Therapeutic Patient Education in Cancer Pain Management: from Practice to Research: Proposals and Strategy of the French EFFADOL Program

Abstract

In the field of cancer pain, therapeutic patient education (TPE) allows patients to develop skills to better manage their pain. In the Lower Normandy region of France, the management of pain is based on networking, thus allowing proximity and accessibility for all concerned. We have thus designed and initiated a broad five-stage research program that includes the following: (1) training for caregivers in TPE; (2) identifying the educational expectations of patients and their relatives with regard to cancer pain; (3) the design of a TPE program; (4) the evaluation of its quality; and (5) the evaluation of its effectiveness by comparative randomization. This article presents this approach and more particularly the research phases (stages 2, 4, 5) for which the objectives, the methodology, and the expected results are justified. Among the key points, particular attention is paid to the evaluation of the educational dimension that provides patients with self-efficacy to participate actively in the management of their pain, their perception of changes in relation to it and its impact. The choice of a specific assessment criterion (subscale 9 of the Brief Pain Inventory) and of the step-wedge design are thus argued. This approach, which is based on a partnership between health care professionals and researchers, aims to demonstrate the benefits provided by TPE to patients in order to enable them to better manage their pain on a daily basis.

Effectiveness of a therapeutic patient education program in improving cancer pain management: EFFADOL, a stepped-wedge randomised controlled trial

“…In this context and according to the regional health policy, we have undertaken an extensive five-step research program, called EFFADOL (“ Ensemble, Faire FAce à la DOuLeur” ), structured in 5 successive phases, each of them briefly described in the paper developing the EFFADOL combined approach from practice to research [15]. Health professionals were first trained in TPE (step 1).…”

<p>Evaluation of patients’ needs to design and assess a patient education program in cancer pain</p>

“…In this context, our team has undertaken an extensive five-step research program (Figure 1): 1) training in TPE of 10 nurse–physician pairs (finalized); 2) identification of educative needs of patients and relatives in cancer pain; 3) development and optimization of a PEP for patients with cancer (which must be authorized by the French Regional Health Agency); 4) regional pilot study aiming to assess the quality and transferability of the program; 5) program evaluation using a comparative interventional randomized study 13. The originality and strengths of this 5-step research are that it provides access to the PEP to all individuals across the community and is based on close collaboration between health care professionals and researchers.

Figure 1Strategy of the 5-step project including focus on step 2. Note: *Optimization phase but already designed and financially supported. Abbreviations: BPI, brief pain inventory; PEP, pain education programs; TPE, therapeutic patient education.

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