Testing the Implementation of a Pain Self-management Support Intervention for Oncology Patients in Clinical Practice

Abstract

Because these outcomes are particularly meaningful for patients, the integration of ANtiPain to routine clinical practice may be substantial. A larger study will be based on these findings.

Implementation of a nurse-led self-management support intervention for patients with cancer-related pain: a cluster randomized phase-IV study with a stepped wedge design (EvANtiPain)

“…The PRO-Self© Plus Pain Control Program (PCP) has been shown to be an effective self-management support intervention by reducing these patient-related barriers towards cancer pain management [3,14]. The intervention was initially developed and successfully tested in the United States [14] and has then been translated, adapted, and tested in the German-speaking context with two pilot randomized controlled trials (RCT) [15,16]. In the first pilot RCT in the German context (PEINCA, n = 39), patient-related barriers were significantly reduced (p = .04), whereas average and worst pain, opioid intake and self-efficacy remained unchanged when compared to standard care [15].…”

“…In particular, ANtiPain now has a more adaptable structure so that it can follow standard clinical care more flexibly whilst core components of the original intervention were kept (e.g., the three key components information, nurse coaching and skills building) [18]. In the second German pilot RCT (n = 39), pain intensity, pain interference with daily activities, and pain-related self-efficacy reduced non-significantly with moderate to high effect sizes with the adapted ANtiPain intervention, while patient-related barriers to cancer pain management improved significantly (p = .03) [16].…”

“…ANtiPain [15,16] and the original PRO-Self© Plus PCP [14] are based on the Theory of Symptom Management [27] and Bandura's Social Cognitive Theory [28]. We assume that it reduces barriers and thus changes pain self-management-related behavior leading to a reduction of pain interference with daily activities [16,18]. In addition, we assumed that the practical aspects of pain management (e.g., timing of analgesic medication in daily routine) would improve patient-related outcomes.…”

“…In addition, we assumed that the practical aspects of pain management (e.g., timing of analgesic medication in daily routine) would improve patient-related outcomes. A more detailed description of the intervention can be found elsewhere [16,18]. In short, ANtiPain entails structured (e.g., each patient is taught how to communicate their pain to health care providers) and tailored components.…”

“…Intervention nurses followed an intervention protocol, applied assessment instruments (e.g., to assess pain or barriers to pain management [30]), and were asked to use a pocket booklet about common analgesics. Corresponding laminated theme-cards were used to visualize topics for patients covered in the discussion [16,18]. During the follow-up calls, pain, side effects of the prescribed analgesic medication, as well as adherence to analgesics and given recommendations were assessed and re-discussed.…”