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Keefe FJ, Winger JG, Kelleher SA. Pain-related suffering: new insights into what it means and new opportunities for research and clinical practice. Pain 2024:00006396-990000000-00534. [PMID: 38452200 DOI: 10.1097/j.pain.0000000000003196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 03/09/2024]
Affiliation(s)
- Francis J Keefe
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
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Fisher HM, Check DK, Somers TJ, Kelleher SA, Majestic C, Yu JA, Reed SD, Li Y, Olsen MK, Lerebours R, Keefe FJ, Steinhauser KE, Breitbart WS, Winger JG. Meaning-centered pain coping skills training for patients with metastatic cancer: Protocol for a randomized controlled efficacy trial. Contemp Clin Trials 2023; 135:107363. [PMID: 37884120 PMCID: PMC10842087 DOI: 10.1016/j.cct.2023.107363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/05/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Many patients with advanced cancer describe pain as a debilitating symptom that greatly interferes with daily activities and enjoyment of life. Psychosocial interventions can improve cancer-related pain but rarely address spiritual concerns (e.g., loss of meaning, peace), which can influence the pain experience for those facing life-threatening illness. To address these needs, we systematically developed and pilot tested a novel psychosocial intervention called Meaning-Centered Pain Coping Skills Training (MCPC). In this randomized controlled trial, we aim to determine MCPC's efficacy for reducing pain interference (primary outcome) and improving secondary outcomes. We will also estimate MCPC's cost-effectiveness. METHOD/DESIGN Patients (target N = 210) with advanced solid tumor malignancies (Stage IV) and clinically-elevated pain interference will be enrolled and block randomized with equal allocation to MCPC + enhanced usual care or enhanced usual care alone. MCPC's four, videoconferenced, 45-60 min weekly sessions will be individually delivered by trained study therapists. Primary (pain interference) and secondary (pain severity, anxiety and depressive symptoms, pain self-efficacy, social support, spiritual well-being) patient-reported outcomes will be assessed at baseline, and 8-weeks (primary endpoint) and 12-weeks after baseline. CONCLUSION Our MCPC intervention is the first to systematically address the biopsychosocial-spiritual aspects of pain in patients with advanced cancer. If MCPC demonstrates efficacy, next steps will involve hybrid efficacy-effectiveness and implementation work to broaden access to this brief, manualized, remotely-delivered intervention, with the goal of reducing suffering in patients with life-threatening illness.
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Affiliation(s)
- Hannah M Fisher
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - Devon K Check
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA; Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Tamara J Somers
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - Sarah A Kelleher
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - Catherine Majestic
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - Justin A Yu
- Division of Pediatric Palliative and Supportive Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Shelby D Reed
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States of America
| | - Yanhong Li
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States of America
| | - Maren K Olsen
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Reginald Lerebours
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Francis J Keefe
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - Karen E Steinhauser
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA; Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA; Center for the Study of Human Aging and Development, Duke University, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, 27705, USA
| | - William S Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph G Winger
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Institute, Duke University Health System, Durham, NC, USA.
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Dorfman CS, Fisher HM, Thomas S, Kelleher SA, Winger JG, Mitchell NS, Miller SN, Somers TJ. Breast cancer survivors with pain: an examination of the relationships between body mass index, physical activity, and symptom burden. Support Care Cancer 2023; 31:604. [PMID: 37782420 PMCID: PMC10721211 DOI: 10.1007/s00520-023-08064-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE Overweight and obesity are common for breast cancer survivors and associated with high symptom burden (i.e., pain, fatigue, depressive symptoms). Physical activity may protect breast cancer survivors with higher body mass indexes (BMI) from increased symptoms. However, the role of physical activity in buffering the relationship between higher BMI and greater symptoms is unclear. METHODS Baseline data from a randomized trial investigating Pain Coping Skills Training among breast cancer survivors (N = 327) with pain were used to examine the relationship between self-reported BMI (kg/m2) and physical activity level (Rapid Assessment of Physical Activity; suboptimal vs. optimal) with pain (Brief Pain Inventory; severity and interference), fatigue (PROMIS-Fatigue short form), and depressive symptoms (Center for Epidemiological Studies Depression Scale). Analyses were conducted in SPSS. Hayes PROCESS macro (Model 1) assessed whether physical activity moderated the relationship between BMI and symptoms. RESULTS Lower BMI (B = .06, p < .01) and optimal physical activity (B = - .69, p < .01) were independently associated with lower pain interference. Lower BMI was also associated with lower pain severity (B = .04, p < .001). Neither BMI nor physical activity was associated with fatigue or depressive symptoms. Physical activity did not moderate the relationship between BMI and symptoms. CONCLUSIONS Among breast cancer survivors experiencing pain, higher BMI and being less physically active were related to greater pain (i.e., severity and/or interference). Physical activity did not buffer the relationships between BMI and pain, fatigue, and depressive symptoms, suggesting that physical activity alone may not be sufficient to influence the strength of the relationships between BMI and symptoms.
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Affiliation(s)
- Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
| | - Hannah M Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Samantha Thomas
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Nia S Mitchell
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Shannon N Miller
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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Li Y, Reed SD, Winger JG, Hyland KA, Fisher HM, Kelleher SA, Miller SN, Davidian M, Laber EB, Keefe FJ, Somers TJ. Cost-Effectiveness Analysis Evaluating Delivery Strategies for Pain Coping Skills Training in Women With Breast Cancer. J Pain 2023; 24:1712-1720. [PMID: 37187219 PMCID: PMC10524546 DOI: 10.1016/j.jpain.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/28/2023] [Accepted: 05/07/2023] [Indexed: 05/17/2023]
Abstract
Pain coping skills training (PCST) is efficacious in patients with cancer, but clinical access is limited. To inform implementation, as a secondary outcome, we estimated the cost-effectiveness of 8 dosing strategies of PCST evaluated in a sequential multiple assignment randomized trial among women with breast cancer and pain (N = 327). Women were randomized to initial doses and re-randomized to subsequent doses based on their initial response (ie, ≥30% pain reduction). A decision-analytic model was designed to incorporate costs and benefits associated with 8 different PCST dosing strategies. In the primary analysis, costs were limited to resources required to deliver PCST. Quality-adjusted life-years (QALYs) were modeled based on utility weights measured with the EuroQol-5 dimension 5-level at 4 assessments over 10 months. A probabilistic sensitivity analysis was performed to account for parameter uncertainty. Implementation of PCST initiated with the 5-session protocol was more costly ($693-853) than strategies initiated with the 1-session protocol ($288-496). QALYs for strategies beginning with the 5-session protocol were greater than for strategies beginning with the 1-session protocol. With the goal of implementing PCST as part of comprehensive cancer treatment and with willingness-to-pay thresholds ranging beyond $20,000 per QALY, the strategy most likely to provide the greatest number of QALYs at an acceptable cost was a 1-session PCST protocol followed by either 5 maintenance telephone calls for responders or 5 sessions of PCST for nonresponders. A PCST program with 1 initial session and subsequent dosing based on response provides good value and improved outcomes. PERSPECTIVE: This article presents the results of a cost analysis of the delivery of PCST, a nonpharmacological intervention, to women with breast cancer and pain. Results could potentially provide important cost-related information to health care providers and systems on the use of an efficacious and accessible nonmedication strategy for pain management. TRIALS REGISTRATION: ClinicalTrials.gov: NCT02791646, registered 6/2/2016.
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Affiliation(s)
- Yanhong Li
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Shelby D. Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Joseph G. Winger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Kelly A. Hyland
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Hannah M. Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Sarah A. Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Shannon N. Miller
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Marie Davidian
- Department of Statistics, North Carolina State University, Raleigh, NC
| | - Eric B. Laber
- Department of Statistical Sciences, Duke University, Durham, NC
| | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Tamara J. Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
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Somers TJ, Winger JG, Fisher HM, Hyland KA, Davidian M, Laber EB, Miller SN, Kelleher SA, Vilardaga JCP, Majestic C, Shelby RA, Reed SD, Kimmick GG, Keefe FJ. Behavioral cancer pain intervention dosing: results of a Sequential Multiple Assignment Randomized Trial. Pain 2023; 164:1935-1941. [PMID: 37079854 PMCID: PMC10733867 DOI: 10.1097/j.pain.0000000000002915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/06/2023] [Indexed: 04/22/2023]
Abstract
ABSTRACT Behavioral pain management interventions are efficacious for reducing pain in patients with cancer. However, optimal dosing of behavioral pain interventions for pain reduction is unknown, and this hinders routine clinical use. A Sequential Multiple Assignment Randomized Trial (SMART) was used to evaluate whether varying doses of Pain Coping Skills Training (PCST) and response-based dose adaptation can improve pain management in women with breast cancer. Participants (N = 327) had stage I-IIIC breast cancer and a worst pain score of > 5/10. Pain severity (a priori primary outcome) was assessed before initial randomization (1:1 allocation) to PCST-Full (5 sessions) or PCST-Brief (1 session) and 5 to 8 weeks later. Responders ( > 30% pain reduction) were rerandomized to a maintenance dose or no dose and nonresponders (<30% pain reduction) to an increased or maintenance dose. Pain severity was assessed again 5 to 8 weeks later (assessment 3) and 6 months later (assessment 4). As hypothesized, PCST-Full resulted in greater mean percent pain reduction than PCST-Brief (M [SD] = -28.5% [39.6%] vs M [SD]= -14.8% [71.8%]; P = 0.041). At assessment 3 after second dosing, all intervention sequences evidenced pain reduction from assessment 1 with no differences between sequences. At assessment 4, all sequences evidenced pain reduction from assessment 1 with differences between sequences ( P = 0.027). Participants initially receiving PCST-Full had greater pain reduction at assessment 4 ( P = 0.056). Varying PCST doses led to pain reduction over time. Intervention sequences demonstrating the most durable decreases in pain reduction included PCST-Full. Pain Coping Skills Training with intervention adjustment based on response can produce sustainable pain reduction.
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Affiliation(s)
- Tamara J. Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Joseph G. Winger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Hannah M. Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Kelly A. Hyland
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Marie Davidian
- Department of Statistics, North Carolina State University, Raleigh, NC
| | - Eric B. Laber
- Department of Statistical Sciences, Duke University, Durham, NC
| | - Shannon N. Miller
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Sarah A. Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | | | - Catherine Majestic
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Rebecca A. Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Shelby D. Reed
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
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Fisher HM, Hyland KA, Winger JG, Miller SN, Amaden GH, Diachina AK, Kelleher SA, Somers TJ. Effect of Pain Coping Skills Training on Pain and Pain Medication Use for Women With Breast Cancer. J Pain Symptom Manage 2023; 66:70-79. [PMID: 37028732 PMCID: PMC10330043 DOI: 10.1016/j.jpainsymman.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Abstract
CONTEXT Pain is distressing for women with breast cancer. Pain medication may not provide full relief and can have negative side-effects. Cognitive-behavioral pain intervention protocols reduce pain severity and improve self-efficacy for pain management. These interventions' impact on pain medication use is less clear. Intervention length and coping skills use might play a role in pain outcomes. OBJECTIVES Secondary analysis to examine differences in pain severity, pain medication use, pain self-efficacy, and coping skill use after five- and one-session cognitive-behavioral pain intervention protocols. Pain self-efficacy and coping skills use were assessed as mediators of intervention effects on pain and pain medication use. METHODS Women (N = 327) with stage I-III breast cancer were enrolled in a randomized trial comparing individually-delivered, five- and one-session pain coping skills training (PCST). Pain severity, pain medication use, pain self-efficacy, and coping skills use were assessed preintervention and five to eight weeks later (postintervention). RESULTS Pain and pain medication use significantly decreased, while pain self-efficacy increased pre-post for women randomized to both conditions (P's <.05). Five-session PCST participants demonstrated less pain (P =.03) and pain medication use (P =.04), and more pain self-efficacy (P =.02) and coping skills use (P =.04) at postintervention compared to one-session PCST participants. Pain self-efficacy mediated the relationship of intervention condition with pain and pain medication use. CONCLUSION Both conditions led to improvements in pain, pain medication use, pain self-efficacy, and coping skills use, and 5-session PCST showed the greatest benefits. Brief cognitive-behavioral pain intervention improve pain outcomes, and pain self-efficacy may play a role in these effects.
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Affiliation(s)
- Hannah M Fisher
- Department of Psychiatry and Behavioral Sciences (H.M.F, K.A.H., J.G.W., S.N.F., G.H.A., A.K.D. S.A.K., T.J.S.), Duke University Medical Center, Durham, North Carolina, USA.
| | - Kelly A Hyland
- Department of Psychiatry and Behavioral Sciences (H.M.F, K.A.H., J.G.W., S.N.F., G.H.A., A.K.D. S.A.K., T.J.S.), Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph G Winger
- Department of Psychiatry and Behavioral Sciences (H.M.F, K.A.H., J.G.W., S.N.F., G.H.A., A.K.D. S.A.K., T.J.S.), Duke University Medical Center, Durham, North Carolina, USA
| | - Shannon N Miller
- Department of Psychiatry and Behavioral Sciences (H.M.F, K.A.H., J.G.W., S.N.F., G.H.A., A.K.D. S.A.K., T.J.S.), Duke University Medical Center, Durham, North Carolina, USA
| | - Grace H Amaden
- Department of Psychiatry and Behavioral Sciences (H.M.F, K.A.H., J.G.W., S.N.F., G.H.A., A.K.D. S.A.K., T.J.S.), Duke University Medical Center, Durham, North Carolina, USA
| | - Allison K Diachina
- Department of Psychiatry and Behavioral Sciences (H.M.F, K.A.H., J.G.W., S.N.F., G.H.A., A.K.D. S.A.K., T.J.S.), Duke University Medical Center, Durham, North Carolina, USA
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences (H.M.F, K.A.H., J.G.W., S.N.F., G.H.A., A.K.D. S.A.K., T.J.S.), Duke University Medical Center, Durham, North Carolina, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences (H.M.F, K.A.H., J.G.W., S.N.F., G.H.A., A.K.D. S.A.K., T.J.S.), Duke University Medical Center, Durham, North Carolina, USA
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Winger JG, Kelleher SA, Ramos K, Check DK, Yu JA, Powell VD, Lerebours R, Olsen MK, Keefe FJ, Steinhauser KE, Porter LS, Breitbart WS, Somers TJ. Meaning-centered pain coping skills training for patients with metastatic cancer: Results of a randomized controlled pilot trial. Psychooncology 2023. [PMID: 37173865 DOI: 10.1002/pon.6151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/07/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE For patients with advanced cancer, pain is a common and debilitating symptom that can negatively impact physical, emotional, and spiritual well-being. This trial examined the feasibility and initial effects of Meaning-Centered Pain Coping Skills Training (MCPC), a cognitive-behavioral pain management intervention with an emphasis on enhancing meaning (i.e., a personal sense of purpose, worth, and significance) and peace. METHODS We enrolled 60 adults with stage IV solid tumor cancers and moderate-severe pain between February 2021 and February 2022. Participants were randomized 1:1 to MCPC + usual care or usual care alone. Meaning-Centered Pain Coping Skills Training consisted of four weekly 60-min individual sessions via videoconference or telephone, delivered by a trained therapist using a manualized protocol. Participants completed validated measures of pain severity, pain interference, pain self-efficacy, spiritual well-being (i.e., meaning, peace, and faith), and psychological distress at baseline and 5-week and 10-week follow-ups. RESULTS All feasibility metrics exceeded prespecified benchmarks. Fifty-eight percent of screened patients were eligible, and 69% of eligible patients consented. Of those assigned to MCPC, 93% completed all sessions and 100% of those who completed follow-ups reported using coping skills weekly. Retention was strong at 5-week (85%) and 10-week (78%) follow-ups. Meaning-Centered Pain Coping Skills Training participants reported better scores than control participants across outcome measures, including moderate-to-large sized differences at 10-week follow-up in pain severity (Cohen's d = -0.75 [95% confidence interval: -1.36, -0.14]), pain interference (d = -0.82 [-1.45, -0.20]), and pain self-efficacy (d = 0.74 [0.13, 1.35]). CONCLUSIONS MCPC is a highly feasible, engaging, and promising approach for improving pain management in advanced cancer. Future efficacy testing is warranted. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04431830, registered 16 June 2020.
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Affiliation(s)
- Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University Health System, Durham, North Carolina, USA
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University Health System, Durham, North Carolina, USA
| | - Katherine Ramos
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University Health System, Durham, North Carolina, USA
- Geriatric Research, Education, and Clinical Center, (GRECC), Durham VA Health Care System, Durham, North Carolina, USA
- Center for the Study of Human Aging and Development, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina, USA
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Devon K Check
- Duke Cancer Institute, Duke University Health System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Justin A Yu
- Division of Pediatric Palliative and Supportive Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Victoria D Powell
- Palliative Care Program, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Geriatrics Research, Education, and Clinical Center (GRECC), LTC Charles S. Kettles VA Medical Center, Ann Arbor, Michigan, USA
| | - Reginald Lerebours
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Maren K Olsen
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University Health System, Durham, North Carolina, USA
| | - Karen E Steinhauser
- Duke Cancer Institute, Duke University Health System, Durham, North Carolina, USA
- Center for the Study of Human Aging and Development, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina, USA
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University Health System, Durham, North Carolina, USA
| | - William S Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University Health System, Durham, North Carolina, USA
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Hyland KA, Amaden GH, Diachina AK, Miller SN, Dorfman CS, Berchuck SI, Winger JG, Somers TJ, Keefe FJ, Uronis HE, Kelleher SA. mHealth Coping Skills Training for Symptom Management (mCOPE) for colorectal Cancer patients in early to mid-adulthood: Study protocol for a randomized controlled trial. Contemp Clin Trials Commun 2023; 33:101126. [PMID: 37077935 PMCID: PMC10106511 DOI: 10.1016/j.conctc.2023.101126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
Background Colorectal cancer (CRC) patients in early to mid-adulthood (≤50 years) are challenged by high symptom burden (i.e., pain, fatigue, distress) and age-related stressors (e.g., managing family, work). Cognitive behavioral theory (CBT)-based coping skills training interventions reduce symptoms and improve quality of life in cancer patients. However, traditional CBT-based interventions are not accessible to these patients (e.g., in-person sessions, during work day), nor designed to address symptoms within the context of this stage of life. We developed a mobile health (mHealth) coping skills training program for pain, fatigue and distress (mCOPE) for CRC patients in early to mid-adulthood. We utilize a randomized controlled trial to test the extent to which mCOPE reduces pain, fatigue and distress (multiple primary outcomes) and improves quality of life and symptom self-efficacy (secondary outcomes). Methods/Design Patients (N = 160) ≤50 years with CRC endorsing pain, fatigue and/or distress are randomized 1:1 to mCOPE or standard care. mCOPE is a five-session CBT-based coping skills training program (e.g., relaxation, activity pacing, cognitive restructuring) that was adapted for CRC patients in early to mid-adulthood. mCOPE utilizes mHealth technology (e.g., videoconference, mobile app) to deliver coping skills training, capture symptom and skills use data, and provide personalized support and feedback. Self-report assessments are completed at baseline, post-treatment (5-8 weeks post-baseline; primary endpoint), and 3- and 6-months later. Conclusions mCOPE is innovative and potentially impactful for CRC patients in early to mid-adulthood. Hypothesis confirmation would demonstrate initial efficacy of a mHealth cognitive behavioral intervention to reduce symptom burden in younger CRC patients.
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Fisher HM, Stalls J, Winger JG, Miller SN, Plumb Vilardaga JC, Majestic C, Kelleher SA, Somers TJ. Role of self-efficacy for pain management and pain catastrophizing in the relationship between pain severity and depressive symptoms in women with breast cancer and pain. J Psychosoc Oncol 2023; 41:87-103. [PMID: 35311481 PMCID: PMC9489816 DOI: 10.1080/07347332.2022.2046676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE This study evaluated the relationship between pain and depressive symptoms through pain self-efficacy and pain catastrophizing in breast cancer patients with pain. DESIGN Secondary analysis of a randomized trial investigating a cognitive-behavioral pain management protocol. SAMPLE Females (N = 327) with stage I-III breast cancer and report of at least moderate pain. METHODS Pain severity, pain self-efficacy, pain catastrophizing, and depressive symptoms were measured. The proposed model was assessed using structural equation modeling. RESULTS Higher pain severity was significantly related to lower pain self-efficacy and higher pain catastrophizing. Lower pain self-efficacy and higher pain catastrophizing were significantly related to more depressive symptoms. Higher pain severity was significantly associated with more depressive symptoms through lower pain self-efficacy and higher pain catastrophizing. The association between pain severity and depressive symptoms was not significant when specified as a direct effect. CONCLUSION Pain severity related to depressive symptoms in breast cancer patients via pain self-efficacy and pain catastrophizing. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Measurement of pain self-efficacy and pain catastrophizing should be incorporated into comprehensive pain assessments for women with breast cancer, as these variables may be relevant therapeutic targets. Psychosocial symptom management interventions should include strategies that increase pain self-efficacy and decrease pain catastrophizing because these pain-related cognitive variables appear to drive the relationship between pain severity and depressive symptoms.
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Affiliation(s)
- Hannah M. Fisher
- Pain Prevention and Treatment Research Program, Duke University Medical Center, Durham, North Carolina, USA
| | - Juliann Stalls
- Pain Prevention and Treatment Research Program, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph G. Winger
- Pain Prevention and Treatment Research Program, Duke University Medical Center, Durham, North Carolina, USA
| | - Shannon N. Miller
- Pain Prevention and Treatment Research Program, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Catherine Majestic
- Pain Prevention and Treatment Research Program, Duke University Medical Center, Durham, North Carolina, USA
| | - Sarah A. Kelleher
- Pain Prevention and Treatment Research Program, Duke University Medical Center, Durham, North Carolina, USA
| | - Tamara J. Somers
- Pain Prevention and Treatment Research Program, Duke University Medical Center, Durham, North Carolina, USA
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Kelleher SA, Fisher HM, Hyland K, Miller SN, Amaden G, Diachina A, Pittman AS, Winger JG, Sung A, Berchuck S, Samsa G, Somers TJ. Hybrid-delivered cognitive behavioral symptom management and activity coaching intervention for patients undergoing hematopoietic stem cell transplant: Findings from intervention development and a pilot randomized trial. J Psychosoc Oncol 2022; 41:539-557. [PMID: 36476318 PMCID: PMC10247893 DOI: 10.1080/07347332.2022.2152519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Develop and pilot test a mobile health (mHealth) cognitive behavioral coping skills training and activity coaching protocol (HCT Symptoms and Steps) for hematopoietic stem cell transplant (HCT) patients. DESIGN Two-phase, mixed methods study. SAMPLE HCT patients and healthcare providers. METHODS Phase I was patient (n = 5) and provider (n = 1) focus groups and user testing (N = 5) to develop the HCT Symptoms and Steps protocol. Phase II was a pilot randomized trial (N = 40) to evaluate feasibility, acceptability, and pre-to-post outcomes (e.g., physical disability, pain, fatigue, distress, physical activity, symptom self-efficacy) compared to an education control. FINDINGS Qualitative feedback on symptoms, recruitment strategies, coping skills, and mHealth components (e.g., Fitbit, mobile app) were integrated into the protocol. HCT Symptoms and Steps were feasible and acceptable. Pre-post changes suggest physical disability and activity improved while symptoms (e.g., fatigue, distress) decreased. CONCLUSIONS HCT Symptoms and Steps have strong feasibility and acceptability and shows promise for benefits. Larger, fully-powered randomized trials are needed to examine intervention efficacy. IMPLICATIONS HCT Symptoms and Steps may reduce physical disability and improve health outcomes post-transplant. CLINICAL TRIAL REGISTRATION NUMBER NCT03859765.
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Affiliation(s)
- Sarah A. Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Hannah M. Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Kelly Hyland
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Shannon N. Miller
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Grace Amaden
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Allison Diachina
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Alyssa Sweet. Pittman
- Department of Physical Therapy and Occupational Therapy, Duke University Medical Center, Durham, NC
| | - Joseph G. Winger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Anthony Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Samuel Berchuck
- Department of Statistical Science, Duke University, Durham, NC
| | - Greg Samsa
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Tamara J. Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
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Winger JG, Kelleher SA, Fisher HM, Somers TJ, Samsa GP. Designing Psychosocial Intervention Pilot Studies: A Tutorial for Palliative Care Investigators. J Pain Symptom Manage 2022; 63:e749-e755. [PMID: 35235856 PMCID: PMC9133099 DOI: 10.1016/j.jpainsymman.2022.02.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/08/2022] [Accepted: 02/18/2022] [Indexed: 11/22/2022]
Abstract
This is a tutorial on designing a persuasive pilot study of a psychosocial intervention (e.g., behavioral symptom management) in the palliative care setting. This tutorial is most relevant for early stages of intervention research that aims to progress toward a randomized controlled trial with a high degree of internal validity. Broadly, a pilot study aims to address multiple elements of feasibility and acceptability so that investigators are well positioned for the next study in their program of research. To assist investigators in writing compelling grant applications we designed this tutorial as an annotated checklist of goals that a pilot study within the palliative care domain should seek to accomplish. These goals include the following: 1) begin with the end in mind, 2) use a formal conceptual model, 3) use measures with strong psychometric properties, 4) justify the timing of study sessions and assessments, 5) test recruitment methods, 6) estimate retention, 7) assess interventionist fidelity, 8) assess acceptability of the intervention, 9) assess feasibility, and 10) identify barriers to the next study. We elaborate on these goals by describing an ongoing pilot study testing the feasibility and acceptability of a psychosocial pain management intervention for patients with advanced cancer. Pilot studies are crucial for building a successful program of research, but they are also limited in terms of their sample size and overall objectives. A persuasive pilot study is one that is limited yet useful rather than limited and trivial.
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Affiliation(s)
- Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Durham, North Carolina, USA.
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Durham, North Carolina, USA
| | - Hannah M Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Durham, North Carolina, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Durham, North Carolina, USA
| | - Gregory P Samsa
- Duke Cancer Institute, Durham, North Carolina, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
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12
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Vilardaga JCP, Fisher HM, Winger JG, Miller SN, Nuñez C, Majestic C, Kelleher SA, Somers TJ. Pain, depressive symptoms, and self-efficacy for pain management: examination in African-American women with breast cancer. Support Care Cancer 2022; 30:6633-6640. [PMID: 35501516 DOI: 10.1007/s00520-022-07083-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/21/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE African-American women with breast cancer face significant disparities, including high levels of pain. Depressive symptoms and self-efficacy for pain management impact how women with breast cancer manage pain, yet little is known about how these variables relate to pain specifically for African-American women with breast cancer. METHODS Baseline linear regression analyses were conducted using a sample of women (n = 98) with stage I-III breast cancer identifying as Black or African-American who were part of a larger intervention trial. Linear regressions explored the effect of depressive symptoms on pain (i.e., severity and interference), and the effect of self-efficacy for pain management on pain. Covariates were age (M = 57.22, SD = 10.76), cancer stage (50% = stage 1), and education level (36% = some college). RESULTS Participants reported moderate levels of pain severity and interference. Higher depressive symptoms were related to both higher pain severity and interference; (B = 0.06, p < 0.01, 95% CI [0.02,0.09]) and (B = 0.13, p < 0.001, 95% CI [0.09, 0.17]) respectively. Likewise, lower self-efficacy for pain management was also related to both higher pain severity and interference; (B = - 0.04, p < 0.001, 95% CI [- 0.05, - 0.02]) and (B = - 0.06, p < 0.001, 95% CI [- 0.08, - 0.04]) respectively. Women reporting less than a high school diploma endorsed significantly higher pain severity and interference than women reporting some college. Age and cancer stage were not significantly related to pain. CONCLUSION Pain for African-American women with breast cancer may be influenced by depressive symptoms and self-efficacy for pain management, in addition to other important variables. Attending to better assessment and treatment of depressive symptoms and self-efficacy for pain management may improve outcomes.
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Affiliation(s)
- Jennifer C Plumb Vilardaga
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA.
| | - Hannah M Fisher
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
| | - Joseph G Winger
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
| | - Shannon N Miller
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
| | - Christine Nuñez
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Catherine Majestic
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
| | - Sarah A Kelleher
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
| | - Tamara J Somers
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
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Winger JG, Ramos K, Kelleher SA, Somers TJ, Steinhauser KE, Porter LS, Kamal AH, Breitbart WS, Keefe FJ. Meaning-Centered Pain Coping Skills Training: A Pilot Feasibility Trial of a Psychosocial Pain Management Intervention for Patients with Advanced Cancer. J Palliat Med 2022. [PMID: 34388037 DOI: 10.1089/jpm.2021.008160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Background: Pain from advanced cancer can greatly reduce patients' physical, emotional, and spiritual well-being. Objective: To examine the feasibility and acceptability of a behavioral pain management intervention, Meaning-Centered Pain Coping Skills Training (MCPC). Design: This trial used a single-arm feasibility design. Setting/Subjects: Thirty participants with stage IV solid tumor cancer, moderate-to-severe pain, and clinically elevated distress were enrolled from a tertiary cancer center in the United States. The manualized protocol was delivered across four 45- to 60-minute videoconference sessions. Measurements: Feasibility and acceptability were assessed through accrual, session/assessment completion, intervention satisfaction, and coping skills usage. Participants completed validated measures of primary outcomes (i.e., pain severity, pain interference, and spiritual well-being) and secondary outcomes at baseline, post-intervention, and four-week follow-up. Results: Eighty-eight percent (38/43) of patients who completed screening met inclusion criteria, and 79% (30/38) consented and completed baseline assessment. Sixty-seven percent (20/30) of participants were female (mean age = 57). Most participants were White/Caucasian (77%; 23/30) or Black/African American (17%; 5/30) with at least some college education (90%; 27/30). Completion rates for intervention sessions and both post-intervention assessments were 90% (27/30), 87% (26/30), and 77% (23/30), respectively. At the post-intervention assessment, participants reported a high degree of intervention satisfaction (mean = 3.53/4.00; SD = 0.46), and 81% (21/26) reported weekly use of coping skills that they learned. Participants also showed improvement from baseline on all primary outcomes and nearly all secondary outcomes at both post-intervention assessments. Conclusions: MCPC demonstrated strong feasibility and acceptability. Findings warrant further evaluation of MCPC in a randomized controlled trial. ClinicalTrials.gov Identifier: NCT03207360.
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Affiliation(s)
- Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katherine Ramos
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center for the Study of Human Aging and Development, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) for Health Services Research and Development, Durham VA Medical Center, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Geriatric, Research, Education and Clinical Center (GRECC), Durham VA Medical Center, Durham, North Carolina, USA
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Karen E Steinhauser
- Center for the Study of Human Aging and Development, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) for Health Services Research and Development, Durham VA Medical Center, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Arif H Kamal
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University Health System, Durham, North Carolina, USA
- Duke Fuqua School of Business, Durham, North Carolina, USA
| | - William S Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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14
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Winger JG, Ramos K, Kelleher SA, Somers TJ, Steinhauser KE, Porter LS, Kamal AH, Breitbart WS, Keefe FJ. Meaning-Centered Pain Coping Skills Training: A Pilot Feasibility Trial of a Psychosocial Pain Management Intervention for Patients with Advanced Cancer. J Palliat Med 2022; 25:60-69. [PMID: 34388037 PMCID: PMC8721493 DOI: 10.1089/jpm.2021.0081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Pain from advanced cancer can greatly reduce patients' physical, emotional, and spiritual well-being. Objective: To examine the feasibility and acceptability of a behavioral pain management intervention, Meaning-Centered Pain Coping Skills Training (MCPC). Design: This trial used a single-arm feasibility design. Setting/Subjects: Thirty participants with stage IV solid tumor cancer, moderate-to-severe pain, and clinically elevated distress were enrolled from a tertiary cancer center in the United States. The manualized protocol was delivered across four 45- to 60-minute videoconference sessions. Measurements: Feasibility and acceptability were assessed through accrual, session/assessment completion, intervention satisfaction, and coping skills usage. Participants completed validated measures of primary outcomes (i.e., pain severity, pain interference, and spiritual well-being) and secondary outcomes at baseline, post-intervention, and four-week follow-up. Results: Eighty-eight percent (38/43) of patients who completed screening met inclusion criteria, and 79% (30/38) consented and completed baseline assessment. Sixty-seven percent (20/30) of participants were female (mean age = 57). Most participants were White/Caucasian (77%; 23/30) or Black/African American (17%; 5/30) with at least some college education (90%; 27/30). Completion rates for intervention sessions and both post-intervention assessments were 90% (27/30), 87% (26/30), and 77% (23/30), respectively. At the post-intervention assessment, participants reported a high degree of intervention satisfaction (mean = 3.53/4.00; SD = 0.46), and 81% (21/26) reported weekly use of coping skills that they learned. Participants also showed improvement from baseline on all primary outcomes and nearly all secondary outcomes at both post-intervention assessments. Conclusions: MCPC demonstrated strong feasibility and acceptability. Findings warrant further evaluation of MCPC in a randomized controlled trial. ClinicalTrials.gov Identifier: NCT03207360.
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Affiliation(s)
- Joseph G. Winger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Address correspondence to: Joseph G. Winger, PhD, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2200 West Main Street, Suite 340, Durham, NC 27705, USA
| | - Katherine Ramos
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Center for the Study of Human Aging and Development, Duke University, Durham, North Carolina, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) for Health Services Research and Development, Durham VA Medical Center, Durham, North Carolina, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Geriatric, Research, Education and Clinical Center (GRECC), Durham VA Medical Center, Durham, North Carolina, USA
| | - Sarah A. Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Tamara J. Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Karen E. Steinhauser
- Center for the Study of Human Aging and Development, Duke University, Durham, North Carolina, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) for Health Services Research and Development, Durham VA Medical Center, Durham, North Carolina, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laura S. Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Arif H. Kamal
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Cancer Institute, Duke University Health System, Durham, North Carolina, USA.,Duke Fuqua School of Business, Durham, North Carolina, USA
| | - William S. Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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Smith SK, Somers TJ, Kuhn E, Laber E, Sung AD, Syrjala KL, Feger B, Kelleher SA, Majestic C, Gebert R, LeBlanc M, Owen JE, Applebaum AJ. A SMART approach to optimizing delivery of an mHealth intervention among cancer survivors with posttraumatic stress symptoms. Contemp Clin Trials 2021; 110:106569. [PMID: 34536584 PMCID: PMC8595815 DOI: 10.1016/j.cct.2021.106569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND/AIMS Many cancer survivors who received intensive treatment such as hematopoietic stem cell transplantation (HCT) experience posttraumatic stress disorder (PTSD) symptoms. PTSD is associated with lower quality of life and other symptoms that require clinical treatment. The iterative treatment decisions that happen in clinical practice are not adequately represented in traditional randomized controlled trials (RCT) of PTSD treatments. The proposed stepped-care SMART design allows for evaluation of initial response to the Cancer Distress Coach mobile app; adaptive stepped-care interventions; and precision treatment strategies that tailor treatment selection to patient characteristics. METHODS/DESIGN HCT survivors (N = 400) reporting PTSD symptoms are being recruited at two cancer centers and randomly assigned to: 1) Cancer Distress Coach app or 2) Usual Care. The app includes educational and cognitive behavioral therapy (CBT)-based activities. Four weeks post-randomization, participants re-rate their PTSD symptoms and, based on intervention response, non-responders are re-randomized to receive video-conferenced sessions with a therapist: 3) coaching sessions in using the mobile app; or 4) CBT specific to HCT survivors. Participants complete outcome measures of PTSD, depression, and anxiety after Months 1, 3, and 6. Participant characteristics moderating intervention responses will be examined. CONCLUSIONS This novel adaptive trial design will afford evidence that furthers knowledge about optimizing PTSD interventions for HCT survivors. To our knowledge, this study is the first SMART design evaluating PTSD symptom management in cancer survivors. If successful, it could be used to optimize treatment among a range of cancer and other trauma survivors.
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Affiliation(s)
- Sophia K Smith
- School of Nursing, Duke University, Durham, NC, United States of America; Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America.
| | - Tamara J Somers
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - Eric Kuhn
- Dissemination and Training Division, National Center for PTSD, Palo Alto, CA, United States of America; Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States of America
| | - Eric Laber
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States of America
| | - Anthony D Sung
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America; Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, United States of America
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Bryan Feger
- Duke Clinical Research Institute, Durham, NC, United States of America
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - Catherine Majestic
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - Rebecca Gebert
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Matthew LeBlanc
- School of Nursing, Duke University, Durham, NC, United States of America
| | - Jason E Owen
- Dissemination and Training Division, National Center for PTSD, Palo Alto, CA, United States of America
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Psychology in Psychiatry, Weill Cornell Medicine, New York, NY, United States of America
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16
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Kelleher SA, Winger JG, Fisher HM, Miller SN, Reed SD, Thorn BE, Spring B, Samsa GP, Majestic CM, Shelby RA, Sutton LM, Keefe FJ, Somers TJ. Behavioral cancer pain intervention using videoconferencing and a mobile application for medically underserved patients: Rationale, design, and methods of a prospective multisite randomized controlled trial. Contemp Clin Trials 2021; 102:106287. [PMID: 33497833 DOI: 10.1016/j.cct.2021.106287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/16/2021] [Accepted: 01/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women with breast cancer in medically underserved areas are particularly vulnerable to persistent pain and disability. Behavioral pain interventions reduce pain and improve outcomes. Cancer patients in medically underserved areas receive limited adjunctive cancer care, as many lack access to pain therapists trained in behavioral interventions, face travel barriers to regional medical centers, and may have low literacy and limited resources. mHealth technologies have the potential to decrease barriers but must be carefully adapted for, and efficacy-tested with, medically underserved patients. We developed an mHealth behavioral pain coping skills training intervention (mPCST-Community). We now utilize a multisite randomized controlled trial to: 1) test the extent mPCST-Community reduces breast cancer patients' pain severity (primary outcome), pain interference, fatigue, physical disability, and psychological distress; 2) examine potential mediators of intervention effects; and 3) evaluate the intervention's cost and cost-effectiveness. METHODS/DESIGN Breast cancer patients (N = 180) will be randomized to mPCST-Community or an attention control. mPCST-Community's four-session protocol will be delivered via videoconferencing at an underserved community clinic by a remote pain therapist at a major medical center. Videoconference sessions will be supplemented with a mobile application. Participants will complete self-report measures at baseline, post-intervention, and 3- and 6-month follow-ups. CONCLUSIONS mPCST-Community has the potential to reduce pain and disability, and decrease barriers for cancer patients in medically underserved areas. This is one of the first trials to test an mHealth behavioral cancer pain intervention developed specifically for medically underserved communities. If successful, it could lead to widespread implementation and decreased health disparities.
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Affiliation(s)
- Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Hannah M Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Shannon N Miller
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Shelby D Reed
- Population Health Sciences, Duke University Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Beverly E Thorn
- The Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gregory P Samsa
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Catherine M Majestic
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
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Winger JG, Nunez C, Kelleher SA, Ingle KK, Gandhi V, Keefe FJ, Somers TJ. Predictors of Intervention Session Completion in a Randomized Clinical Trial of a Behavioral Cancer Pain Intervention. J Pain Symptom Manage 2020; 59:1268-1277. [PMID: 32045676 DOI: 10.1016/j.jpainsymman.2020.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 01/21/2023]
Abstract
CONTEXT Some patients with cancer are able to complete psychosocial pain management intervention sessions, and others find it difficult to do so. OBJECTIVES Conduct a secondary analysis of a randomized clinical trial (N = 178) that compared delivery formats (in-person vs. videoconference) of a pain coping skills training (PCST) intervention for patients with cancer to examine if intervention session completion predicts postintervention outcomes of pain severity and interference, psychological distress, physical well-being, and pain self-efficacy; and identify predictors (i.e., demographics, medical characteristics, baseline outcome scores) of session completion. METHODS Session completion (i.e., completing all four sessions vs. missing at least one session) was tested as a predictor of postintervention outcomes. Predictors of session completion were then examined. RESULTS In both study conditions combined, PCST session completion predicted improvement from baseline to postintervention in pain severity (β = -0.27; P = 0.03), pain interference (β = -0.25; P = 0.048), and pain self-efficacy (β = 0.23; P = 0.07). Participants in the videoconference condition were significantly more likely than those in the in-person condition to complete all sessions (83% vs. 65%; P = 0.006). Participants with at least some college education (odds ratio [OR] 4.36; P = 0.04), a diagnosis of breast cancer (OR 6.73; P = 0.04), and higher levels of pain self-efficacy (OR 2.32; P = 0.02) were more likely to complete videoconference sessions. Participants who lived closer to the medical center (OR 0.64; P = 0.07), had early stage cancer (OR 3.82; P = 0.07), and fewer medical comorbidities (OR 0.59; P = 0.04) were more likely to complete in-person sessions. CONCLUSION Completing PCST sessions is important for improving pain outcomes. Efforts to increase session completion (e.g., videoconference delivery) should be considered.
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Affiliation(s)
- Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA.
| | - Christine Nunez
- Miller School of Medicine, University of Miami, Coral Gables, Florida, USA
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Krista K Ingle
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Vicky Gandhi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
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Kelleher SA, Winger JG, Dorfman CS, Ingle KK, Moskovich AA, Abernethy AP, Keefe FJ, Samsa GP, Kimmick GG, Somers TJ. A behavioral cancer pain intervention: A randomized noninferiority trial comparing in-person with videoconference delivery. Psychooncology 2019; 28:1671-1678. [PMID: 31162756 PMCID: PMC10141528 DOI: 10.1002/pon.5141] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 05/09/2019] [Accepted: 05/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Behavioral cancer pain interventions are efficacious for improving important pain outcomes; yet, traditional in-person delivery limits patient access. This study compared videoconference-delivered mobile health pain coping skills training (mPCST) to in-person pain coping skills training (PCST-traditional). METHODS This study was a randomized, noninferiority trial with cancer patients. Participants (N = 178) were randomly assigned to four, 45-minute sessions of mPCST or PCST-traditional. Session content focused on evidence-based cognitive and behavioral pain management skills. Assessments were completed at baseline, posttreatment, and 3-month posttreatment, and included measures of primary intervention outcomes (ie, pain severity and pain interference) and secondary intervention outcomes (ie, physical symptoms, psychological distress, physical well-being, and self-efficacy). The main study aim tested whether mPCST was more accessible (defined as feasibility, acceptability, patient burden, and engagement) than PCST-traditional. The second aim tested whether mPCST was noninferior to PCST-traditional. RESULTS mPCST demonstrated significantly greater feasibility (ie, attrition, adherence, and time to completion) than PCST-traditional. Both groups reported similar patient burden and engagement as well as a high degree of acceptability. All intervention outcomes demonstrated noninferiority at posttreatment and, with the exception of physical symptoms, 3-month posttreatment. Concerning the primary intervention outcomes, 95% CIs for the mean differences (d) were below the noninferiority margin of 1 for pain severity (posttreatment d = 0.09, 95% CI, -0.63-0.81; 3 months d = -0.43 95% CI, -1.22-0.36) and pain interference (posttreatment d = -0.11, 95% CI, -0.99-0.76; 3 months d = -0.26 95% CI, -1.14-0.62). CONCLUSION mPCST is highly accessible and noninferior to PCST-traditional.
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Affiliation(s)
- Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Krista K Ingle
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Ashley A Moskovich
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Amy P Abernethy
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Greg P Samsa
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Gretchen G Kimmick
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
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Dorfman CS, Kelleher SA, Winger JG, Shelby RA, Thorn BE, Sutton LM, Keefe FJ, Gandhi V, Manohar P, Somers TJ. Development and pilot testing of an mHealth behavioral cancer pain protocol for medically underserved communities. J Psychosoc Oncol 2018; 37:335-349. [PMID: 30585762 PMCID: PMC10183752 DOI: 10.1080/07347332.2018.1479327] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to refine and test a mobile-health behavioral cancer pain coping skills training protocol for women with breast cancer and pain from medically underserved areas. Three focus groups (Phase 1) were used to refine the initial protocol. A single-arm pilot trial (Phase 2) was conducted to assess feasibility, acceptability, and changes in outcomes. The intervention was delivered at a community-based clinic via videoconferencing technology. Participants were women (N = 19 for Phase 1 and N = 20 for Phase 2) with breast cancer and pain in medically underserved areas. Major themes from focus groups were used to refine the intervention. The refined intervention demonstrated feasibility and acceptability. Participants reported significant improvement in pain severity, pain interference, and self-efficacy for pain management. Our intervention is feasible, acceptable, and likely to lead to improvement in pain-related outcomes for breast cancer patients in medically underserved areas. Implications for Psychosocial Oncology Practice Breast cancer patients being treated in medically underserved areas have a dearth of exposure to behavioral interventions that may improve their ability to manage pain. Evidence from this single-arm pilot trial suggests that our mobile-health behavioral cancer pain coping skills training protocol is acceptable and feasible in this vulnerable population. Appropriately adapted mobile-health technologies may provide an avenue to reach underserved patients and implement behavioral interventions to improve pain management.
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Affiliation(s)
| | - Sarah A Kelleher
- a Duke University Medical Center , Durham , North Carolina , USA
| | - Joseph G Winger
- a Duke University Medical Center , Durham , North Carolina , USA
| | - Rebecca A Shelby
- a Duke University Medical Center , Durham , North Carolina , USA
| | | | - Linda M Sutton
- a Duke University Medical Center , Durham , North Carolina , USA
| | - Francis J Keefe
- a Duke University Medical Center , Durham , North Carolina , USA
| | - Vicky Gandhi
- a Duke University Medical Center , Durham , North Carolina , USA
| | - Preethi Manohar
- a Duke University Medical Center , Durham , North Carolina , USA
| | - Tamara J Somers
- a Duke University Medical Center , Durham , North Carolina , USA
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Somers TJ, Kelleher SA, Dorfman CS, Shelby RA, Fisher HM, Rowe Nichols K, Sullivan KM, Chao NJ, Samsa GP, Abernethy AP, Keefe FJ. An mHealth Pain Coping Skills Training Intervention for Hematopoietic Stem Cell Transplantation Patients: Development and Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e66. [PMID: 29555620 PMCID: PMC5881038 DOI: 10.2196/mhealth.8565] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/16/2017] [Accepted: 12/06/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Pain is a challenge for patients following hematopoietic stem cell transplantation (HCT). OBJECTIVE This study aimed to develop and test the feasibility, acceptability, and initial efficacy of a Web-based mobile pain coping skills training (mPCST) protocol designed to address the needs of HCT patients. METHODS Participants had undergone HCT and reported pain following transplant (N=68). To guide intervention development, qualitative data were collected from focus group participants (n=25) and participants who completed user testing (n=7). After their input was integrated into the mPCST intervention, a pilot randomized controlled trial (RCT, n=36) was conducted to examine the feasibility, acceptability, and initial efficacy of the intervention. Measures of acceptability, pain severity, pain disability, pain self-efficacy, fatigue, and physical disability (self-report and 2-min walk test [2MWT]) were collected. RESULTS Participants in the focus groups and user testing provided qualitative data that were used to iteratively refine the mPCST protocol. Focus group qualitative data included participants' experiences with pain following transplant, perspectives on ways to cope with pain, and suggestions for pain management for other HCT patients. User testing participants provided feedback on the HCT protocol and information on the use of videoconferencing. The final version of the mPCST intervention was designed to bridge the intensive outpatient (1 in-person session) and home settings (5 videoconferencing sessions). A key component of the intervention was a website that provided personalized messages based on daily assessments of pain and activity. The website also provided intervention materials (ie, electronic handouts, short videos, and audio files). The intervention content included pain coping advice from other transplant patients and instructions on how to apply pain coping skills while engaging in meaningful and leisure activities. In the RCT phase of this research, HCT patients (n=36) were randomized to receive the mPCST intervention or to proceed with the treatment as usual. Results revealed that the mPCST participants completed an average of 5 out of 6 sessions. The participants reported that the intervention was highly acceptable (mean 3/4), and they found the sessions to be helpful (mean 8/10) and easy to understand (mean 7/7). The mPCST participants demonstrated significant improvements in pre- to post-treatment pain, self-efficacy (P=.03, d=0.61), and on the 2MWT (P=.03, d=0.66), whereas the patients in the treatment-as-usual group did not report any such improvements. Significant changes in pain disability and fatigue were found in both groups (multiple P<.02); the magnitudes of the effect sizes were larger for the mPCST group than for the control group (pain disability: d=0.79 vs 0.69; fatigue: d=0.94 vs 0.81). There were no significant changes in pain severity in either group. CONCLUSIONS Using focus groups and user testing, we developed an mPCST protocol that was feasible, acceptable, and beneficial for HCT patients with pain. TRIAL REGISTRATION ClinicalTrials.gov NCT01984671; https://clinicaltrials.gov/ct2/show/NCT01984671 (Archived by WebCite at http://www.webcitation.org/6xbpx3clZ).
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Affiliation(s)
- Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Hannah M Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Krista Rowe Nichols
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, United States
| | - Keith M Sullivan
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, United States
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, United States
| | - Gregory P Samsa
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, United States
| | - Amy P Abernethy
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
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Cox CE, Hough CL, Carson SS, White DB, Kahn JM, Olsen MK, Jones DM, Somers TJ, Kelleher SA, Porter LS. Effects of a Telephone- and Web-based Coping Skills Training Program Compared with an Education Program for Survivors of Critical Illness and Their Family Members. A Randomized Clinical Trial. Am J Respir Crit Care Med 2018; 197:66-78. [DOI: 10.1164/rccm.201704-0720oc] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Christopher E. Cox
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
- Duke Program to Support People and Enhance Recovery
| | - Catherine L. Hough
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Shannon S. Carson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Douglas B. White
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Jeremy M. Kahn
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Maren K. Olsen
- Department of Biostatistics, and
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina
| | - Derek M. Jones
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
- Duke Program to Support People and Enhance Recovery
| | - Tamara J. Somers
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Sarah A. Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Laura S. Porter
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
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O'Sullivan ML, Shelby RA, Dorfman CS, Kelleher SA, Fisher HM, Rowe Nichols KA, Keefe FJ, Sung AD, Somers TJ. The effect of pre-transplant pain and chronic disease self-efficacy on quality of life domains in the year following hematopoietic stem cell transplantation. Support Care Cancer 2017; 26:1243-1252. [PMID: 29124418 DOI: 10.1007/s00520-017-3947-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/23/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Pain is common for hematopoietic stem cell transplant (HSCT) patients and may be experienced pre-transplant, acutely post-transplant, and for months or years following transplant. HSCT patients with persistent pain may be at risk for poor quality of life following transplant; however, the impact of pre-transplant pain on quality of life post-transplant is not well understood. Self-efficacy for chronic disease management is associated with quality of life among cancer patients and may impact quality of life for HSCT patients. The primary aim was to examine the effect of pre-transplant pain and self-efficacy on quality of life domains in the year following transplant. METHODS One hundred sixty-six HSCT patients completed questionnaires providing information on pain, self-efficacy, and quality of life prior to transplant, at discharge, and 3-, 6-, and 12-months post-transplant as part of a longitudinal, observational study. Linear mixed modeling examined the trajectories of these variables and the effect of pre-transplant pain and self-efficacy on post-transplant quality of life. RESULTS Pain and social and emotional quality of life remained stable in the year following transplant while self-efficacy and physical and functional quality of life improved. Pre-transplant pain was significantly related to lower physical well-being post-transplant. Lower pre-transplant self-efficacy was related to lower quality of life across all domains post-transplant. CONCLUSION Above and beyond the effect of pre-transplant pain, self-efficacy for managing chronic disease is important in understanding quality of life following transplant. Identifying patients with pain and/or low self-efficacy pre-transplant may allow for early intervention with self-management strategies.
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Affiliation(s)
- Madeline L O'Sullivan
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main St., Suite 340, Durham, NC, 27705, USA
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main St., Suite 340, Durham, NC, 27705, USA
| | - Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main St., Suite 340, Durham, NC, 27705, USA
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main St., Suite 340, Durham, NC, 27705, USA
| | - Hannah M Fisher
- Department of Psychology, University of Miami, 5665 Ponce De Leon Blvd, Coral Gables, FL, USA
| | - Krista A Rowe Nichols
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, 2400 Pratt St., Suite 9000, Durham, NC, 27710, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main St., Suite 340, Durham, NC, 27705, USA
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, 2400 Pratt St., Suite 9000, Durham, NC, 27710, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main St., Suite 340, Durham, NC, 27705, USA.
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Kelleher SA, Dorfman CS, Plumb Vilardaga JC, Majestic C, Winger J, Gandhi V, Nunez C, Van Denburg A, Shelby RA, Reed SD, Murphy S, Davidian M, Laber EB, Kimmick GG, Westbrook KW, Abernethy AP, Somers TJ. Optimizing delivery of a behavioral pain intervention in cancer patients using a sequential multiple assignment randomized trial SMART. Contemp Clin Trials 2017; 57:51-57. [PMID: 28408335 DOI: 10.1016/j.cct.2017.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/21/2017] [Accepted: 04/08/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND/AIMS Pain is common in cancer patients and results in lower quality of life, depression, poor physical functioning, financial difficulty, and decreased survival time. Behavioral pain interventions are effective and nonpharmacologic. Traditional randomized controlled trials (RCT) test interventions of fixed time and dose, which poorly represent successive treatment decisions in clinical practice. We utilize a novel approach to conduct a RCT, the sequential multiple assignment randomized trial (SMART) design, to provide comparative evidence of: 1) response to differing initial doses of a pain coping skills training (PCST) intervention and 2) intervention dose sequences adjusted based on patient response. We also examine: 3) participant characteristics moderating intervention responses and 4) cost-effectiveness and practicality. METHODS/DESIGN Breast cancer patients (N=327) having pain (ratings≥5) are recruited and randomly assigned to: 1) PCST-Full or 2) PCST-Brief. PCST-Full consists of 5 PCST sessions. PCST-Brief consists of one 60-min PCST session. Five weeks post-randomization, participants re-rate their pain and are re-randomized, based on intervention response, to receive additional PCST sessions, maintenance calls, or no further intervention. Participants complete measures of pain intensity, interference and catastrophizing. CONCLUSIONS Novel RCT designs may provide information that can be used to optimize behavioral pain interventions to be adaptive, better meet patients' needs, reduce barriers, and match with clinical practice. This is one of the first trials to use a novel design to evaluate symptom management in cancer patients and in chronic illness; if successful, it could serve as a model for future work with a wide range of chronic illnesses.
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Affiliation(s)
- Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Jen C Plumb Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Catherine Majestic
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Joseph Winger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Vicky Gandhi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Christine Nunez
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Alyssa Van Denburg
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Shelby D Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Susan Murphy
- Department of Statistics, University of Michigan, Ann Arbor, MI, United States
| | - Marie Davidian
- Department of Statistics, North Carolina State University, Raleigh, NC, United States
| | - Eric B Laber
- Department of Statistics, North Carolina State University, Raleigh, NC, United States
| | - Gretchen G Kimmick
- Department of Internal Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Kelly W Westbrook
- Department of Internal Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Amy P Abernethy
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, United States
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States.
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Perlman KL, Shelby RA, Wren AA, Kelleher SA, Dorfman CS, O'Connor E, Kim C, Johnson KS, Soo MS. Positive and negative mood following imaging-guided core needle breast biopsy and receipt of biopsy results. PSYCHOL HEALTH MED 2016; 22:1149-1162. [PMID: 28007008 DOI: 10.1080/13548506.2016.1271438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Positive and negative mood are independent psychological responses to stressful events. Negative mood negatively impacts well-being and co-occurring positive mood leads to improved adjustment. Women undergoing core needle breast biopsies (CNB) experience distress during CNB and awaiting results; however, influences of mood are not well known. This longitudinal study examines psychosocial and biopsy- and spirituality-related factors associated with mood in patients day of CNB and one week after receiving results. Ninety women undergoing CNB completed questionnaires on psychosocial factors (chronic stress, social support), biopsy experiences (pain, radiologist communication), and spirituality (peace, meaning, faith) day of CNB. Measures of positive and negative mood were completed day of CNB and one week after receiving results (benign n = 50; abnormal n = 25). Multiple linear regression analyses were conducted. Greater positive mood correlated with greater peace (β = .25, p = .02) day of CNB. Lower negative mood correlated with greater peace (β = -.29, p = .004) and there was a trend for a relationship with less pain during CNB (β = .19, p = .07). For patients with benign results, day of CNB positive mood predicted positive mood post-results (β = .31, p = .03) and only chronic stress predicted negative mood (β = .33, p = .03). For women with abnormal results, greater meaning day of CNB predicted lower negative mood post-results (β = -.45, p = .03). Meaning and peace may be important for women undergoing CNB and receiving abnormal results.
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Affiliation(s)
- Katherine L Perlman
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Rebecca A Shelby
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Anava A Wren
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Sarah A Kelleher
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Caroline S Dorfman
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Erin O'Connor
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Connie Kim
- b Department of Radiology, Breast Imaging Division , DUMC , Durham , NC , USA
| | - Karen S Johnson
- b Department of Radiology, Breast Imaging Division , DUMC , Durham , NC , USA
| | - Mary Scott Soo
- b Department of Radiology, Breast Imaging Division , DUMC , Durham , NC , USA
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Abstract
BACKGROUND AND AIMS Patient reported outcomes (PROs) are increasingly being implemented into the care of patients with cancer. The use of a standard set of PROs (e.g., pain) in cancer is becoming established and there is interest in what additional PROs might provide valuable information. The goal of this observational study was to examine how the PROs of self-efficacy for pain and other symptoms assessed at the point of service were associated with pain, symptom severity and distress, and physical and psychosocial functioning in a sample of breast and gastrointestinal patients. We also sought to examine differences in these relationships by cancer type (breast and gastrointestinal) as well as understand differences in self-assessment mode (paper/pencil or electronic tablet). METHODS 178 patients with breast (n=65) and gastrointestinal cancer (n = 113) completed the Chronic Pain Self Efficacy Scale, M.D. Anderson Symptom Inventory, and Functional Assessment of Cancer Therapy-General questionnaires. Measures were completed with paper and pencil and electronically using a tablet computer while patients waited for their clinical appointment. Responses from the initial completed questionnaires on both the paper and electronic instruments were analyzed. RESULTS Patients' self-efficacy scores for pain and other symptoms correlated positively with pain, symptom severity and distress, and physical and psychosocial functioning; patients with lower levels of self-efficacy reported poorer outcomes and functioning overall. The results were independent of cancer type and mode of assessment. No statistically significant differences were found in the PROs when collected by electronic technology versus paper-pencil mode; patients were very satisfied with using the tablet computer to complete the PRO measures. CONCLUSIONS AND IMPLICATIONS Our results suggest that self-efficacy for pain and symptom management may be a beneficial addition to clinic-based PRO assessment batteries for patients with cancer and other chronic diseases. Existing short, validated symptom self-efficacy scales could easily be integrated into clinical practice to help healthcare providers identify patients that might benefit from intervention. Study results also support existing research that suggests electronic approaches are a practical way to collect PRO data, including self-efficacy data, in the clinic. Overall, our data suggest that patients who have particularly low levels of self-efficacy for pain and symptom management may be at risk for higher levels of pain and disability. Thus, if self-efficacy for pain and symptom management were routinely collected at the time of clinical service, psychosocial interventions to improve self-efficacy for pain and symptom management, and in turn overall quality of life, could be implemented in a timely fashion.
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Affiliation(s)
- Sarah A Kelleher
- Department Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, United States
| | - Tamara J Somers
- Department Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, United States
| | - Tracie Locklear
- Center for Learning Health Care, Duke University Medical Center, Durham, NC 27705, United States
| | - Alexandra D Crosswell
- Center for Health and Community, University of California San Francisco, San Francisco, CA 94143, United States
| | - Amy P Abernethy
- Center for Learning Health Care, Duke University Medical Center, Durham, NC 27705, United States
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Williams DM, Dunsiger S, Davy BM, Kelleher SA, Marinik EL, Winett RA. Psychosocial mediators of a theory-based resistance training maintenance intervention for prediabetic adults. Psychol Health 2016; 31:1108-24. [PMID: 27090395 DOI: 10.1080/08870446.2016.1179740] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Examine psychosocial mediators of the effects of high vs. low-dose resistance training (RT) maintenance interventions among older (ages 50-69), overweight and pre-diabetic adults. DESIGN Participants (N = 123) completed a three-month supervised RT initiation phase and were subsequently randomised (time 1) to high or low-dose six-month unsupervised RT maintenance interventions (time 2), followed by a six-month no-contact phase (time 3). MAIN OUTCOME MEASURES Online measures of putative mediators and RT behaviour. RESULTS RT intervention condition (high vs. low dose) had significant effects on change from time 1 to time 2 in behavioural expectation, self-regulation and perceived satisfaction (f(2) = .04-.08), but not outcome expectancies, RT strategies or behavioural intentions (f(2) ≤ .02). Change in each of the putative mediators, except for outcome expectancies (f(2) ≤ .02), had significant effects on RT behaviour at times 2 (f(2) = .12-.27) and 3 (f(2) = .23-.40). In a multiple mediation model, behavioural expectation (f(2) = .11) and self-regulation (f(2) = .06) mediated the effects of RT intervention condition on time 2 RT behaviour, whereas perceived satisfaction did not (f(2) = .01). Self-regulation was a significant mediator of intervention effects on time 3 RT behaviour (f(2) = .11), but behavioural expectation and perceived satisfaction were not (f(2) = .04). CONCLUSIONS Findings suggest that behavioural expectation and self-regulation are appropriate targets for RT maintenance interventions among at-risk older adults.
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Affiliation(s)
- David M Williams
- a Department of Behavioral and Social Sciences , Brown University School of Public Health , Providence , RI , USA
| | - Shira Dunsiger
- a Department of Behavioral and Social Sciences , Brown University School of Public Health , Providence , RI , USA.,b Centers for Behavioral and Preventive Medicine , The Miriam Hospital , Providence , RI , USA
| | - Brenda M Davy
- c Department of Human Nutrition, Foods, and Exercise , Virginia Tech , Blacksburg , RI , USA
| | - Sarah A Kelleher
- d Department of Psychology , Virginia Tech , Blacksburg , RI , USA
| | - Elaina L Marinik
- c Department of Human Nutrition, Foods, and Exercise , Virginia Tech , Blacksburg , RI , USA
| | - Richard A Winett
- d Department of Psychology , Virginia Tech , Blacksburg , RI , USA
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Somers TJ, Abernethy AP, Edmond SN, Kelleher SA, Wren AA, Samsa GP, Keefe FJ. A Pilot Study of a Mobile Health Pain Coping Skills Training Protocol for Patients With Persistent Cancer Pain. J Pain Symptom Manage 2015; 50:553-8. [PMID: 26025279 PMCID: PMC4592787 DOI: 10.1016/j.jpainsymman.2015.04.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 11/21/2022]
Abstract
CONTEXT Pain coping skills training (PCST) interventions have shown efficacy for reducing pain and providing other benefits in patients with cancer. However, their reach is often limited because of a variety of barriers (e.g., travel, physical burden, cost, time). OBJECTIVES This study examined the feasibility and acceptability of a brief PCST intervention delivered to patients in their homes using mobile health (mHealth) technology. Pre-to-post intervention changes in pain, physical functioning, physical symptoms, psychological distress, self-efficacy for pain management, and pain catastrophizing also were examined. METHODS Patients with a diagnosis of breast, lung, prostate, or colorectal cancer who reported persistent pain (N = 25) participated in a four-session intervention delivered using mHealth technology (videoconferencing on a tablet computer). Participants completed measures of pain, physical functioning, physical symptoms, psychological distress, self-efficacy for pain management, and pain catastrophizing. We also assessed patient satisfaction. RESULTS Participants completed an average of 3.36 (SD = 1.11) of the four intervention sessions for an overall session completion rate of 84%. Participants reported that the program was of excellent quality and met their needs. Significant preintervention to postintervention differences were found in pain, physical symptoms, psychological distress, and pain catastrophizing. CONCLUSION The use of mHealth technology is a feasible and acceptable option for delivery of PCST for patients with cancer. This delivery mode is likely to dramatically increase intervention access for cancer patients with pain compared to traditional in-person delivery. Preliminary data also suggest that the program is likely to produce pretreatment to post-treatment decreases in pain and other important outcomes.
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Affiliation(s)
- Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Amy P Abernethy
- Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Sara N Edmond
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA.
| | - Anava A Wren
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Greg P Samsa
- Department of Biostatistics and Bioinformation, Duke University Medical Center, Durham, North Carolina, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
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Winett RA, Davy BM, Savla J, Marinik EL, Kelleher SA, Winett SG, Halliday TM, Williams DM. Theory-based approach for maintaining resistance training in older adults with prediabetes: adherence, barriers, self-regulation strategies, treatment fidelity, costs. Transl Behav Med 2015; 5:149-59. [PMID: 26029277 DOI: 10.1007/s13142-015-0304-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Effectively preventing and treating chronic diseases through health behavior changes often require intensive theory- and evidence-based intervention including long-term maintenance components. We assessed the efficacy of theory-based maintenance approaches varying by dose for persistently performing resistance training (RT) with the hypothesis that a higher-dose social cognitive theory (SCT) approach would produce greater RT adherence than lower-dose Standard. The Resist-Diabetes study first established 2×/week resistance training (RT) in a 3-month supervised intervention in older (50-69 years, N = 170), overweight to obese (BMI 25-39.9 kg/m(2)) previously inactive adults who fit prediabetes criteria (fasting glucose concentration = 95-125 mg/dl; oral glucose tolerance test 2-h glucose concentration = 140-199 mg/dl or both). After the supervised phase, participants (N = 159) were then randomly assigned to one of two conditions for transition (3 weeks) and then RT alone in community settings for extended contact, maintenance (6 months), and then no contact (6 months). SCT featured continued tailored, interactive personal, and web-based check-ups focused on RT, self-regulation, and a barrier/strategies approach. Standard involved low-dose, generic personal, and web-based check-ups within the same theoretical approach. SCT and Standard both resulted in similar RT, 2×/week adherence during maintenance (74.4 %) and no-contact phases (53.1 %). Cost analysis indicated the Standard intervention for transition and maintenance was inexpensive ($160). Standard can be translated into practice with the potential for continuous contact and persistence in RT beyond the typical program maintenance phase.
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Affiliation(s)
| | - Brenda M Davy
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA USA
| | - Jyoti Savla
- Human Development, Center for Gerontology, Virginia Tech, Blacksburg, VA USA
| | - Elaina L Marinik
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA USA
| | | | | | - Tanya M Halliday
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA USA
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Abstract
This article describes the most common diseases that affect the integumentary system of ferrets. Emphasis is placed on diagnosis and treatment of each disease.
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Affiliation(s)
- S A Kelleher
- Broward Avian and Exotic Animal Clinic, Pompano Beach, Florida, USA.
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Abstract
Thermoregulatory responses of heat production and heat loss were measured in seven adult volunteers (four women and three men, aged 21-57 yr) during 45-min dorsal exposures of the whole body to 450 MHz continuous wave radio frequency (RF) fields. Two power densities (PD) (local peak PD = 18 and 24 mW/cm2; local peak specific absorption rate = 0.320 [W/kg]/[mW/cm2]) were tested in each of three ambient temperatures (Ta = 24, 28, and 31 degrees C) plus Ta controls (no RF). No changes in metabolic heat production occurred under any exposure conditions. Vigorous increases in sweating rate on back and chest, directly related to both Ta and PD, cooled the skin and ensured efficient regulation of the deep body (esophageal) temperature to within 0.1 degrees C of the normal level. Category judgments of thermal sensation, comfort, sweating, and thermal preference usually matched the measured changes in physiological responses. Some subtle effects related to gender were noted that confirm classic physiological data. Our results indicate that dorsal exposures of humans to a supraresonant frequency of 450 MHz at local peak specific absorption rates up to 7.68 W/kg are mildly thermogenic and are counteracted efficiently by normal thermophysiologic heat loss mechanisms, principally sweating.
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Affiliation(s)
- E R Adair
- USAF Armstrong Laboratory, Brooks AFB, Texas 78235, USA.
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Abstract
Thermoregulatory responses of heat production and heat loss were measured in two different groups of seven adult volunteers (males and females) during 45-min dorsal exposures of the whole body to 450 or 2450 MHz continuous-wave radio frequency (RF) fields. At each frequency, two power densities (PD) were tested at each of three ambient temperatures (T(a) = 24, 28, and 31 degrees C) plus T(a) controls (no RF). The normalized peak surface specific absorption rate (SAR), measured at the location of the subject's center back, was the same for comparable PD at both frequencies, i.e., peak surface SAR = 6.0 and 7.7 W/kg. No change in metabolic heat production occurred under any exposure conditions at either frequency. The magnitude of increase in those skin temperatures under direct irradiation was directly related to frequency, but local sweating rates on back and chest were related more to T(a) and SAR. Both efficient sweating and increased local skin blood flow contributed to the regulation of the deep body (esophageal) temperature to within 0.1 degrees C of the baseline level. At both frequencies, normalized peak SARs in excess of ANSI/IEEE C95.1 guidelines were easily counteracted by normal thermophysiological mechanisms. The observed frequency-related response differences agree with classical data concerning the control of heat loss mechanisms in human beings. However, more practical dosimetry than is currently available will be necessary to evaluate realistic human exposures to RF energy in the natural environment.
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Affiliation(s)
- E R Adair
- United States Air Force Research Laboratory, HEDR, Brooks Air Force Base, Texas 78235-5324, USA.
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Abstract
We have examined experimentally the question of increased vulnerability to the thermalizing effects of MW exposure during febrile illness. In a controlled ambient temperature of 26 degrees C, autonomic mechanisms of heat production and heat loss were measured in febrile squirrel monkeys during 30-min exposures to 450 or 2450 MHz CW MW fields at different phases of the fever cycle (induction, plateau, defervescence). We have shown that MW energy absorbed during a febrile episode spares endogenous energy production, but may augment the fever if deposited deep in the body, as is the case during exposure at the resonant frequency. The fever may also be exacerbated if the MW exposure occurs late in the febrile episode, a condition that may put an organism at some risk, especially if the field strength exceeds safety guidelines.
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Affiliation(s)
- E R Adair
- John B. Pierce Laboratory, New Haven, Connecticut 06519, USA
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Spiers DE, Kelleher SA, Eichen PA. Ethanol effect on activation and maintenance of cold stress response in immature rats. Pharmacol Biochem Behav 1996; 54:555-64. [PMID: 8743629 DOI: 10.1016/0091-3057(95)02218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Rats at thermoneutral ambient temperature (Ta) exhibit change in thermoregulatory response to ethanol (EtOH) from 2 to 15 days of age. In the present study, rats at 2-3, 8-9, and 14-15 days of age were administered either saline or EtOH (4 g/kg b.wt.;IP) using two different routines to determine EtOH effect on specific cold defense mechanisms. Injection of EtOH in the first routine occurred after exposure to cold Ta, to determine effect on maintenance of cold thermogenesis. EtOH-induced metabolic depression increased from 3 to 8 days of age, with little change after this time. Injection of EtOH in the second routine was at thermoneutral Ta, followed at 20 min postinjection by rapid exposure to cold Ta to determine effect on activation of cold thermogenesis. EtOH-treatment delayed onset of cold thermogenesis at 2-3 and 14-15 days of age, and completely eliminated 8-9-day-old response to cold Ta. Rats exposed to cold Ta at 2-3 days of age exhibited a slower rate of EtOH absorption and lower blood EtOH concentration than rats in the older groups, to explain some age differences in EtOH response.
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Affiliation(s)
- D E Spiers
- Animal Sciences Department, University of Missouri, Columbia 65211, USA
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