Cancer Health Empowerment for Living without Pain (Ca-HELP): study design and rationale for a tailored education and coaching intervention to enhance care of cancer-related pain

Kravitz, Richard L.; Tancredi, Daniel J.; Street, Richard L.; Kalauokalani, Donna; Grennan, Tim; Wun, Theodore; Slee, Christina; Dean, Dionne Evans; Lewis, Linda; Saito, Naomi; Franks, Peter

doi:10.1186/1471-2407-9-319

Cited by 22 publications

(32 citation statements)

References 29 publications

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“…A total of 265 patients received either the TEC or EUC, which represented 86% of the patients randomized in the study (see Kravitz et al[46] for detailed information on patient recruitment). Of these, 148 (56%) additionally consented to have their consultations audio-recorded.…”

Section: Resultsmentioning

confidence: 99%

“…Complete details of the conceptual model, study design, and research measures are presented elsewhere [46]. The present study examined the effect of the intervention on a subset of the research participants who allowed their consultations to be audio-recorded for further analysis.…”

Section: Methodsmentioning

confidence: 99%

“…The TEC intervention assessed each patient’s learning needs, goals, and values to develop a set of individualized messages and skill-building exercises designed to increase self-efficacy, enhance patient-physician communication, and improve care of cancer-related pain [46]. Paid Health Educators in this project were intensively trained over approximately 80 hours to elicit patients’ values, deliver plain-spoken messages, and to be sensitive to cultural differences that may influence how different patients respond to their illness and to the intervention.…”

Section: Methodsmentioning

confidence: 99%

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Improving physician–patient communication about cancer pain with a tailored education-coaching intervention

Street

Slee

Kalauokalani

et al. 2010

Patient Education and Counseling

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103

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Objective This study examined the effect of a theoretically grounded, tailored education-coaching intervention to help patients more effectively discuss their pain-related questions, concerns, and preferences with physicians. Methods Grounded in social-cognitive and communication theory, a tailored education coaching (TEC) intervention was developed to help patients learn pain management and communication skills. In a RCT, 148 cancer patients agreed to have their consultations audio-recorded and were assigned to the intervention or a control group. The recordings were used to code for patients’ questions, acts of assertiveness, and expressed concerns and to rate the quality of physicians’ communication. Results Patients in the TEC group discussed their pain concerns more than did patients in the control group. More active patients also had more baseline pain and interacted with physicians using participatory decision-making. Ratings of physicians’ information about pain were higher when patients talked more about their pain concerns. Conclusions The study demonstrates the efficacy of a theoretically grounded, coaching intervention to help cancer patients talk about pain control. Practice implications Coaching interventions can be effective resources for helping cancer patients communicate about their pain concerns if they are theoretically grounded, can be integrated within clinical routines, and lead to improve health outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Improving physician–patient communication about cancer pain with a tailored education-coaching intervention

Street

Slee

Kalauokalani

et al. 2010

Patient Education and Counseling

Self Cite

103

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“…On arrival, they were greeted by a trained health educator, who brought them to a quiet space, obtained written informed consent, and provided a pre-intervention questionnaire. The health educator then administered the patient’s randomly assigned intervention, either tailored education and coaching intervention or enhanced usual care (control) 10. Patients then completed a post-intervention, pre-visit questionnaire, attended their physician visit, and then completed a post-visit questionnaire.…”

Section: Methodsmentioning

confidence: 99%

“…To begin to examine these issues, we conducted secondary prospective observational analyses of data from Cancer Health Empowerment for Living without Pain (Ca-HELP), a randomized controlled trial (RCT) of a patient coaching intervention, designed to enhance patient communication with cancer physicians and help them cope with and manage cancer-related pain 10. The coaching intervention led to more active pain-related communication by patients11 but no improvement in the general tendency to adhere to provider-recommended treatments, as measured with the well validated Medical Outcomes Study (MOS) general adherence self-report measure,12,13 and no decrease in subsequent pain (unpublished data).…”

mentioning

confidence: 99%

Tendency to adhere to provider-recommended treatments and subsequent pain severity among individuals with cancer

Jerant

Franks

Tancredi³

et al. 2011

PPA

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BackgroundPatients’ general tendency to adhere to health care provider-recommended treatments is associated with a number of health outcomes, but whether it influences pain severity over time among individuals with cancer is unclear. We explored the relationship between adherence tendency and subsequent pain severity among cancer patients participating in a randomized controlled trial of coaching to enhance communication with physicians and reduce pain severity.MethodsAssociations between baseline Medical Outcomes Study general adherence measure score and pain severity over 12 weeks were examined with repeated-measures regression models. Model 1 included sociodemographics, study group and site, follow-up point, and baseline pain; Model 2 included these variables plus partner status, physical and mental health status (12-item Short Form Health Survey [SF-12®]), and pain control self-efficacy.ResultsOf 307 patients randomized, 224 (73%) had at least one follow-up pain severity assessment plus complete data for other model variables and were included in the analyses. In Model 1, adherence tendency was associated with less subsequent pain severity: a one standard deviation increase in adherence tendency was associated with a 0.22-point adjusted mean decrease in pain severity on a 0–10 scale (95% confidence interval 0.40, 0.03). The association was diminished and not statistically significant in Model 2, primarily due to adjustment for the SF-12.ConclusionTendency to adhere to provider-recommended treatments was associated with subsequent pain severity among individuals with cancer, suggesting a potential way of predicting and intervening to improve cancer pain control. However, the association was attenuated after adjusting for health status, suggesting mediation or confounding of the relationship by health status.

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Improving Pain Self-Management Among Rural Older Adults With Cancer

Shen,

Stokes,

Yarborough

et al. 2024

JAMA Netw Open

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ImportanceUndertreated cancer pain is a major public health concern among older adults in rural communities. Interventions to improve pain management among this vulnerable population are needed.ObjectiveTo test the feasibility, acceptability, and changes in pain outcomes from exposure to an adapted intervention, Cancer Health Empowerment for Living without Pain (CA-HELP), to improve patients’ communication about pain to their clinicians.Design, Setting, and ParticipantsOlder adults with cancer (aged ≥65 years) who were residing in a noninstitutional rural setting and receiving outpatient care at a rural-based clinic in Tennessee were enrolled in the study, in which everyone received the intervention, in May 2022. All patients were given assessments at baseline and 1 week after intervention. Mean score differences were analyzed using 1-tailed paired sample t tests (α = .05). Data were analyzed in June 2022.ExposureThe adapted version of CA-HELP included an 18-page patient-facing workbook and a 30-minute telephone coaching call with a registered nurse to coach patients on pain education and communication techniques to discuss pain with their medical team.Main Outcomes and MeasuresFeasibility was examined through accrual and completion rates. Acceptability was measured by helpfulness, difficulty, and satisfaction with the intervention. Changes in outcomes were measured using mean score differences from pre-post assessments of pain self-management, self-efficacy for communicating with clinicians about pain, patient-reported pain, and misconceptions about pain.ResultsAmong the 30 total participants, the mean (SD) age was 73.0 (5.1) years; 17 participants (56.7%) were female, 5 (16.7%) were Black or African American, 30 (100%) were non-Hispanic or non-Latino, 24 (80.0%) were White, 16 (53.3%) had less than a high school education, and 15 (50.0%) reported income less than $21 000 per year. Based on accrual and completion rates of 100%, this intervention was highly feasible. Fidelity rates for delivering intervention components (100%) and communication competence (27 participants [90%]) were also high. Regarding acceptability, all patients rated the intervention as helpful, with the majority (24 participants [80%]) rating it as “very helpful.” Most patients rated the intervention as “not at all difficult” (27 participants [90%]), enjoyed participating (21 participants [70%]), and reported being “very satisfied” (25 participants [83.3%]). Pre-post changes in outcomes suggested significant improvements in pain self-management and self-efficacy for communicating with clinicians about pain, as well as significant reductions in patient-reported pain and pain misconceptions.Conclusions and RelevanceIn this case-series study of CA-HELP, results suggested the adapted version of CA-HELP was feasible and acceptable and showed changes in pain-related outcome measures among older adults with cancer in a rural setting.

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Cancer Health Empowerment for Living without Pain (Ca-HELP): study design and rationale for a tailored education and coaching intervention to enhance care of cancer-related pain

Cited by 22 publications

References 29 publications

Improving physician–patient communication about cancer pain with a tailored education-coaching intervention

Improving physician–patient communication about cancer pain with a tailored education-coaching intervention

Tendency to adhere to provider-recommended treatments and subsequent pain severity among individuals with cancer

Improving Pain Self-Management Among Rural Older Adults With Cancer

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