Randomized Clinical Trial of the Effectiveness of a Self-Care Intervention to Improve Cancer Pain Management

Miaskowski, Christine; Dodd, Marylin; West, Claudia; Schumacher, Karen; Paul, Steven M.; Tripathy, Debasish; Koo, Peter

doi:10.1200/jco.2004.06.140

Cited by 216 publications

(220 citation statements)

References 27 publications

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“…Model programs have emphasized patient teaching interventions including the use of pain assessment tools, strategies to dispel misconceptions, and patient coaching regarding the reporting and documenting of their symptoms. [32][33][34] The findings from our study support this hypothesis.…”

Section: Discussionsupporting

confidence: 86%

Overcoming Barriers to Cancer Pain Management: An Institutional Change Model

Sun

Borneman

Ferrell

et al. 2007

Journal of Pain and Symptom Management

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The Agency for Health Care Policy and Research (AHCPR) Pain Guidelines of 1994 recognized pain as a critical symptom that impacts quality of life (QOL). The barriers to optimum pain relief were classified into three categories: patient, professional and system barriers. A prospective, longitudinal clinical trial is underway to test the effects of the "Passport to Comfort" innovative intervention on pain and fatigue management. This paper reports on pre-intervention findings related to barriers to pain management. Cancer patients with a diagnosis of breast, lung, colon, or prostate cancer who reported a pain rating of ≥ 4 were accrued. Subjects completed questionnaires to assess subjective ratings of overall QOL, barriers to pain management, and pain knowledge at baseline and at one-and three-month evaluations. A chart audit was conducted at one month to document objective data related to pain management. The majority of subjects had moderate (4-6 on a zero to ten numeric rating scale) pain at the time of accrual. Patient barriers to pain management existed in attitudes and knowledge regarding addiction, tolerance, and not being able to control pain. Subjects who were currently receiving chemotherapy were reluctant to communicate their pain with health care professionals. Professional and system barriers were focused around screening, documentation, reassessment, and follow-up of pain. Lack of referrals to supportive care services for patients was also noted. Several well-described patient, professional, and system barriers continue to hinder efforts to provide optimal pain relief. Phase II of this initiative will attempt to eliminate these barriers using the "Passport" intervention to manage cancer pain.

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Section: Discussionsupporting

confidence: 86%

Overcoming Barriers to Cancer Pain Management: An Institutional Change Model

Sun

Borneman

Ferrell

et al. 2007

Journal of Pain and Symptom Management

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“…Other pain education studies of longer intervention duration or covering more targeted areas than our training have found less consistent pain relief effects (deWit et al 1997;Ferrell et al 1995;Keefe et al 2005). This may be a case where fewer targets for training result in better outcomes, although more extensive training has, in some cases, shown broadly improved pain outcomes although over a shorter follow-up period (Miaskowski et al 2004).…”

Section: Discussionmentioning

confidence: 72%

“…Some studies have reported success in reducing worst pain when using longer training periods and more extended professional time in training (Lin et al 2006;Miaskowski et al 2004). Worst pain may be more difficult to treat because of its fluctuating and sometimes very brief nature.…”

Section: Discussionmentioning

confidence: 99%

“…However, effective strategies are needed that have sustained impact while requiring feasible amounts of professional time. Clinical trials document the efficacy of patient education in improving cancer pain knowledge (Chang et al 2002;deWit et al 1997;Lin et al 2006;Wells et al 2003) and outcomes (Devine 2003;Miaskowski et al, 2004;Oliver et al, 2001), although these efforts are not universally successful in reducing pain (deWit et al 1997;Ward et al 2000). Nearly all clinical trials have had relatively brief endpoints of two to six weeks, whereas cancer pain often continues for much longer.…”

Section: Introductionmentioning

confidence: 99%

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Patient training in cancer pain management using integrated print and video materials: A multisite randomized controlled trial ☆

Syrjala

Abrams

Polissar³

et al. 2008

Pain

101

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Standard guidelines for cancer pain treatment routinely recommend training patients to reduce barriers to pain relief, use medications appropriately, and communicate their pain-related needs. Methods are needed to reduce professional time required while achieving sustained intervention effectiveness. In a multisite, randomized controlled trial, this study tested a pain training method versus a nutrition control. At six oncology clinics, physicians (N=22) and nurses (N=23) enrolled patients (N=93) who were over 18, with cancer diagnoses, pain, and a life expectancy of at least six months. Pain training and control interventions were matched for materials and method. Patients Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access

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“…This descriptive correlational study is part of a large randomized clinical trial (RCT) that evaluated the effectiveness of the PRO-SELF© Pain Control Program compared to standard care in improving cancer pain management (12)(13)(14). Two hundred and twelve oncology outpatients were recruited from seven outpatient settings in Northern California including a university-based cancer center, two community-based oncology practices, one outpatient radiation therapy center, one health maintenance organization, one Veterans Administration facility, and one military hospital.…”

Section: Sample and Settingsmentioning

confidence: 99%

Differences in the Prevalence and Severity of Side Effects Based on Type of Analgesic Prescription in Patients with Chronic Cancer Pain

Villars

Dodd

West

et al. 2007

Journal of Pain and Symptom Management

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An understanding of the relationship between the type of analgesic prescription and the prevalence and severity of side effects is crucial in making appropriate treatment decisions. The purposes of this study were: to determine if there were differences in the prevalence of side effects among four different types of analgesic prescriptions (i.e., no opioid, only an as needed (PRN) opioid, only an around-the-clock (ATC) opioid, or an ATC + PRN opioid); to determine if there were differences in the severity of side effects among the four prescriptions groups; and to determine the relationships between the total dose of opioid analgesic medication prescribed and taken and the severity of side effects. As part of a larger study, 174 cancer patients with bone metastasis reported their analgesic use and the prevalence and severity of eleven side effects. Significant differences (P < 0.05) were found in prevalence rates for seven of the side effects among the four prescription groups. The highest prevalence rates were found in the only ATC and ATC + PRN groups. Significant differences were found in the severity scores for five of the side effects, with the highest severity scores reported by patients in the only ATC and ATC + PRN groups. Significant positive correlations were found between the severity of six of the side effects and the total dose of opioid prescribed and taken. Risk factors for analgesic-induced side effects are ATC and ATC + PRN prescription types and higher doses of opioid analgesics.

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Randomized Clinical Trial of the Effectiveness of a Self-Care Intervention to Improve Cancer Pain Management

Abstract: The use of a psychoeducational intervention that incorporates nurse coaching within the framework of self-care can improve the management of cancer pain.

Cited by 216 publications

References 27 publications

Overcoming Barriers to Cancer Pain Management: An Institutional Change Model

Overcoming Barriers to Cancer Pain Management: An Institutional Change Model

Patient training in cancer pain management using integrated print and video materials: A multisite randomized controlled trial ☆

Differences in the Prevalence and Severity of Side Effects Based on Type of Analgesic Prescription in Patients with Chronic Cancer Pain

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