Testing the Implementation of a Pain Self-management Support Intervention for Oncology Patients in Clinical Practice: A Randomized Controlled Pilot Study (ANtiPain)

Enhancing nursing's role in community-based palliative care: closing gaps to improve patient outcomes

BACKGROUND

Nursing-led palliative care is essential for improving the quality of life of patients with life-limiting illnesses by addressing their physical, emotional and social needs. Effective symptom management, facilitated by nursing interventions, plays a critical role in this process.

AIM

This study aimed to evaluate the effectiveness of a community-based palliative care program designed to enhance the role of nursing in closing existing gaps in care.

METHODS

A quasi-experimental design with pre- and post-test assessments was conducted at the Oncology and Palliative Care Unit of Zagazig University Hospitals, Egypt. A convenience sample of 140 adult patients diagnosed with cancer or other life-limiting illnesses was recruited. Data were collected using three standardised instruments: the Palliative Outcome Scale (POS), the Edmonton Symptom Assessment Scale (ESAS) and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). The community-based palliative care programme was delivered over eight weeks and focused on symptom management, emotional support, educational resources, and social and spiritual care.

RESULTS

The intervention resulted in a significant reduction in symptom severity, with marked improvements in physical symptoms (mean score reduction from 3.5 to 1.0), psychological symptoms (from 5.3 to 2.5), emotional and spiritual needs (from 4.0 to 1.5), all statistically significant (p < 0.001). EORTC QLQ-C30 results showed improved quality of life, with physical functioning scores increasing from 60.0 to 80.0 and emotional functioning scores increasing from 55.0 to 75.0. Participants also reported improved perceptions of social support and general well-being, indicating an overall improvement in quality of life.

CONCLUSION

This study highlights the positive impact of structured, nurse-led community palliative care interventions on patient outcomes and highlights the importance of nursing involvement in community engagement to provide comprehensive support for people with cancer and other life-limiting conditions.

RECOMMENDATIONS

It is recommended that healthcare providers incorporate standardised assessment tools into routine palliative care practice and consider implementing similar community-based care programmes to improve the quality of care for patients with serious illness.

CLINICAL TRIAL

No clinical trial.

Behavior change theory and behavior change technique use in cancer rehabilitation interventions: a secondary analysis

BACKGROUND

There is limited evidence depicting ways that behavioral theory and techniques have been incorporated into cancer rehabilitation interventions. Examining their use within cancer rehabilitation interventions may provide insight into the active ingredients that can maximize patient engagement and intervention effectiveness.

AIM

This secondary analysis aimed to describe the use of behavior change theory and behavior change techniques (BCTs) in two previously conducted systematic reviews of cancer rehabilitation interventions.

DESIGN

Secondary analysis of randomized controlled trials (RCTs) drawn from two systematic reviews examining the effect of cancer rehabilitation interventions on function and disability.

SETTING

In-person and remotely delivered rehabilitation interventions.

POPULATION

Adult cancer survivors.

METHODS

Data extraction included: behavior change theory use, functional outcome data, and BCTs using the Behavior Change Technique Taxonomy (BCTTv1). Based on their effects on function, interventions were categorized as "very", "quite" or "non-promising". To assess the relative effectiveness of coded BCTs, a BCT promise ratio was calculated (the ratio of promising to non-promising interventions that included the BCT).

RESULTS

Of 180 eligible RCTs, 25 (14%) reported using a behavior change theory. Fifty-four (58%) of the 93 BCTs were used in least one intervention (range 0-29). Interventions reporting theory use utilized more BCTs (median=7) compared to those with no theory (median=3.5; U=2827.00, P=0.001). The number of BCTs did not differ between the very, quite, and non-promising intervention groups (H(2)=0.24, P=0.85). 20 BCTs were considered promising (promise ratio >2) with goal setting, graded tasks, and social support (unspecified) having the highest promise ratios.

CONCLUSIONS

While there was a wide range of BCTs utilized, they were rarely based on theoretically-proposed pathways and the number of BCTs reported was not related to intervention effectiveness.

CLINICAL REHABILITATION IMPACT

Clinicians should consider basing new interventions upon a relevant behavior change theory. Intentionally incorporating the BCTs of goal setting, graded tasks, and social support may improve intervention efficacy.

Cancer pain self-management interventions in adults: scoping review

BACKGROUND

The predominant trend in cancer treatment now leans towards outpatient care, placing the responsibility of pain management largely on the patients themselves. Moreover, a significant portion of treatment for advanced cancer occurs in the home environment, so patient self-management becomes increasingly crucial for the effective treatment of cancer pain.

OBJECTIVES

To map self-management for pain in patients with cancer at all phases of the disease before examining the potential of pain self-care interventions for ill patients with cancer.

METHODS

A search was conducted on six electronic databases to locate studies published in English, from 2013 to 2023. We followed Arskey and O'Malley's Scoping Reviews guidelines.

RESULTS

This study thoroughly examined the provision of cancer pain self-management by healthcare professionals and identified four intervention types from 23 studies. Education emerged as the most prevalent form of self-management for cancer pain.

CONCLUSION

Guiding patients in managing their pain effectively, starting from their hospitalisation and extending to their discharge.

Empowering Cancer Patients with Self-Care and Pain Management Skills: A Quasi-Experimental Study

BACKGROUND

Cancer patients experience distress as a result of their health condition, which, in turn, contributes to the progression of the disease. Moreover, their daily activities, well-being, and health status are significantly impacted by pain and other symptoms. In this context, empowering these patients with self-care and pain management skills can greatly contribute to effective symptom control.

AIM

To develop and implement an educational approach focused on empowering family caregivers and patients with advanced cancer in effectively managing pain at home.

METHOD

An educational program, PECP/C-Pain Management, was developed to empower family caregivers and cancer patients to manage pain at home. A quasi-experimental study involving 52 participants with advanced cancer was conducted to test the program. Participants' skills, behaviors, and knowledge related to self-care and pain management were assessed before and after the intervention using an appropriate instrument, the Pain Management Knowledge and Behavior Scale.

RESULTS

Pain was reported as the primary symptom, and following the educational program, participants were able to monitor pain and other symptoms and effectively self-manage their treatment.

CONCLUSIONS

The findings suggest that the PECP/C-Pain Management intervention was effective in improving participants' knowledge and skills in managing pain, leading to better symptom control. In addition, the Pain Management Knowledge and Behavior Scale is a reliable tool for measuring the outcomes of this intervention.

The influence of telehealth-based cancer rehabilitation interventions on disability: a systematic review

PURPOSE

To characterize delivery features and explore effectiveness of telehealth-based cancer rehabilitation interventions that address disability in adult cancer survivors.

METHODS

A systematic review of electronic databases (CINAHL Plus, Cochrane Library: Database of Systematic Reviews, Embase, National Health Service's Health Technology Assessment, PubMed, Scopus, Web of Science) was conducted in December 2019 and updated in April 2021.

RESULTS

Searches identified 3,499 unique studies. Sixty-eight studies met inclusion criteria. There were 81 unique interventions across included studies. Interventions were primarily delivered post-treatment and lasted an average of 16.5 weeks (SD = 13.1). They were most frequently delivered using telephone calls (59%), administered delivered by nursing professionals (35%), and delivered in a one-on-one format (88%). Risk of bias of included studies was primarily moderate to high. Included studies captured 55 measures of disability. Only 54% of reported outcomes had data that allowed calculation of effect sizes ranging -3.58 to 15.66.

CONCLUSIONS

The analyses suggest small effects of telehealth-based cancer interventions on disability, though the heterogeneity seen in the measurement of disability makes it hard to draw firm conclusions. Further research using more diverse samples, common measures of disability, and pragmatic study designs is needed to advance telehealth in cancer rehabilitation.

IMPLICATIONS FOR CANCER SURVIVORS

Telehealth-based cancer rehabilitation interventions have the potential to increase access to care designed to reduce disability across the cancer care continuum.

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

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

Supporting Pain Self-Management in Patients With Cancer: App Development Based on a Theoretical and Evidence-Driven Approach

BACKGROUND

To inform the development of an intervention, it is essential to have a well-developed theoretical understanding of how an intervention causes change, as stated in the UK Medical Research Council guidelines for developing complex interventions. Theoretical foundations are often ignored in the development of mobile health apps intended to support pain self-management for patients with cancer.

OBJECTIVE

This study aims to systematically set a theory- and evidence-driven design for a pain self-management app and specify the app's active features.

METHODS

The Behavior Change Wheel (BCW) framework, a step-by-step theoretical approach to the development of interventions, was adopted to achieve the aim of this study. This started by understanding and identifying sources of behavior that could be targeted to support better pain management. Ultimately, the application of the BCW framework guided the identification of the active contents of the app, which were characterized using the Behavior Change Technique Taxonomy version 1.

RESULTS

The theoretical analysis revealed that patients may have deficits in their capability, opportunity, and motivation that prevent them from performing pain self-management. The app needs to use education, persuasion, training, and enablement intervention functions because, based on the analysis, they were found the most likely to address the specified factors. Eighteen behavior change techniques were selected to describe precisely how the intervention functions can be presented to induce the desired change regarding the intervention context. In other words, they were selected to form the active contents of the app, potentially reducing barriers and serving to support patients in the self-management of pain while using the app.

CONCLUSIONS

This study fully reports the design and development of a pain self-management app underpinned by theory and evidence and intended for patients with cancer. It provides a model example of the BCW framework application for health app development. The work presented in this study is the first systematic theory- and evidence-driven design for a pain app for patients with cancer. This systematic approach can support clarity in evaluating the intervention's underlying mechanisms and support future replication.

Effects of self-management interventions for cancer patients with pain: A systematic review of randomised controlled trials

AIMS

To evaluate the effects of self-management interventions targeting individuals with cancer-related pain on pain intensity, self-efficacy, quality of life (QoL), pain medication adherence, and pain-related knowledge and provide recommendations for the content and format of self-management interventions based on the existing evidence.

DESIGN

A systematic review of randomised controlled trials (RCTs) and narrative synthesis.

DATA SOURCES

A search of six electronic databases, including Medline, PsycINFO, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus.

REVIEW METHODS

This systematic review followed the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published from January 2011 to March 2022 in English were retrieved. The Cochrane Risk of Bias Tool was used to assess quality. Data were summarised using narrative synthesis.

RESULTS

This systematic review included six RCTs involving 748 patients with cancer-related pain. The results support the effectiveness of the intervention on QoL and pain-related knowledge. Mixed results were observed in the effectiveness on pain intensity, self-efficacy and medication adherence. Overall, the quality of the evidence was low. The content of self-management interventions varied across studies but with similar formats (face-to-face coaching and telephone follow-up).

CONCLUSION

The existing evidence supports the effectiveness of self-management interventions on pain-related knowledge and QoL. Further high-quality RCTs are needed to determine the most effective interventions.

RELEVANCE TO CLINICAL PRACTICE

Self-management is recommended to improve cancer patients' pain awareness, self-management behaviour and adaptability. Components for self-management of cancer pain, including patient attitude and knowledge assessment, nurse coaching and counselling, reinforcement during follow-up period, and provision of supplementary materials on pain management and medication adherence, could be covered in the intervention. In the future, it is worthwhile exploring an effective intervention using Internet-based information technology, for example WeChat, to aid the delivery of self-management intervention.

NO PATIENT OR PUBLIC CONTRIBUTION

This systematic review does not necessarily involve patients or public members in this work.

Effects of nurse-led nonpharmacological pain interventions for patients with cancer: A systematic review and meta-analysis

PURPOSE

The purposes of this study were to review the types of nurse-led nonpharmacological pain interventions (NPI) offered to cancer patients and/or family caregivers, and to determine a comprehensive and robust estimate of the effect size of nurse-led NPI for cancer patients on various pain-related outcomes.

DESIGN

Systematic review and meta-analysis. Studies assessing nurse-led NPIs targeting cancer patients and published between January 2008 and December 2020 were identified by searching multiple literature databases, including MEDLINE^® , EMBASE, Google Scholar, Cochrane Library, ProQuest Medical Library, and CINAHL^® .

METHODS

This review was conducted in accordance with the Preferred Reporting Item for Systematic Reviews and Meta-analyses guidelines. The selected randomized clinical trials were independently assessed for methodological quality. The effect sizes (ESs) of treatment were presented as standardized mean differences (Hedges' g) and 95% confidence intervals (CIs).

FINDINGS

A meta-analysis was performed to analyze data from 22 randomized clinical trials. Three types of nurse-led NPI were offered, mainly to cancer patients but also to some caregivers: music, physical, and psycho-educational interventions. The dose and duration of nonpharmacological interventions varied widely. The study participants ranged in age from 44.1 to 67.3 years. Meta-analysis indicated that, although these interventions had small effects in long-term (g = 0.24, 95% CI: 0.06-0.43, p = 0.011) to medium effects in short-term (g = 0.43, 95% CI: 0.32-0.53, p < 0.001), they significantly reduced patients' pain, increased their knowledge of pain management, reduced barriers to pain management and pain coping, and improved other physical and emotional symptoms. The significance of the ES differed according to the type of intervention, with psycho-educational and physical NPIs having a significant but medium short-term ES, whereas music NPI had a significant but large short-term ES. Only psycho-educational NPIs had significant long-term effects.

CONCLUSION

The combined ES showed that these nurse-led NPIs were significantly effective in both the short and long-term. Types of intervention as a potential moderator were associated with short-term and long-term effects of nonpharmacological interventions on patient outcomes.

CLINICAL RELEVANCE

Research-tested interventions should be provided to help patients cope effectively with pain.

Pain and Self-Management Status Among Chinese Patients With Cancer During the COVID-19 Pandemic

BACKGROUND

To investigate the pain and self-management status of patients with cancer and the influencing factors of pain and self-management status during the COVID-19 pandemic.

METHODS

A cross-sectional design was used. Eighty-one Chinese patients with cancer were recruited in December 2020. The Brief Pain Inventory, the Pain Management Inventory, and the Pain Self-efficacy Questionnaire were used to evaluate patients' pain and self-management status. Descriptive statistical analysis and multiple linear regression models were conducted for the research aims.

RESULTS

Two thirds of the participants experienced moderate to severe pain. Cancer pain had moderate to severe interference on 90.12% of patients' lives. Self-management of pain in these participants was low. The most commonly used methods of pain management included adjusting activity intensity to avoid fatigue, using distraction techniques, and massaging the sore area. The most effective methods to manage pain included taking analgesics prescribed by doctor, taking over-the-counter analgesics, and massaging the sore area. Fifteen patients (18.5%) believed that the COVID-19 pandemic had an impact on pain management and 26 patients (32.1%) needed support. Pain education, pain interference on sleep, chemotherapy, and payment status were significantly associated with cancer patients 'pain self-management.

CONCLUSIONS

During the COVID-19 pandemic, patients with cancer had moderate to severe pain intensity with low levels of self-management and self-efficacy towards that pain.

The Effect of Pain Self-Management Education on Pain Severity and Quality of Life in Metastatic Cancer Patients

Objective:

Proper pain control in cancer patients is one of the prime needs of metastatic cancer patients. It is, then, one of the essential objectives of health care workers. The present study aimed to pinpoint the impact of pain self-management education on the pain severity and the quality of life in patients with metastatic cancers using complementary medicine approaches.

Methods:

This clinical trial study was performed in the Oncology Specialty Clinic of Ahvaz Golestan Hospital on 82 metastatic cancer patients picked based on inclusion criteria. They were randomly assigned to two groups: the intervention group and one as the control group. In the intervention group, pain self-management was taught in the three steps of providing information, skill development, and guidance. Self-management approaches were also practically taught face to face along with feedback. Furthermore, the quality of life was measured at 1-and 3-month follow-ups and the pain severity was measured during 7 weeks. In the control group, the quality of life questionnaire and the pain severity checklist were given to the participants to fill out. Finally, data were analyzed through SPSS version 22 in general and repeated-measures ANOVA and Friedman tests.

Results:

It was observed that after the intervention, the trend of pain severity during weeks 1–7 was significantly different in the intervention and control groups (P < 0.0001). In addition, a significant difference was observed for the quality of life at 1 and 3 months after the intervention between the two studied groups (P < 0.0001).

Conclusions:

Findings of the present study indicate a positive impact of pain self-management on improving pain severity and the indicators of quality of life in metastatic cancer patients. Accordingly, the current study findings can help nurses, nursing students, and other team members improve pain control skills and subsequently increase the quality of life in patients with metastatic cancers.

A Review and Conceptual Analysis of Cancer Pain Self-Management

OBJECTIVES

In this concept analysis article, we will clarify the concept "self-management of cancer pain" by identifying related antecedents, attributes, and consequences to further refine the conceptual and operational definitions of the concept.

DESIGN

A review was conducted.

REVIEW/ANALYSIS METHODS

The Walker and Avant method was used for this concept analysis.

DATA SOURCES

CINAHL, PubMed, and PsycInfo were searched systemically.A total of eight studies on "self-management of cancer pain or self-care of cancer pain" published between 2004 and 2019 were identified.

RESULTS

Attributes for self-management of cancer pain include self-efficacy, integration of methods for pain relief into daily life, decision-making related to pain management, process for solving pain-related issues, and initiation of interactions with healthcare professionals. Antecedents include knowledge regarding pain assessment and management, cognitive abilities, motivation, undergoing pain treatment, patient education and counseling, social support, and accountability from all parties involved. Consequences include pain control, improved quality of life, and increased opioid intake.

CONCLUSIONS

Self-management of cancer pain was reported to be a self-regulation process with the aim to encourage patients to use skills attained through development of self-efficacy, so they can actively participate in their pain management. This outcome may enhance their quality of life by decreasing their pain, depression, and anxiety and increasing the availability of social support.

Evaluation of Appropriateness of A Nursing Intervention Program to Promote Pain Self-Management for Adult Outpatients with Cancer Pain

Objective:

This study aimed to develop a nursing intervention program structured to promote pain self-management for adult outpatients with cancer pain to enable coping with cancer pain-related problems and evaluate the appropriateness and clinical applicability of the program.

Methods:

A questionnaire survey was conducted with two pharmacists and ten oncology nursing specialists using a questionnaire created by the authors. The questionnaire comprised of 23 items asking about the appropriateness of the program, clinical applicability, and feasibility of instruction materials, rated by 5-point scales.

Results:

We collected 11 responses. The mean score of all the 23 items was 4.3 (standard deviation [SD] 0.6), the mean scores of the items were 4.4 (SD 0.6) for the appropriateness of the program, 4.2 (SD 0.5) for the clinical applicability of the program, and 4.3 (SD 0.7) for the feasibility of the instruction materials. The participants provided comments that the program made it easier to select patients for intervention and tasks that patients and nurses can share. Some comments pointed out that the program should be improved to allow patients who need the same intervention several times. Based on these comments, we modified the program partially and completed the first edition of the cancer pain self-management (CPSM) program.

Conclusions:

The findings suggest that the CPSM program may be considered appropriate and clinically applicable from the point of view of pharmacists and oncology nurses. Further studies are needed to verify the effects and usefulness of the program in clinical settings.

Telephone Follow-up Design and Practice for Advanced Cancer Pain Patients

To describe the design of a telephone follow-up protocol and to evaluate the feasibility of this protocol for advanced cancer pain patients. A series of nine telephone follow-up calls was implemented with 40 advanced cancer pain patients within 3 months after their discharge from the Department of Chemotherapy. Cancer pain information and the pain-related knowledge of the patients were collected by nurses using pain follow-up information sheets and the Patient Pain Questionnaire (PPQ); pain self-efficacy and the quality of life were reported by patients using the Chronic Pain Self-Efficacy Scale (CPSS) Chinese version and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC-QLQ-C30) Chinese version. The average score assessed by advanced cancer pain patients of the need for pain care from nurses was 24.28 (SD = 4.90). Twenty-one and eight patients completed all nine telephone follow-up calls and seven self-reported questionnaires, respectively. The pain intensity of patients at the time of follow-up was mild, but there had been breakthrough pain in the previous week. All patients were satisfied with the nurses' pain follow-up practices. There was a highly positive correlation between the time of follow-up and the patients' pain-related knowledge scores (r = 0.963**, p < 0.01). Patients' pain self-efficacy scores and quality of life scores varied across different dimensions. The baseline pain self-efficacy subscales were associated with all dimensions of quality of life (p < 0.05 or p < 0.01). Telephone follow-up can be an effective method of transitional care. For advanced cancer pain patients, it is still necessary to further explore the cost effectiveness of this method, including the appropriate follow-up duration, endpoints, and outcome measures based on government requirements and policies.

Psychometric Evaluation of the Patient-Related Nausea and Vomiting Management Barriers Questionnaire

CONTEXT

The Nausea and Vomiting Management Barriers Questionnaire (NVMBQ) measures patient-related barriers to antiemetic medication.

OBJECTIVES

The primary aim of this study was to test the construct validity, internal consistency, and content validity of the NVMBQ. The secondary aim was to develop a shortened version of the NVMBQ.

METHODS

A quantitative secondary data analysis from a previous cross-sectional study of the NVMBQ (n = 299) was performed. It included analyses of descriptive data, factor structure, internal consistency, and patient comments. Content validity was established with 10 experts (including patients, nurses, physicians, and scientists) using the item-wise content validity index and the scale CVI (S-CVI).

RESULTS

The exploratory factor analysis revealed eight underlying dimensions that were mostly congruent with the hypothesized structure when developing the NVMBQ. Internal consistency was high (α = 0.90). More than 70% of the items were estimated as relevant by the experts. However, the S-CVI was moderate (S-CVI = 0.74). A 14-item short version of the NVMBQ was identified. Qualitative analysis suggested the inclusion of additional clinically relevant items (e.g., the inability to take oral antiemetics if nausea was already present).

CONCLUSION

The NVMBQ provides a good basis for assessing patient-related barriers to chemotherapy-induced nausea and vomiting management. We will use the resulting and translated NVMBQ in a larger study to assess the relationships between chemotherapy-induced nausea and vomiting, patient-related barriers, and current antiemetic regimens.

Implementation of a nurse-led self-management support intervention for patients with cancer-related pain: a cluster randomized phase-IV study with a stepped wedge design (EvANtiPain)

Background

Pain self-management support interventions were effective in controlled clinical trials and meta analyses. However, implementation of these complex interventions may not translate into identical effects. This paper evaluates the implementation of ANtiPain, a cancer pain self-management support intervention in routine clinical practice according to the Reach Efficacy-Adoption Implementation Maintenance framework.

Methods

In this cluster randomized study with a stepped wedge design, N = 153 adult patients with cancer-related pain were recruited from 01/17 to 05/18 on 17 wards of 3 hospitals in Vienna, Austria. ANtiPain entailed a face-to-face in-hospital session by a trained nurse to prepare discharge according to key strategies, information on pain self-management, and skills building. After discharge, cancer-pain self-management was coached via phone calls. Patient-level data were collected at recruitment, and 2, 4 and 8 weeks after discharge via postal or online questionnaire. Primary outcome was pain interference with daily activities. Secondary outcomes included pain intensity, self-efficacy, and patient satisfaction. Organizational-level data (e.g., on implementation procedures) were collected by study or intervention nurses. The mixed model to analyze patient-level data included a random intercept and a random slope for individual and a random intercept for ward.

Results

Recruitment was slower than expected and unevenly distributed over wards and hospitals. The face-to-face session was clinically feasible (mean duration = 33 min) as well as the mean amount (n = 2) and duration of phone calls (mean = 17 min). Only 16 (46%) of 35 trained nurses performed the intervention on nine wards. To deal with the loss of power, analyses were adapted. Overall effects on pain interference were not significant. However, effects were significant in sub analyses of the nine wards that recruited patients in the intervention period (p = .009). Regarding secondary outcomes, the group-by-time effect was significant for self-efficacy (p = .033), and patient satisfaction with information on pain-self-management (p = .002) and in-hospital pain management (p = .018).

Conclusions

The implementation of ANtiPain improved meaningful patient outcomes on wards that applied the intervention routinely. Our analyses showed that the implementation benefited from being embedded in larger scale projects to improve cancer pain management and that the selection of wards with a high percentage of oncology patients may be crucial.

Trial registration

ClinicalTrials.gov Identifier: NCT02891785 Date of registration: September 8, 2016.

Nontraditional and Home-Based Self-management Interventions in Cancer Patients With Pain: A Mixed-Method Systematic Review

One or 2 decades ago, oncologists focused on only cancer treatments or acute care related to cancer. Since cancer care is considered as long-term cares, cancer patients require self-management (SM) ability or skill to manage their symptoms and daily cares. This mixed-method review is to evaluate quantitative and qualitative studies, which were conducted using non-traditional SM interventions for cancer pain based. This review also explores the process of SM in the chronic care model (CCM). PubMed, CINAHL, Scopus, and Wiley were used from 2011 to 2018. A total of 16 quantitative and 2 qualitative studies were included for this review. All interventions are divided into 3 types, which are educational and/or counseling programs, complementary and alternative medicine (CAM) therapy, and exercise. Ten of the included 16 studies were statistically significant on pain management: 3 CAM studies (100%), 1 exercise study (100%), and 6 of the 12 educational and/or counseling studies (50%). The CAM and exercise were statistically effective in improving cancer pain in the review. However, uncertainty remains regarding the strength of the evidence, due to the small number of studies included and lack of consistent methodologies. The application (5A) of SM support may help cancer patients to manage their pain.

Supporting self-management in palliative care throughout the cancer care trajectory

PURPOSE OF REVIEW

Despite increased survivorship and the subsequent need for chronic management of cancer, the association of self-management and palliative care is still emerging within cancer care. Routine and timely use of self-management strategies in the palliative setting can help reduce self-management burden and maximize quality of life. In this review, we consider the complementary relationship of self-management and palliative care and how they support living with cancer as a chronic illness.

RECENT FINDINGS

Recent studies provide evidence of support among patients, family caregivers and healthcare professionals for integration of self-management interventions into palliative cancer care. As a guiding framework, components of the revised Self and Family Management Framework correspond to the provision of palliative care across the care trajectory, including the phases of curative care, palliative care, end-of-life care and bereavement. Additional work among self-management partners facing cancer and other life-limiting illnesses, that is patients, family caregivers and healthcare professionals, would be useful in developing interventions that incorporate self-management and palliative care to improve health outcomes.

SUMMARY

There is an increasing acceptance of the complementarity of self-management and palliative care in cancer care. Their integration can support patients with cancer and their family caregivers across the care trajectory.

Behavioral Pain Intervention for Hospice and Palliative Care Patients: An Integrative Review

Despite the advances in pain management, achieving optimal pain control in hospice and palliative care is challenging. Patient/caregiver's lack of pain management knowledge, poor pain reporting, and poor adherence to pain management regimens are all associated with inadequate pain control. The purpose of this integrated review is to examine behavioral interventions designed for patients and caregivers to improve pain control in hospice and palliative care settings. Ten studies were identified through a database search. Seven of the 10 studies found significant improvement in at least 1 pain marker. Of the 7 studies that looked at changes in pain knowledge, 5 had significant improvements in at least 1 knowledge subscale. The 2 studies that looked at adherence to pain management found significant improvements. One limitation of the reviewed studies was that the delivery of them would not be efficient across all health-care settings, and, as a consequence, more technologically sophisticated delivery methods are needed. Therefore, while it is clear from the review that effective pain management interventions have been developed for hospice and palliative care patients, it is also clear that future research needs to focus on providing these same interventions through a more technologically sophisticated delivery method.