Dalton, J. A., Keefe, F. J., Carlson, J. & Youngblood, R. (2004). Tailoring cognitive-behavioral treatment for cancer pain. Pain Management Nursing, 5, 3–18.

To determine whether a profile-tailored cognitive-behavioral therapy (CBT) treatment program was more effective than either standard CBT or usual care in changing outcomes for patients with cancer-related pain.

Patients received standard CBT, profile-tailored CBT, or usual care. Therapy group sessions ranged from 5 to 50 minutes.

Standard CBT is comprehensive CBT that evaluates thoughts, feelings, and behaviors. It uses six to eight treatment strategies to teach patients to understand the relationship among pain, suffering, and emotions; to use symptom-coping skills, problem solving, relaxation, and self control; and to modify cognitive distortions associated with emotional distress.

Profile-tailored CBT matches patients’ scores on the Biobehavioral Pain Profile (BPP) to specific CBT modules, environmental influences, loss of control, healthcare avoidance, past and current experience, physiologic responsivity, and thoughts of disease progression.

RNs received a two-day training course to deliver the intervention.

• The study was comprised of 131 patients who were experiencing cancer-related chronic pain for more than six weeks that was associated with disease progression, adjuvant therapy, or surgical exploration.
• Mean patient age was 52 years.
• Of the patients, 72% were female, 63% were Caucasian, and 35% were African American.
• Patients had at least one elevated score on the BPP.
• The most common diagnoses were lymphoma and breast, colon, and lung cancers.

The study was conducted at one inpatient and three outpatient cancer centers in the southeastern United States.

Patients were undergoing the active treatment phase of care.

This was a randomized, controlled trial.

• Brief Pain Inventory (BPI)
• Profile of Mood States (POMS)
• Karnofsky Performance Status Score (KPS)
• Medical Outcomes Study–Short Form Health Survey (MOS-SF)
• Katz Index of Independence in Activities of Daily Living (ADL)

Short-term outcome:  Based on the BPI, interference with sleep improved from baseline to immediately postintervention for the profile-tailored CBT group.

Between-group comparison of the treatment effect over the entire study found treatment effects for interference of pain with mood and sleep. Response to the intervention decreased with time.

• Poor retention was noted, with only 28 patients completing the study.
• The final sample size was very small.
• Other concepts were measured, such as fatigue, pain, bowel patterns, symptom distress, quality of life (QOL), and better KPS.
• RNs required a two-day training course to deliver the intervention.
• Space is needed to provide the intervention.