Impact of an Educational Program on Pain Management in Patients With Cancer Living at Home

A Prospective Study to Compare Caregivers' Knowledge and Perception of Cancer Pain with Patients' Pain Assessment and to Evaluate their Quality of Life

Objectives

Family caregivers (FCGs) play a crucial role in the home care of terminally ill patients. Therefore, evaluating their comprehension of patients' symptoms and doctors' advice becomes crucial. Moreover, this might negatively impact their quality of life (QOL). Thus, the purpose of the study was to examine FCGs' perception and understanding of cancer pain in relation to patients' pain assessments, as well as the effect this has on their own QOL.

Materials and Methods

The family pain questionnaire (FPQ) and patient pain questionnaire (PPQ) were used for both patient as well as their FCGs. The scores for each subscale, knowledge, and experience were calculated. Furthermore, FCGs' own QOL was assessed using the caregiver quality of life index-cancer (CQOLC) questionnaire. Results were statistically analysed.

Results

The FCGs of 93 individuals were examined. The Cronbach alphas for the current dataset showed that the FPQ (0.754) and PPQ (0.759) overall reliability scales were satisfactory. The knowledge, experience, and total average scores for the PPQ (FPQ) subscales were reported as 35.91 (35.31), 27.19 (26.86), and 63.10 (62.17), respectively. The knowledge, experience, and overall scales of the PPQ (FPQ) were evaluated to provide median scores of 37 (36), 28 (25), and 65 (62) correspondingly. A t-test was used to determine the significance of the observed average differences (d) for knowledge (0.602), experience (0.333), and overall (0.935). The results showed that there were no significant differences (P > 0.05). An inverse relationship was elicited between the total QOL and the pain assessment scores of FCGs, as well as the age of the patient. The difference was, however, majorly statistically non-significant (P > 0.5). Further, statistical significance was found only between the burden component of the CQOLC and the age of the patients (P = 0.034), as well as total pain knowledge (P = 0.007) and total pain scores (P = 0.001) of the FCGs'.

Conclusion

As per our analysis, FCGs had less knowledge and experience of patients' pain, though statistically , it was not significant. The age of the patient, as well as total pain knowledge and total pain scores of the FCGs' were found to affect the QOL of FCGs'. Studies with large sample sizes might help in strengthening the findings.

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.

The development of a Cancer Pain Belief Modification Program for patients with oral cancer in China: a feasibility study

BACKGROUND

Acceptance-based pain management interventions have been receiving growing attention in cancer pain care. This study aimed to develop a cancer pain management program based on belief modification to improve the cancer pain experience of Chinese oral cancer survivors and to explore the acceptability and preliminary outcomes of the Cancer Pain Belief Modification Program (CPBMP).

METHODS

A mixed-methods approach was applied to develop and revise the program. The CPBMP was developed and revised using the Delphi technique, and its further improvement was explored with a one-group pre- and post-trial designed with a sample of 16 Chinese oral cancer survivors, and semi-structured interviews. Research instruments included Numeric Rating Scale (NRS), Chinese version of Illness Perception Questionnaire-Revised for Cancer Pain (IPQ-CaCP), and the University of Washington Quality of Life assessment scale (UW-QOL). Descriptive statistics, t-test, and Mann-Whitney U test were used to analyse the data. The semi-structured questions were analysed using content analysis.

RESULTS

The six-module CPBMP was endorsed by most experts and patients. The expert authority coefficient value was 0.75 in the first round of the Delphi survey and 0.78 in the second round. The "pain intense", "negative pain beliefs" scores of pre- and post-testing decreased from 5.63 ± 0.48 to 0.81 ± 0.54 (t = -3.746, p < 0.001); from 140.63 ± 9.02 to 52.75 ± 7.27 (Z = 12.406, p < 0.001); and the "positive pain beliefs", "quality of life" scores increased from 55.13 ± 4.54 to 66.00 ± 4.70 (Z = -6.983, p < 0.001); from 66.97 ± 15.01 to 86.69 ± 8.42 (Z = 7.283, p < 0.001). The qualitative data also indicated that CPBMP was well acceptable.

CONCLUSION

Our study showed the acceptability and preliminary outcomes of CPBMP patients. CPBMP improves the pain experience of Chinese oral cancer patients and provides a reference for cancer pain management in the future.

TRIAL REGISTRATION

The feasibility study has already been registered on the Chinese Clinical Trial Registry (ChiCTR) ( www.chictr.org.cn ) in 11/09/2021. (ChiCTR2100051065).

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.

Family caregivers of Palliative Cancer Patients at Home: The puzzle of Pain Management

The purpose of this grounded theory study was to understand the processes used by family care-givers to manage the pain of cancer patients at home. A total of 24 family caregivers participated. They were recruited using purposeful then theoretical sampling. The data sources were taped, transcribed (semi-structured) interviews and field notes. Data analysis was based on Strauss and Corbin's (1998) requirements for open, axial, and selective coding. The result was an explanatory model titled “the puzzle of pain management,” which includes four main processes: “drawing on past experiences”; “strategizing a game plan”; “striving to respond to pain”; and “gauging the best fit,” a decision-making process that joins the puzzle pieces. Understanding how family caregivers assemble their puzzle pieces can help health care professionals make decisions related to the care plans they create for pain control and help them to recognize the importance of providing information as part of resolving the puzzle of pain management.

[Challenges for home care services in the pain management of cancer patients : A qualitative study]

BACKGROUND

People with cancer are increasingly supported by home care services. Pain is a relevant symptom of these diseases and nurses of home care services are involved in the treatment. The German National Expert Standard "Pain management in nursing" includes evidence-based recommendations for the implementation of adequate pain management. Considering the given structural conditions of home care services, nurses describe both barriers and challenges with the implementation.

METHODS

By means of five guideline-based discussion groups, nurses of 14 home care services were questioned about the challenges they had experienced in pain management. The questioning focuses on the level of implementation of the recommendation for each aspect: pain assessment, pharmacological pain therapy, non-pharmacological pain therapy, pain-related side effects, information, training, and counseling in the care of people with cancer. A qualitative content analysis was conducted.

RESULTS

On the one hand, the results illustrate a need for further knowledge and possibilities, e.g., for the assessment of pain as a multidimensional phenomenon and, on the other hand, that the conditions for continuous pain monitoring of cancer patients in home care services are limited. The need for short-term reconciliation with the treatment team and the practitioners proved to be more difficult than the cooperation with the palliative care network. Involvement of family members is important to ensure uninterrupted treatment.

CONCLUSIONS

Beside knowledge and competencies regarding nursing care, structures and processes for interprofessional pain management need further development and research.

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

CONTEXT

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

OBJECTIVES

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Improving Adherence to Adjuvant Endocrine Therapy in Breast Cancer Through a Therapeutic Educational Approach: A Feasibility Study

PURPOSE/OBJECTIVES

To develop and test the feasibility of a tailored therapeutic educational program, with the aim of improving adherence to oral endocrine adjuvant chemotherapy in women with breast cancer. 
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DESIGN

A qualitative study to identify educational needs and a feasibility study assessing the efficacy of the program.
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SETTING

A comprehensive cancer center, the Lucien Neuwirth Cancer Institute in Saint-Priest-en-Jarez, France.
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SAMPLE

Two consecutive samples (N = 11, N = 6) of women taking adjuvant oral endocrine chemotherapy for breast cancer. 
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METHODS

A mixed qualitative and quantitative method was used. The participants' representations of disease and treatment were explored through one-on-one interviews and then translated into educational needs, which were used to develop a tailored therapeutic education program. The pilot study evaluated the reach and efficacy using before-and-after comparisons. 
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MAIN RESEARCH VARIABLES

Educational objectives, knowledge, trust in the treatment, and anxiety.
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FINDINGS

Five educational objectives (acquiring knowledge, improving communication skills, managing anxiety, managing side effects, and improving adherence) were identified through 11 interviews. A three-session program was developed. Eight of the 23 patients invited to participate in a pilot study accepted, and six completed the intervention. Knowledge improved from 38.9 of 100 preintervention to 69.4 of 100 postintervention (p = 0.045). Trust in treatment showed a trend to improvement from 5.5 of 10 to 8 of 10 (p = 0.14), but anxiety did not change significantly; anxiety went from 6 to 7 (p = 0.88).
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CONCLUSIONS

Results from the feasibility study showed promising efficacy for the educational objectives and provided information about how the program could be improved. 
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IMPLICATIONS FOR NURSING

Tailored educational programs conducted by trained nurses may help patients to adhere to and live with the effects of endocrine therapy.

The Effectiveness of a Pain Management Program on Intensify of Pain and Quality of Life Among Cancer Patients in Myanmar

Introduction: Cancer is one of the leading causes of death worldwide and is rapidly becoming a global pandemic. Cancer pain significantly affects the diagnosis, quality of life and survival of patients with cancer. The aim of this study is to analyse the effect of a Pain Management Program (PMP) on pain and quality of life in a patient with cancer.Methods: This study used a quasi-experimental design with a randomised pre-post test design approach. The data was collected from cancer patients in No 2 Military Hospital (500-Bedded), Yangon, Myanmar. The patients were recruited using a random allocation sampling technique and consisted of 30 respondents (experimental group) and 30 respondents (control group) taken according to the inclusion criteria. The Short Form-McGill Pain Questionnaire 2 (SF-MPQ 2) was used to assess pain, and The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) was used to assess the quality of life.Results: A MANOVA test was used to analyse the effect of PMP. It showed that 1) PMP decreased the pain and 2) PMP increased the quality of life in patients with cancer.Conclusion: Improvements in the quality of life and to do with pain-related cancer suggests that the vicious cycle of chronic pain may be alleviated by PMP. As we look at the results, PMP can be an effective treatment to be used by nurses for decreasing pain and increasing the quality of life in patients with cancer.

[Pain in dependent elderly people: home visit program culturally adapted to a rural population]

OBJECTIVE

To assess the effects of a culturally adapted home visit program on pain intensity in elderly people with disability and poverty conditions in the rural population of Cáqueza-Cundinamarca, Colombia.

METHOD

Quasi-experimental study with pre-test and post-test. The study included 34 people over 60 years of age with physical or visual impairment and total or partial dependence. The home visit program consisted of seven visits paid for an average of two hours and an interval of 13 to 15 days. A syncretism of drugs, medicinal plants and home remedies was proposed for pain management. Pain was assessed using the verbal pain scale and qualitative data were recorded in the field diary. Wilcoxon signed-rank test was applied.

RESULTS

During the pre-test, 100 % of the participants presented with a type of pain, while favorable and significant effects were observed in the post-test (p value <0.001) in relation to pain reduction. Changes are qualitatively attributed, partly, to the development of the program and other explanations include values and beliefs of the group.

CONCLUSIONS

The culturally adapted home visits program shows that it is possible to act in contexts where dialogues occur between popular and professional knowledge, achieving a safe practice adapted to the cultural universe of people. Latin America requires professionals culturally sensitive to expressions and perceptions of pain, who are curious to explore, based on evidence, the therapeutic possibilities proposed by popular knowledge.

Pain Neuroscience Education: State of the Art and Application in Pediatrics

Chronic pain is a widespread problem in the field of pediatrics. Many interventions to ameliorate pain-related dysfunction have a biobehavioral focus. As treatments for chronic pain (e.g., increased movement) often stand in stark contrast to treatments for an acute injury (e.g., rest), providing a solid rationale for treatment is necessary to gain patient and parent buy-in. Most pain treatment interventions incorporate psychoeducation, or pain neuroscience education (PNE), as an essential component, and in some cases, as a stand-alone approach. The current topical review focuses on the state of pain neuroscience education and its application to pediatric chronic pain. As very little research has examined pain neuroscience education in pediatrics, we aim to describe this emerging area and catalyze further work on this important topic. As the present literature has generally focused on adults with chronic pain, pain neuroscience education merits further attention in the realm of pediatric pain in order to be tailored and implemented in this population.

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

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

Effect of an education program on knowledge, self-care behavior and handwashing competence on prevention of febrile neutropenia among breast cancer patients receiving Doxorubicin and Cyclophosphamide in Chemotherapy Day Centre

Objective:

To evaluate the efficacy of an education program on the prevention of febrile neutropenia (FN) among breast cancer patients receiving AC regimen.

Methods:

Randomized controlled trial with the repeated-measures design was conducted in a Chemotherapy Day Centre of an acute hospital in Hong Kong. Twenty-five subjects in the intervention group received an individual education session followed by three follow-up sessions and routine care. Twenty-four subjects in the control group received routine care. Primary outcomes included the incidence of admission due to FN, the self-care behavior adherence, the knowledge level on prevention of FN and the self-efficacy in self-management, handwashing competence were assessed by self-designed questionnaires, Chinese version of patient activation measure, and handwashing competence checklist.

Results:

No statistically significant difference between the intervention group and the control group on the incidence of admission due to FN, the self-efficacy in self-management, and the knowledge on prevention of FN. The self-care behavior adherence was significant at cycle 4 of AC regimen in favor of the intervention group (P = 0.036). Handwashing competence improved more significantly among subjects in the intervention group than the control group (P = 0.009).

Conclusions:

The education program on the prevention of FN had significantly favorable effects on self-care behavior adherence and handwashing competence across time. However, the intervention did not lead to statistically significant improvement on the incidence of admission due to FN, the self-efficacy in self-management and the knowledge level on prevention of FN.

Patient Education, Coaching, and Self-Management for Cancer Pain

Purpose

Multiple systematic reviews and meta-analyses have identified the effectiveness of patient education in improving cancer pain management. However, the mechanisms by which patient education improves pain outcomes are uncertain, as are the optimal delivery, content, timing, frequency, and duration. This review provides best-bet recommendations based on available evidence to guide service managers and clinicians in developing a patient education program.

Methods

We used patient-centered care, self-management, coaching, and a behavior change wheel as lenses through which to consider the evidence for elements of patient education most likely to be effective within the context of other strategies for overcoming barriers to cancer pain assessment and management.

Results

The evidence suggests that optimal strategies include those that are patient-centered and tailored to individual needs, are embedded within health professional–patient communication and therapeutic relationships, empower patients to self-manage and coordinate their care, and are routinely integrated into standard cancer care. An approach that integrates patient education with processes and systems to ensure implementation of key standards for pain assessment and management and education of health professionals has been shown to be most effective.

Conclusion

Patient education is effective in reducing cancer pain and should be standard practice in all settings. For optimal results, patient education should be integrated with other strategies for implementing evidence-based, person-centered care and overcoming barriers at the levels of patient, provider, and health system.

Analyzing acute procedural pain in clinical trials

Because acute procedural pain tends to increase with procedure time, assessments of pain management strategies must take that time relationship into account. Statistical time-course analyses are, however, complex and require large patient numbers to detect differences. The current study evaluated the abilities of various single and simple composite measures such as averaged pain or individual patient pain slopes to detect treatment effects. Secondary analyses were performed with the data from 3 prospective randomized clinical trials that assessed the effect of a self-hypnotic relaxation intervention on procedural pain, measured every 10-15 minutes during vascular/renal interventions, breast biopsies, and tumor embolizations. Single point-in-time and maximal pain comparisons were poor in detecting treatment effects. Linear data sets of individual patient slopes yielded the same qualitative results as the more complex repeated measures analyses, allowing the use of standard statistical approaches (eg, Kruskal-Wallis), and promising analyses of smaller subgroups, which otherwise would be underpowered. With nonlinear data, a simple averaged score was highly sensitive in detecting differences. Use of these 2 workable and relatively simple approaches may be a first step towards facilitating the development of data sets that could enable meta-analyses of data from acute pain trials.

Flying blind: sources of distress for family caregivers of palliative cancer patients managing pain at home

Pain requiring treatment is experienced by many cancer patients at the end of life. Family caregivers are often directly implicated in pain management. This article highlights areas of psychosocial concern for family caregivers managing a family member's cancer pain at home as they engage in pain management processes. This article is based on the secondary analysis, guided by interpretive description, of data collected for a grounded theory study that explored the processes used by family caregivers to manage cancer patients' pain in the home. Interviews and field notes from 24 family caregiver interviews were examined to identify areas of family caregiver psychosocial distress. The analysis revealed that family caregivers experienced distress at different phases of the pain management process. Sources of distress for caregivers included feeling as though they were "in a prison" (overwhelmingly responsible), "lambs to slaughter" (unsupported), and "flying blind" (unprepared). In addition, family caregivers expressed distress when witnessing their loved one in pain and when pain crises invoked thoughts of death. In sum, family caregivers managing a loved one's cancer pain at home are at risk for psychosocial distress. This study identified four key sources of distress that can help health care professionals better understand the experiences of these family caregivers and tailor supportive interventions to meet their needs. Knowledge about sources of distress can help healthcare professionals understand the experiences of these family caregivers and tailor supportive interventions to meet their needs.

Improvement of pain-related self-management for cancer patients through a modular transitional nursing intervention: a cluster-randomized multicenter trial

Patients' self-management skills are affected by their knowledge, activities, and attitudes toward pain management. This trial aimed to test the Self Care Improvement through Oncology Nursing (SCION)-PAIN program, a multimodular structured intervention to reduce patients' barriers to self-management of cancer pain. Two hundred sixty-three patients with diagnosed malignancy, pain>3 days, and average pain > or = 3/10 participated in a cluster-randomized trial on 18 wards in 2 German university hospitals. Patients on the intervention wards received, in addition to standard pain treatment, the SCION-PAIN program consisting of 3 modules: pharmacologic, nonpharmacologic pain management, and discharge management. The intervention was conducted by specially trained cancer nurses and included components of patient education, skills training, and counseling. Starting with admission, patients received booster sessions every third day and one follow-up telephone counseling session within 2 to 3 days after discharge. Patients in the control group received standard care. Primary end point was the group difference in patient-related barriers to self-management of cancer pain (Barriers Questionnaire-BQ II) 7 days after discharge. The SCION-PAIN program resulted in a significant reduction of patient-related barriers to pain management 1 week after discharge from the hospital: mean difference on BQ II was -0.49 points (95% confidence interval -0.87 points to -0.12 points; P=0.02). Furthermore, patients showed improved adherence to pain medication; odds ratio 8.58 (95% confidence interval 1.66-44.40; P=0.02). A post hoc analysis indicated reduced average and worst pain intensity as well as improved quality of life. This trial reveals the positive impact of a nursing intervention to improve patients' self-management of cancer pain.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

Objective

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

Methods

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

Results

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

Conclusions

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A systematic review of cognitive behavioral interventions in advanced cancer

OBJECTIVE

To systematically review cognitive behavioral interventions for people with advanced cancer.

METHODS

A literature search was conducted using Medline©, CINAHL©, and Psych-info©.

INCLUSION CRITERIA

studies were included in the review if they met the following criteria: (1) the design was a randomized clinical trial, (2) the study tested a cognitive behavioral therapy, including psycho-educational, alternative and complementary therapies (i.e. acupuncture, relaxation), expressive, support and skill building interventions, (3) participants were adults (18 years of age or older) with advanced cancer and the (4) outcomes were directly related to the patient with advanced cancer.

RESULTS

11 studies met the inclusion criteria. Of the studies in the review: treatment effects were not statistically significant in most studies, methods were not consistently described, and samples had limited racial/ethnic diversity.

CONCLUSION

The interpretation of the effectiveness of the CBIs was limited by major challenges to the internal validity of the studies included in the review. The lack of data about the efficacy of CBIs to support people with advanced cancer is a gap in the current knowledge base.

PRACTICE IMPLICATIONS

Given the needs of people living with advanced cancer well-designed studies are needed to test interventions that will improve outcomes for people living with advanced cancer.

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

CONTEXT

Cancer pain continues to be extensively undertreated, despite established guidelines. Although the efficacy of interventions that support patients' self-management of cancer pain has been demonstrated in several studies, the most effective components of these interventions remain unknown.

OBJECTIVES

The purpose of this review of experimental and quasi-experimental studies was to systematically describe the structure and content components, as well as the efficacy of various components, of interventions designed to improve patients' self-management of cancer pain.

METHODS

A systematic review of the literature was done that supplemented the 2009 meta-analysis of Bennett et al. Intervention components were categorized using content analysis. The intervention components were compared based on their calculated largest effect sizes (ESs) within each study (i.e., Hedges G(u) for between-group differences in pain intensity scores).

RESULTS

Based on 34 publications (i.e., 24 interventions), seven structure and 16 content components were identified. In 11 studies with statistically significant ESs, the largest ES within each study ranged from -1.87 to -0.44, which represented clinically meaningful effects. No single component was found to have a discernable influence on ES.

CONCLUSION

This analysis provides researchers and clinicians with a detailed overview of the various structural and content components, as well as various combinations that were tested in intervention studies to improve cancer pain management. However, because of a variety of limitations, the most efficacious intervention components or combination of components remain to be determined in future studies.

Patient, primary care physician and specialist expectations of primary care physician involvement in cancer care

BACKGROUND

In Canada, many health authorities recommend that primary care physicians (PCP) stay involved throughout their patients' cancer journey to increase continuity of care. Few studies have focused on patient and physician expectations regarding PCP involvement in cancer care.

OBJECTIVE

To compare lung cancer patient, PCP and specialist expectations regarding PCP involvement in coordination of care, emotional support, information transmission and symptom relief at the different phases of cancer.

DESIGN

Canadian survey of lung cancer patients, PCPs and cancer specialists

PARTICIPANTS

A total of 395 patients completed questionnaires on their expectations regarding their PCP participation in several aspects of care, at different phases of their cancer. Also, 45 specialists and 232 community-based PCP involved in these patients' care responded to a mail survey on the same aspects of cancer care.

RESULTS

Most specialists did not expect participation of the PCP in coordination of care in the diagnosis and treatment phases (65% and 78% respectively), in contrast with patients (83% and 85%) and PCPs (80% and 59%) (p < 0.0001). At these same phases, the best agreement among the 3 groups was around PCP role in emotional support: 84% and more of all groups had this expectation. PCP participation in symptom relief was another shared expectation, but more unanimously at the treatment phase (p = 0.85). In the advanced phase, most specialists expect a major role of PCP in all aspects of care (from 81% to 97%). Patients and PCP agree with them mainly for emotional support and information transmission.

CONCLUSION

Lung cancer patient, PCP and specialist expectations regarding PCP role differ with the phase of cancer and the specific aspect of cancer care. There is a need to reach a better agreement among them and to better define PCP role, in order to achieve more collaborative and integrated cancer care.

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

AIMS

This paper reports a quantitative systematic review of the effects of educational interventions on quality of life, pain intensity and pain interference in cancer patients.

BACKGROUND

Cancer pain has a marked negative impact on quality of life, and this has become an important issue in discussions of treatment options. Patient education seems to be effective in pain management, but no review has been published with quality of life as an outcome measure.

DATA SOURCES

Relevant publications from 2000 to 2010 were identified in six databases (Medline, CIHAHL, PubMed, EMBASE, PsycINFO and DARE) and by means of hand-searches. All randomized controlled trial studies of pain-education programmes for cancer patients were considered, and a quantitative review of effectiveness carried out.

REVIEW METHODS

Studies were critically appraised by three independent reviewers, and the Jadad score was used to assess the quality of those included.

RESULTS

Four studies meeting the inclusion criteria were used, after methodological quality assessment. Pain intensity and pain interference were significantly reduced after education, but statistical change in quality of life was not found in any of the studies.

CONCLUSIONS

Pain and quality of life are complex matters, and quality of life might not be a sensitive indicator of the effectiveness of pain education. To improve quality of life and reduce the severity of pain in cancer patients, individualized care, recognition of variations in patient experience, and a multi-disciplinary approach are required. Further research is recommended into patients' preferences of any educational intervention, and into the quality of existing education programmes and the expertise of the healthcare professionals concerned.

Striving to respond to palliative care patients' pain at home: a puzzle for family caregivers

PURPOSE/OBJECTIVES

to describe the types of pain patients in palliative care at home experience and how family caregivers assess them and intervene.

RESEARCH APPROACH

qualitative using grounded theory.

SETTING

family caregivers' homes.

PARTICIPANTS

24 family caregivers of patients with advanced cancer receiving palliative care at home.

METHODOLOGIC APPROACH

semistructured interviews and field notes. Data analysis used Strauss and Corbin's recommendations for open, axial, and selective coding.

MAIN RESEARCH VARIABLES

pain, pain management, family caregivers, palliative care, and home care.

FINDINGS

caregivers assessed different types of pain and, therefore, were experimenting with different types of interventions. Not all family caregivers were able to distinguish between the different pains afflicting patients, and, consequently, were not selecting the most appropriate interventions. This often led to poorly managed pain and frustrated family caregivers.

CONCLUSIONS

The accurate assessment of the types of pain the patient is experiencing, coupled with the most appropriate intervention for pain control, is critical for optimal pain relief as well as supporting the confidence and feelings of family caregivers who are undertaking the complex process of cancer pain management.

INTERPRETATION

nurses involved with patients receiving palliative care and their family caregivers should be aware of all types of pain experienced by the patient and how caregivers are managing the pain. Nurses should be knowledgeable about different pain relief interventions to help family caregivers obtain accurate information, understand their options, and administer these interventions safely and effectively.

Cancer Health Empowerment for Living without Pain (Ca-HELP): effects of a tailored education and coaching intervention on pain and impairment

We aimed to determine the effectiveness of a lay-administered tailored education and coaching (TEC) intervention (aimed at reducing pain misconceptions and enhancing self-efficacy for communicating with physicians) on cancer pain severity, pain-related impairment, and quality of life. Cancer patients with baseline "worst pain" of ≥4 on a 0-10 scale or at least moderate functional impairment due to pain were randomly assigned to TEC or enhanced usual care (EUC) during a telephone interview conducted in advance of a planned oncology office visit (265 patients randomized to TEC or EUC; 258 completed at least one follow-up). Patients completed questionnaires before and after the visit and were interviewed by telephone at 2, 6, and 12 weeks. Mixed effects regressions were used to evaluate the intervention adjusting for patient, practice, and site characteristics. Compared to EUC, TEC was associated with increased pain communication self-efficacy after the intervention (P<.001); both groups showed significant (P<.0001), similar, reductions in pain misconceptions. At 2 weeks, assignment to TEC was associated with improvement in pain-related impairment (-0.25 points on a 5-point scale, 95% confidence interval -0.43 to -0.06, P=.01) but not in pain severity (-0.21 points on an 11-point scale, -0.60 to 0.17, P=.27). The improvement in pain-related impairment was not sustained at 6 and 12 weeks. There were no significant intervention by subgroup interactions (P>.10). We conclude that TEC, compared with EUC, resulted in improved pain communication self-efficacy and temporary improvement in pain-related impairment, but no improvement in pain severity.

Family physician involvement in cancer care follow-up: the experience of a cohort of patients with lung cancer

PURPOSE

There has been little research describing the involvement of family physicians in the follow-up of patients with cancer, especially during the primary treatment phase. We undertook a prospective longitudinal study of patients with lung cancer to assess their family physician's involvement in their follow-up at the different phases of cancer.

METHODS

In 5 hospitals in the province of Quebec, Canada, patients with a recent diagnosis of lung cancer were surveyed every 3 to 6 months, whether they had metastasis or not, for a maximum of 18 months, to assess aspects of their family physician's involvement in cancer care.

RESULTS

Of the 395 participating patients, 92% had a regular family physician but only 60% had been referred to a specialist by him/her or a colleague for the diagnosis of their lung cancer. A majority of patients identified the oncology team or oncologists as mainly responsible for their cancer care throughout their cancer journey, except at the advanced phase, where a majority attributed this role to their family physician. At baseline, only 16% of patients perceived a shared care pattern between their family physician and oncologists, but this proportion increased with cancer progression. Most patients would have liked their family physician to be more involved in all aspects of cancer care.

CONCLUSIONS

Although patients perceive that the oncology team is the main party responsible for the follow-up of their lung cancer, they also wish their family physicians to be involved. Better communication and collaboration between family physicians and the oncology team are needed to facilitate shared care in cancer follow-up.

Relationship between age and symptoms of pain and fatigue in adults undergoing treatment for cancer

BACKGROUND

Pain and fatigue are 2 of the most common symptoms experienced by individuals undergoing treatment for cancer. It has been hypothesized that older adults experience lower levels of severity and interference from pain and fatigue when compared with younger adults.

OBJECTIVE

The purpose of this study was to identify how pain and fatigue, severity, and interference may vary between younger and older adults undergoing cancer treatment over time.

METHODS

This study is a secondary analysis of data of 2 different randomized controlled trials that examined the symptom experience in adults undergoing treatment for cancer. A linear mixed model analysis was used to determine the differences based on age across 6 contacts over 8 weeks.

RESULTS

Results indicate that pain severity is significantly (P < .01) related to age. Age was not found to be significantly related to the level of interference associated with pain or the severity or interference associated with fatigue.

CONCLUSION

Symptoms of pain and fatigue are prevalent across age groups and will vary across time. Older and younger adults do not necessarily experience symptoms differently. Interference associated with pain and fatigue impacts all age groups; interference may not be directly related to the level of severity.

IMPLICATIONS FOR PRACTICE

This study highlights the importance of assessing both severity and interference associated with symptoms in all adults undergoing treatment for cancer. Further research is needed to better understand the relationship between age and symptoms in individuals undergoing treatment for cancer.

Brief DVD-based educational intervention for patients with cancer pain: feasibility study

Patient attitudes and knowledge regarding cancer pain and strong opioid analgesia can sometimes be a barrier to good pain control. Educational interventions that address these barriers are effective in oncology outpatients but have not been evaluated in patients with more advanced disease. We assessed the feasibility of a randomized, controlled clinical trial evaluating a brief DVD-based educational intervention for cancer pain in palliative care patients. Participants were shown DVD at baseline (V1) and at 1 week (V2). Outcomes were assessed using Brief Pain Inventory (BPI) and Patient Pain Questionnaire (PPQ) before intervention, and at V2 and V3 (4 weeks later). Fifteen patients and 10 carers were recruited. Between V1 and V2, total BPI and PPQ scores improved significantly by 9.6% (p = 0.02) and 17% (p = 0.04) respectively with no further improvements at V3. Our findings suggest that this intervention is feasible and potentially effective between 7-30 days follow up. A multicentre clinical trial is now needed to evaluate this intervention further.

Improvement of pain related self management for oncologic patients through a trans institutional modular nursing intervention: protocol of a cluster randomized multicenter trial

Background

Pain is one of the most frequent and distressing symptoms in cancer patients. For the majority of the patients, sufficient pain relief can be obtained if adequate treatment is provided. However, pain remains often undertreated due to institutional, health care professional and patient related barriers. Patients self management skills are affected by the patients' knowledge, activities and attitude to pain management. This trial protocol is aimed to test the SCION-PAIN program, a multi modular structured intervention to improve self management in cancer patients with pain.

Methods

240 patients with diagnosed malignancy and pain > 3 days and average pain ≥ 3/10 will participate in a cluster randomized trial on 18 wards in 2 German university hospitals. Patients from the intervention wards will receive, additionally to standard pain treatment, the SCION-PAIN program consisting of 3 modules: pharmacologic pain management, nonpharmacologic pain management and discharge management. The intervention will be conducted by specially trained oncology nurses and includes components of patient education, skills training and counseling to improve self care regarding pain management beginning with admission followed by booster session every 3rd day and one follow up telephone counseling within 2 to 3 days after discharge. Patients in the control group will receive standard care.

Primary endpoint is the group difference in patient related barriers to management of cancer pain (BQII), 7 days after discharge. Secondary endpoints are: pain intensity & interference, adherence, coping and HRQoL.

Discussion

The study will determine if the acquired self management skills of the patients continue to be used after discharge from hospital. It is hypothesized that patients who receive the multi modular structured intervention will have less patient related barriers and a better self management of cancer pain.

Trial Registration

ClinicalTrials NCT00779597

Self care and end of life care in advanced cancer: literature review

BACKGROUND

Self care is a key feature of health care policy in the UK. It has been suggested that self care by patients with cancer improves quality of life, symptom management, and patient satisfaction. However, little is known about self care and end of life care.

OBJECTIVES

This review sets out to find out what is known about how people experiencing end of life care manage their illness themselves, in the advanced stages of their disease.

METHODS

A systematic review was conducted; searching key databases; extracting relevant literature, using RefMan, NVIVO; grading, analysing, and appraising the literature.

RESULTS

Eighteen articles were included in the review. Themes identified were; interventions for end of life care; self care behaviours used by patients; factors that prevent patients to self care.

CONCLUSION

The nurses' role in supporting self care for people with advanced cancer is important. The review identifies various ways nurses can empower patients to self care related to oncology.

How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis

This review aimed to quantify the benefit of patient-based educational interventions in the management of cancer pain. We undertook a systematic review and meta-analysis of experimentally randomised and non-randomised controlled clinical trials identified from six databases from inception to November 2007.Two reviewers independently selected trials comparing intervention (formal instruction on cancer pain and analgesia on an individual basis using any medium) to usual care or other control in adults with cancer pain. Methodological quality was assessed, and data extraction undertaken by one reviewer with a second reviewer checking for accuracy. We used random effects model to combine the effect estimates from studies. Main outcome measures were effects on knowledge and attitudes towards cancer pain and analgesia, and pain intensity. Twenty-one trials (19 randomised) totalling 3501 patients met inclusion criteria, and 15 were included in the meta-analysis. Compared to usual care or control, educational interventions improved knowledge and attitudes by half a point on 0-5 rating scale (weighted mean difference 0.52, 95% confidence interval 0.04-1.0), reduced average pain intensity by over one point on 0-10 rating scale (WMD -1.1, -1.8 to -0.41) and reduced worst pain intensity by just under one point (WMD -0.78, -1.21 to -0.35). We found equivocal evidence for the effect of education on self-efficacy, but no significant benefit on medication adherence or on reducing interference with daily activities. Patient-based educational interventions can result in modest but significant benefits in the management of cancer pain, and are probably underused alongside more traditional analgesic approaches.

Randomized clinical trial of an intensive nursing-based pain education program for cancer outpatients suffering from pain

Introduction

The prevalence of pain in patients with cancer is still too high. Factors relating to ineffective pain treatment fall into three categories: the health care system, professional care providers, and patients. In patients, various barriers lead to noncompliance. Previous educational interventions have increased their knowledge of pain and decreased short-term pain levels. In this randomized controlled trial, the authors investigated how an intensive home-based education program given by nurses affected short-term and long-term pain levels.

Materials and methods

One hundred and twenty cancer patients were randomized to receive either the pain education program (PEP) or usual care. Pain, knowledge, quality of life, anxiety, and depression were measured at baseline and after 4 and 8 weeks. In the intervention group, effects on symptom levels were communicated to the treating physician.

Results

The level of pain had decreased at 4 weeks, but not at 8 weeks. Significant decreases in pain only persisted in those patients with a high pain score at baseline. Knowledge of pain significantly increased in the intervention group. No correlation was found between increased pain knowledge and decreased pain levels.

Conclusions

The PEP given by nurses lowered pain intensity levels in cancer patients and increased their knowledge of pain. More attention should be paid to patient education and to communication between patients and health professionals regarding pain and pain management.

Roles of the urologist and nurse from the perspective of patients with prostate cancer receiving luteinizing hormone-releasing hormone analogue therapy

OBJECTIVES

To establish the roles of the urologist, general practitioner (GP) and nurse from the perspective of the patient with prostate cancer receiving hormone therapy, and to assess patient satisfaction, in particular with management and information needs.

PATIENTS AND METHODS

Patients with prostate cancer receiving luteinizing hormone-releasing hormone analogue (LHRH-a) therapy were recruited by a representative sample of 58 French urologists (March to April 2007) and invited to complete a 42-item questionnaire.

RESULTS

In all, 350 representative patients participated in the study; >90% were totally or quite satisfied with the information given by their urologist at diagnosis and the start of treatment. Their main contact during treatment was with the nurse who gave the injection (84% of patients). The nurse's main role was to provide clarity (60% of patients), guidance (35%) and support to the family (28%). Fewer patients discussed disease stage and progression with their nurse (29%) than with a doctor (urologist, 63%; or GP, 61%). Fewer also discussed treatment (24% vs 32%) but as many patients discussed the impact of their disease and treatment with their nurse as with their doctor (e.g. 33% discussed general health and fatigue with the nurse, vs 26% with the urologist). The need for contact with a health professional was greater during the early stages of treatment. Patients treated for <12 months with 3-monthly injections were less likely to be in favour of spacing injections than patients treated for >or=3 years.

CONCLUSION

The patient consults the urologist for reliable information on disease and treatment, and to the GP for further support, if needed, but the nurse has the pivotal role. A 3-monthly injection schedule enables regular face-to-face contact between the nurse and the patient and their family, and contributes towards the patient's coping strategies and quality of life.