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BACKGROUND/RATIONALE:
Cancer pain is a pervasive problem for the person with cancer. Despite advances in knowledge, effective cancer management is infrequently achieved. While this problem is multi-factorial, the patient may have attitudinal barriers to effective pain management that can be ameliorated with novel interventions.
OBJECTIVE(S):
The primary objective of this study is to determine the effects of two nursing interventions on the improvement of pain management (PM), functional status (FS) and quality of life (QOL) in veterans receiving cancer care in VA ambulatory care clinics. The two interventions will utilize selected cancer pain management strategies developed as Clinical Practice Guidelines by the Agency for Health Care Policy and Research (AHCPR). This study will test the hypothesis that those veterans in the intervention arms will have lower pain intensity scores, greater pain relief and satisfaction with PM, and will have higher QOL and FS scores specifically in the areas of physical and social functioning. A secondary aim is to measure the extent that cancer PM is affected by the intervening variables of age, affect, attitudinal barriers, veteran culture, type/stage of disease, and type of cancer treatment.
METHODS:
The design of this randomized trial has one between-subjects factor, GROUP, with three levels (usual care, structured education, individualized coaching), and one within-subjects factor, TIME, with two measures, pre-test and post-test. Patients with cancer pain (n=320) are randomly assigned to one of three groups after stratifications to control for the confounding variables of pain intensity and effects of cancer treatment. Those in the structured education arm view a video on cancer pain management and receive the AHCPR patient pamphlet on cancer pain management. Those subjects in the individualized coaching arm receive the same structured education as above, but also partake in four telephone coaching sessions focusing on the individual's specific pain management problems. The primary outcome variables measured after 12 weeks are: satisfaction with pain management, quality of life and functional status.
FINDINGS/RESULTS:
A convenience sample of 289 adults with pain related to cancer and/or its/treatment participated The sample was predominantly male (88%), veteran, middle-aged (mn=60.8 +/- 11.5 years), with a variety of cancers types; over 30% were receiving cancer therapy. Analysis of variance was used to assess the difference within the three groups in the amount of change in the dependent variables. Patients in the Coaching group demonstrated significantly less interference with function from pain than those in the other groups and improved more in vitality than the Education group participants. They also had less pain, and improved pain relief and emotional well-being, although these were not statistically significant.
IMPACT:
Our study evaluated two interventions aimed at reducing the pain related to cancer. These interventions will improve the quality of life and functional ability of cancer patients experiencing pain from their disease. Our findings will provide guidelines and strategies for both advanced practice and staff nurses caring for veterans experiencing pain from their cancer.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Communication and Decision Making, Quality of Care
Keywords:
Clinical practice guidelines, Nursing, Pain
MeSH Terms:
none
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