Automated pain intervention for underserved minority women with breast cancer

Abstract

BACKGROUND Minority patients with breast cancer are at risk for undertreatment of cancer-related pain. We evaluated the feasibility and efficacy of an automated pain intervention for improving pain and symptom management of underserved African American and Latina women with breast cancer. METHODS Sixty low-income African American and Latina women with breast cancer and cancer-related pain were enrolled in a pilot study of an automated, telephone-based interactive voice response (IVR) intervention. The intervention group patients were called twice per week by the IVR system and asked to rate the intensity of their pain and other symptoms. The patients’ oncologists received e-mail alerts if reported symptoms were moderate to severe. The patients also reported barriers to pain management and received education regarding any reported obstacles. RESULTS The proportion of women in both groups reporting moderate to severe pain decreased during the study, but the decrease was significantly greater for the intervention group. The IVR intervention was also associated with improvements in other cancer-related symptoms, including sleep disturbance and drowsiness. Although patient adherence to the IVR call schedule was good, the oncologists treating the patients rated the intervention as only somewhat useful for improving symptom management. CONCLUSIONS The IVR intervention reduced pain and symptom severity for underserved minority women with breast cancer. Additional research on technological approaches to symptom management is needed.

Can patient-reported measurements of pain be used to improve cancer pain management? A systematic review and meta-analysis

“…In total, 3412 titles were identified by searching four databases and by screening reference lists. No new studies were identified in the updated MEDLINE search (December 2015); however, one new article was identified after the initial database searches17 which was linked to the research team of an earlier study 18…”

“…Nine trials used pen and paper,19 23 25 26 28 34 40 45 four used touch screen devices or personal digital assistants to collect the data,20 36 37 41 three used automated telephone monitoring,17 18 35 one used web-based systems,21 and in two trials, the patient was interviewed by a nurse27 or a health educator29 for the data. One study offered a choice between automated telephone monitoring or online monitoring 33…”

“…Summary data were given to a clinician in advance of a consultation in eight studies 17 20 21 28 36 37 40 42. None of the clinicians in these studies were given specific instructions about how to use the data except in the study by Vallières et al ,41 in which clinicians were asked to alter analgesics according to the WHO's analgesic ladder.…”

“…Five studies17 21 27 29 34 used the patient-generated data to target education on analgesic use, self-management skills and communicating about pain. Berry et al 21 embedded automated tailored coaching messages into their web-based intervention.…”

“…The coaching messages typically focused on how to communicate about unrelieved symptoms with professionals. Four interventions17 18 27 35 contained automatic alerts to physicians based on predetermined symptom thresholds. One study19 also used a symptom threshold concept within their paper diary intervention, instructing patients to contact their nurse if pain intensity or analgesic use crossed a threshold.…”