A randomized clinical trial of the efficacy of a self-care intervention to improve cancer pain management.

BACKGROUND: The undertreatment of cancer pain remains a significant clinical problem. OBJECTIVE: The aim of this randomized controlled trial was to evaluate the efficacy of the PRO-SELF Pain Control Program that was modified for Norwegian cancer patients in decreasing pain and increasing opioid intake compared with control care. INTERVENTIONS/METHODS: Oncology outpatients with pain from bone metastasis were randomized into the PRO-SELF (n = 87) or control (n = 92) groups. A nurse visited patients in the PRO-SELF group in their home at weeks 1, 3, and 6 and conducted telephone interviews at weeks 2, 4, and 5. Patients in both groups completed a daily diary of pain intensity ratings and analgesic intake. RESULTS: For both groups, significant decreases in pain intensity scores and in hours per day in pain (both, P < .001) were found over the 6 weeks of the study. However, no significant group × time interactions were found for any of the pain measures. In both groups, total dose of opioid taken increased over time. However, no significant group × time interactions were found for changes over time in the total dose, around-the-clock dose, or as-needed dose of opioid analgesics taken. CONCLUSIONS: Possible reasons for the lack of efficacy include an inadequate dose of the psychoeducational intervention, inadequate changes in analgesic prescriptions, and/or the impact of attention provided to the control group. IMPLICATIONS FOR PRACTICE: Coaching, nursing support, and the use of a pain diary may be important interventions to reduce pain intensity.

The PRO-SELF pain control program improves family caregivers' knowledge of cancer pain management.

BACKGROUND: The majority of cancer treatment is provided in outpatient settings. Family caregivers' (FCs') knowledge and beliefs about pain and its management are critical components of effective care. OBJECTIVE: This study's aim was to evaluate the efficacy of a psychoeducational intervention, compared with control, to increase FCs' knowledge of cancer pain management. INTERVENTION/METHODS: Family caregivers of oncology outpatients were randomized together with the patients into the PRO-SELF Pain Control Program (n = 58) or a control group (n = 54). Family caregivers completed a demographic questionnaire and the Family Pain Questionnaire (FPQ) at the beginning and end of the study to assess their knowledge about pain and its management. The intervention consisted of nurse coaching, home visits, and phone calls that occurred over 6 weeks. RESULTS: One hundred twelve FCs (60% female) with a mean age of 63 (SD, 10.7) years participated. Compared with FCs in the control group, FCs in the PRO-SELF group had significantly higher knowledge scores on all of the single items on the FPQ, except for the item "cancer pain can be relieved," as well as for the total FPQ score. CONCLUSION: The use of a knowledge and attitude survey like the FPQ, as part of a psychoeducational intervention provides an effective foundation for FC education about cancer pain management. IMPLICATIONS FOR PRACTICE: Oncology nurses can use FCs' responses to the FPQ to individualize teaching and spend more time on identified knowledge deficits. This individualized approach to FC education may save staff time and improve patient outcomes.

The PRO-SELF(©) Pain Control Program improves patients' knowledge of cancer pain management.

CONTEXT: Inadequate knowledge is one barrier to effective cancer pain management. OBJECTIVES: This study's aim was to evaluate the effects of a psychoeducational intervention (the Norwegian version of the PRO-SELF(©) Pain Control Program) compared with a control group in increasing patients' knowledge of cancer pain management. METHODS: Adult oncology outpatients with pain from bone metastasis of 2.5 or greater on a 0 to 10 numeric rating scale were randomized into the PRO-SELF (n=87) or control (n=92) groups. Patients completed a demographic questionnaire and the Pain Experience Scale (PES) at the beginning and end of the study to assess their knowledge and attitudes. The six-week intervention consisted of education, skills building, and nurse coaching. Mixed-model analyses with tests of a group×time interaction were done for each of the individual items and total PES scores to evaluate between-group differences in changes in knowledge over time. RESULTS: Except for functional status, no differences were found between the PRO-SELF and control groups on any baseline demographic, clinical, or pain characteristics. Significant group×time interactions were found for all the single item and total PES scores. Compared with the control group, patients in the PRO-SELF group had significant increases in knowledge scores. CONCLUSION: The use of a knowledge and attitude survey, like the PES, as part of a psychoeducational intervention provides an effective foundation for patient education in cancer pain management. This individualized approach to education about pain management may save staff time and improve patient outcomes.