efficiency, which presents an opportunity to consolidate messages, strategies and skills throughout a communication curriculum and the possibility of expanding the research agenda regarding communication, feedback and debriefing in productive ways. METHODS A meta-synthesis of the feedback, debriefing and clinical communication literature was conducted to achieve these objectives. RESULTS Our analysis revealed that the concepts underlying the framework can be usefully categorised as stages, goals, strategies, micro-skills and meta-skills. Guidelines for conversations typically shared a common structure, and strategies aligned with a stage. Core transferrable communication skills (i.e., micro-skills) were identified across various types of conversation, and the major differences between frameworks were related to the way that power was distributed in the conversation and the evolution of conversations along the along the path of redistributing power. As part of the synthesis, an overarching framework "prepare-EMPOWER enact" was developed to capture these shared principles across discourses. CONCLUSIONS Adopting frameworks for work-based communication that promote dialogue and empower individuals to contribute may represent an important step towards learner-centred education and person-centred care for patients.
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Affiliation(s)
- Matthew Jon Links
- Gold Coast University Hospital and Health Service, Southport, Australia.
- Griffith University Institute of Educational Research and School of Medicine, Brisbane, Australia.
- Medical Oncology, 1 Hospital Boulevarde, Southport, QLD, 4215, Australia.
| | - Leonie Watterson
- Sydney Clinical Skills and Simulation Centre, Royal North Shore Hospital Sydney, Sydney, New South Wales, Australia
| | - Peter Martin
- Deakin University Faculty of Health, School of Medicine, Geelong, Australia
| | - Stephanie O'Regan
- Sydney Clinical Skills and Simulation Centre, Royal North Shore Hospital Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Molloy
- Department of Medical Education, University of Melbourne, Melbourne, Australia
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te Boveldt N, Vernooij-Dassen M, Leppink I, Samwel H, Vissers K, Engels Y. Patient empowerment in cancer pain management: an integrative literature review. Psychooncology 2014; 23:1203-11. [DOI: 10.1002/pon.3573] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 02/04/2014] [Accepted: 04/16/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Nienke te Boveldt
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Center (Radboudumc); Nijmegen The Netherlands
| | - Myrra Vernooij-Dassen
- Department of IQ Healthcare, Department of Primary and Community Care; Radboud University Nijmegen Medical Center (Radboudumc); Nijmegen The Netherlands
- Kalorama Foundation; Beek-Ubbergen The Netherlands
| | - Irene Leppink
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Center (Radboudumc); Nijmegen The Netherlands
| | - Han Samwel
- Department of Medical Psychology; Radboud University Nijmegen Medical Center (Radboudumc); Nijmegen The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Center (Radboudumc); Nijmegen The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Center (Radboudumc); Nijmegen The Netherlands
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Street RL, Tancredi DJ, Slee C, Kalauokalani DK, Dean DE, Franks P, Kravitz RL. A pathway linking patient participation in cancer consultations to pain control. Psychooncology 2014; 23:1111-7. [PMID: 24687847 DOI: 10.1002/pon.3518] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 02/09/2014] [Accepted: 02/21/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To test a pathway through which a tailored, pain management education-coaching intervention could contribute to better cancer pain control through the effects of patients' communication about pain on physician prescribing of pain medication. METHODS Secondary analysis of data from a randomized controlled trial that tested the effects of a tailored education-coaching intervention on pain control for patients with advanced cancer. The current analysis focused on a subset of the patients (n = 135) who agreed to have their consultations audio-recorded. Patients' active communication about pain (e.g., expressing questions, concerns, and preferences about pain-related issues) was coded from audio-recordings. Change in pain medication was measured by patient self-report. Improvement in pain control was scored as the difference between baseline pain score and pain reported at 6 weeks. RESULTS Patients' pain-related communication was a significant predictor of patient-reported changes in physician prescribing of pain medication (p < .0001) and mediated the effect of baseline pain on medication change. Other predictors of change in pain medication were age (younger) and having participated in the intervention (as opposed to usual care). Of the patients reporting adjustment in pain medications, 49% experienced better pain control compared with only 27% of patients reporting no change in pain management (p < .02). CONCLUSIONS Cancer patients who ask questions, express concerns, and state preferences about pain-related matters can prompt physicians to change their pain management regimen, which in turn may lead to better pain control. Future research should model pathways through which clinician-patient communication can lead to better cancer outcomes.
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Affiliation(s)
- Richard L Street
- Texas A&M University, College Station, TX, USA; Houston Center for Healthcare Innovation, Quality, and Safety and Baylor College of Medicine, Houston, TX, USA
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Street RL. How clinician-patient communication contributes to health improvement: modeling pathways from talk to outcome. PATIENT EDUCATION AND COUNSELING 2013; 92:286-291. [PMID: 23746769 DOI: 10.1016/j.pec.2013.05.004] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 05/04/2013] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Although researchers have long investigated relationships between clinician-patient communication and health outcomes, much of the research has produced null, inconsistent, or contradictory findings. This essay examines challenges in the study of how clinician-patient communication contributes to a patient's health and offers recommendations for future research. DISCUSSION Communication may directly impact outcomes, but more often it will have an indirect effect through its influence on intervening variables (e.g., patient understanding, clinician-patient agreement on treatment, adherence to treatment). For example, a patient communication skills intervention may not directly improve pain control for cancer patients. However, it may do so indirectly by activating patients to talk about cancer pain, which prompts the physician to change pain medication, which leads to better pain control. Additionally, communication measurement is complicated because relationships among communication behavior, meaning, and evaluation are complex. CONCLUSION Researchers must do more to model pathways linking clinician-patient communication to the outcomes of interest, particularly pathways in which the communication effects are indirect or mediated through other variables. To better explicate how communication contributes to health outcomes, researchers must critically reflect on the assumptions they are making about communication process and choose measures consistent with those assumptions.
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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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Copanitsanou P, Valkeapää K. Effects of education of paediatric patients undergoing elective surgical procedures on their anxiety - a systematic review. J Clin Nurs 2013; 23:940-54. [DOI: 10.1111/jocn.12187] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - Kirsi Valkeapää
- Department of Nursing Science; University of Turku; Turku Finland
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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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Kravitz RL, Tancredi DJ, Jerant A, Saito N, Street RL, Grennan T, Franks P. Influence of patient coaching on analgesic treatment adjustment: secondary analysis of a randomized controlled trial. J Pain Symptom Manage 2012; 43:874-84. [PMID: 22560357 DOI: 10.1016/j.jpainsymman.2011.05.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 05/24/2011] [Accepted: 06/14/2011] [Indexed: 12/11/2022]
Abstract
CONTEXT For patients with cancer-related pain and their physicians, routine oncology visits are an opportunity to adjust the analgesic regimen and secure better pain control. However, treatment intensification occurs haphazardly in practice. OBJECTIVES To estimate the effect of patient-centered tailored education and coaching (TEC) on the likelihood of analgesic treatment adjustment during oncology visits, and in turn, the influence of treatment adjustment on subsequent cancer pain control, we studied patients enrolled in a randomized trial of TEC. METHODS Just before a scheduled oncology visit, 258 patients with at least moderate baseline pain received TEC or control; just after the same visit, they reported on whether the physician recommended a new pain medicine or a change in dose of an existing medicine. Pain severity and pain-related impairment were measured two, six, and 12 weeks later. RESULTS Patients assigned to TEC were more likely than controls to report a change in the analgesic treatment regimen (60% vs. 36%, P<0.01); significant effects persisted after adjustment for baseline pain, study site, and physician (adjusted odds ratio 2.61, 95% confidence interval 1.55, 4.40, P<0.01). In a mixed-effects repeated measures regression, analgesic change (but not TEC itself) was associated with a sustained decrease in pain severity (P<0.05). CONCLUSION TEC increases the likelihood of self-reported, physician-directed adjustments in analgesic prescribing, and treatment intensification is associated with better cancer pain outcomes.
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Affiliation(s)
- Richard L Kravitz
- Department of Internal Medicine, University of California, Davis, Sacramento, California, USA.
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Jerant A, Franks P, Kravitz RL. Associations between pain control self-efficacy, self-efficacy for communicating with physicians, and subsequent pain severity among cancer patients. PATIENT EDUCATION AND COUNSELING 2011; 85:275-280. [PMID: 21159483 DOI: 10.1016/j.pec.2010.11.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 10/21/2010] [Accepted: 11/21/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Coaching patients to be more active in health encounters may improve communication with physicians but does not necessarily improve health outcomes. We explored this discrepancy by examining relationships between self-efficacy for communicating with physicians and pain control self-efficacy and subsequent pain severity among cancer patients participating in a coaching trial. METHODS We analyzed data from 244 English-speaking adults with various cancer types reporting significant pain, recruited from 49 oncology physicians' offices. Mixed model linear regression examined relationships between post-intervention communication self-efficacy and pain control self-efficacy and subsequent pain severity over 12 weeks. RESULTS Post-intervention pain control self-efficacy (but not communication self-efficacy) was significantly related to subsequent pain severity: a one standard deviation increase was associated with a 0.19 point decrease (95% confidence interval=-0.33, -0.04; p=0.01) in pain severity over time, approximately 25% of the effect size of the influence of post-intervention pain on subsequent pain. CONCLUSION Among cancer patients enrolled in a coaching trial, post-intervention pain control self-efficacy, but not communication self-efficacy, was significantly related to subsequent pain severity. PRACTICE IMPLICATIONS Identifying behavioral mediators of cancer pain severity may lead to coaching interventions that are more effective in improving cancer pain control.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine, University of California, Davis, Sacramento, CA 95817, USA.
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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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Health risk appraisal for older people 5: self-efficacy in patient-doctor interactions. Prim Health Care Res Dev 2011; 12:348-56. [PMID: 21774869 DOI: 10.1017/s1463423611000296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Enhancing self-efficacy is central to programmes promoting self-care and self-management. However, little is known about older people's self-efficacy in doctor-patient interactions. This paper investigates lifestyle, medical and demographic factors associated with self-efficacy in doctor-patient interactions in older people in general practice. METHODS A cross-sectional analysis of data from a randomised controlled trial of older people was conducted in a health risk appraisal study in London. Self-efficacy was measured using the Perceived Efficacy in Patient-Physician Interactions Questionnaire. RESULTS Older people with higher self-efficacy were significantly more likely to report having had recent preventive care measures such as recent blood pressure measurement and influenza immunisation. Women were less likely to have higher self-efficacy than men. Older people were significantly less likely to have high self-efficacy if they reported having poor memory, low mood, limited activities due to fear of falling, basic education, difficulties with at least one activity of daily living, reduced physical activity, living alone, or risk of social isolation. CONCLUSION A third of people had low self-efficacy in doctor-patient interactions. They appear to be a vulnerable group. Low self-efficacy in interactions with doctors may be a symptom or a characteristic of older people who experience social isolation and depression. Policies that depend on enhancing self-care and self-management need to consider the large number of older people with low self-efficacy in using medical services, and understanding characteristics in older people associated with lower confidence in doctor-patient interactions may be useful in clinical practice and research.
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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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18
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Jerant A, Franks P, Tancredi DJ, Saito N, Kravitz RL. Tendency to adhere to provider-recommended treatments and subsequent pain severity among individuals with cancer. Patient Prefer Adherence 2011; 5:23-31. [PMID: 21311699 PMCID: PMC3034299 DOI: 10.2147/ppa.s16236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Patients' general tendency to adhere to health care provider-recommended treatments is associated with a number of health outcomes, but whether it influences pain severity over time among individuals with cancer is unclear. We explored the relationship between adherence tendency and subsequent pain severity among cancer patients participating in a randomized controlled trial of coaching to enhance communication with physicians and reduce pain severity. METHODS Associations between baseline Medical Outcomes Study general adherence measure score and pain severity over 12 weeks were examined with repeated-measures regression models. Model 1 included sociodemographics, study group and site, follow-up point, and baseline pain; Model 2 included these variables plus partner status, physical and mental health status (12-item Short Form Health Survey [SF-12(®)]), and pain control self-efficacy. RESULTS Of 307 patients randomized, 224 (73%) had at least one follow-up pain severity assessment plus complete data for other model variables and were included in the analyses. In Model 1, adherence tendency was associated with less subsequent pain severity: a one standard deviation increase in adherence tendency was associated with a 0.22-point adjusted mean decrease in pain severity on a 0-10 scale (95% confidence interval 0.40, 0.03). The association was diminished and not statistically significant in Model 2, primarily due to adjustment for the SF-12. CONCLUSION Tendency to adhere to provider-recommended treatments was associated with subsequent pain severity among individuals with cancer, suggesting a potential way of predicting and intervening to improve cancer pain control. However, the association was attenuated after adjusting for health status, suggesting mediation or confounding of the relationship by health status.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine, Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA, USA
- Correspondence: Anthony Jerant, Department of Family and Community Medicine, Center for Healthcare Policy and Research, University of California, Davis School of Medicine, 4860 Y Street, Sacramento, CA 95817, USA, Tel +1 916 734 7081, Fax +1 916 734 5641, Email
| | - Peter Franks
- Department of Family and Community Medicine, Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Daniel J Tancredi
- Department of Pediatrics, Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Naomi Saito
- Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Richard L Kravitz
- Department of Internal Medicine, Division of General Medicine, Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA, USA
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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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