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Objective-To determine the efficacy in overcoming attitudinal barriers to reporting cancer pain and using analgesics of an educational intervention presented to patients accompanied by a significant other (SO) compared to patients alone.Design-Patient-SO pairs (N=161) were randomized to the Dyad condition (patient and SO received the intervention), Solo condition (patient received the intervention), or care-as-usual. Dyad and Solo conditions received the intervention at baseline, and two-and four-weeks later. Main Outcome Measures-Patientsand SOs attitudes about analgesic use and patients' pain outcomes (pain severity, pain relief, interference with life, negative mood, and global quality of life [QOL]) at baseline (T1), five weeks later (T2), and nine weeks later (T3).Results-Completers' analyses revealed no significant differences between groups at T2. At T3, patients in the Dyad and the Solo groups showed greater decreases in attitudinal barriers compared to controls. T1-T3 changes in patients' barriers mediated between the Dyad and Solo interventions and pain severity, pain relief, pain interference, negative mood, and global QOL. Conclusion-The intervention was no more efficacious when it was presented to dyads than to patients alone. Conditions under which to include SOs in interventions need to be determined. Keywords cancer pain; representational intervention; patient education; dyadsMany persons with cancer are reticent to report pain and to use potent analgesics to control their pain because of their attitudinal barriers, including excessive fear of addiction and fatalism about achieving pain control (Thomason, McCune, Bernard, Winer, Tremont, & Lindley, 1998;Ward, Goldberg, Miller-McCauley, Mueller, Nolan, Pawlik-Plank, et al., 1993). Attempts to overcome these attitudinal barriers have yielded mixed results, with patient education interventions found to be effective for some but not all outcomes such as pain severity and quality of life (de Wit, van Dam, Zandbelt, van Buuren, van der Hejden, et al., 1997;Kim, Dodd, West, Paul, Facione, Schumacher et al., 2004;Oliver, Kravitz, Kaplan, & Meyers, Ward, Donovan, Gunnarsdottir, Serlin, Shapiro, & Hughes, 2008). Many of these interventions have lacked strong guidance from theory and it is therefore challenging to determine precisely why effects are inconsistent. The purpose of the present study was to test the efficacy of an intervention that has evolved from a theoretical perspective on patient education termed the Representational Approach to patient education (Donovan & Ward, 2001;Donovan, Ward, Song, Heidrich, Gunnarsdottir, & Phillips, 2007).The Representational Approach is based on two complementary theories, one that addresses the structure of knowledge and another that addresses the processes through which knowledge changes. Leventhal's Common Sense Model (Leventhal, & Diefenbach, 1991) focuses on the structure of health-related knowledge, i.e., on person's cognitive representations of health problems and the influence of those representati...

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The C-SCAT demonstrated feasibility and acceptability. With refinement based on study results, the C-SCAT has potential to: (a) empower AYAs to communicate their symptom experience and partner with providers in their care; (b) improve symptom management and ameliorate distress; and (c) translate to use with other highly symptomatic populations.

Greater clarity and consistency are needed in the use of the terms race, ethnicity, and minority. Groups were treated as if they were homogeneous, and details were lacking about whether subgroups of different races or ethnicities had been studied. Although reported disparities in pain management were small, they were consistent. Further research is needed to examine differences within groups and to explain possible reasons for disparities across groups.

Forty children between the ages of 8 and 18 years, who were admitted to a hospital pediatric unit, were randomly assigned to an animalassisted intervention (aaI) or an active control condition (working on an age-appropriate jigsaw puzzle). Ratings of pain and anxiety were taken both pre-and post-condition. the attachment Questionnaire and Family life Space Diagram (FlSD) also were administered, and information on medications taken was recorded. a significant post-condition difference was found between groups for anxiety, with the aaI group having lower anxiety scores. however, no significant within-or between-group pre-post changes in either pain or anxiety were detected. Nearly two-thirds of the children (64%) reporting pain at baseline were receiving some type of analgesic, which may have influenced outcomes. Findings demonstrate some support that attachment may be a moderating variable: children with a secure attachment style reported lower pain and anxiety at baseline, with large effect sizes for differences in both anxiety (g = 1.34) and pain (g = 1.23). although the aaI did not significantly reduce anxiety and pain in these hospitalized children, further investigation of the influence of analgesic use and the moderating effect of attachment style is indicated.

Adolescents and young adults (AYAs) with cancer experience multiple distressing symptoms during treatment. Because the typical approach to symptom assessment does not easily reflect the symptom experience of individuals, alternative approaches to enhancing communication between the patient and provider are needed. We developed an iPad-based application that uses a heuristic approach to explore AYAs' cancer symptom experiences. In this mixed-methods descriptive study, 72 AYAs (13-29 years old) with cancer receiving myelosuppressive chemotherapy used the Computerized Symptom Capture Tool (C-SCAT) to create images of the symptoms and symptom clusters they experienced from a list of 30 symptoms. They answered open-ended questions within the C-SCAT about the causes of their symptoms and symptom clusters. The images generated through the C-SCAT and accompanying free-text data were analyzed using descriptive, content, and visual analyses. Most participants (n = 70) reported multiple symptoms (M = 8.14). The most frequently reported symptoms were nausea (65.3%), feeling drowsy (55.6%), lack of appetite (55.6%), and lack of energy (55.6%). Forty-six grouped their symptoms into one or more clusters. The most common symptom cluster was nausea/eating problems/appetite problems. Nausea was most frequently named as the priority symptom in a cluster and as a cause of other symptoms. Although common threads were present in the symptoms experienced by AYAs, the graphic images revealed unique perspectives and a range of complexity of symptom relationships, clusters, and causes. Results highlight the need for a tailored approach to symptom management based on how the AYA with cancer perceives his or her symptom experience.

Purpose: Adolescents and young adults (AYAs) with cancer need self-management strategies to cope with multiple symptoms. Self-efficacy, self-regulation, and negotiated collaboration are key theoretical components of the self-management process and have not been fully explored with AYAs with cancer. This study examined the effects of a heuristic symptom assessment tool on AYAs' self-efficacy for symptom management, AYAs' self-regulation abilities related to their symptoms, and communication with their providers about symptoms. Methods: AYAs (15-29 years of age) receiving chemotherapy used the Computerized Symptom Capture Assessment Tool (C-SCAT) to illustrate their symptom experience and discuss their symptoms with providers during two clinic visits. Participants completed the PROMIS Self-efficacy for Managing Symptoms Scale, a measure of satisfaction with provider communication, and a short interview about self-regulation and communication behaviors at baseline and after each provider visit. Results: Eighty-five AYAs who used the C-SCAT showed improved self-efficacy for managing symptoms. Qualitative data suggest that the C-SCAT was useful for enhancing a number of AYAs' self-regulation abilities related to symptom management, such as awareness and recall of symptoms, how symptoms were related, and how they planned to talk about their symptoms to providers. AYAs reported C-SCAT facilitated communication with providers about symptoms and symptom management because it was a visual prompt showing priority and related symptoms. Conclusions: Because AYAs continue to experience multiple distressing symptoms, symptom selfmanagement remains an important area for practice and research. Use of heuristic tools, such as the C-SCAT, may help AYAs more effectively self-manage their symptoms for better health outcomes.