Jahn, P., Kuss, O., Schmidt, H., Bauer, A., Kitzmantel, M., Jordan, K., . . . Landenberger, M. (2014). Improvement of pain-related self-management for cancer patients through a modular transitional nursing intervention: A cluster-randomized multicenter trial. Pain, 155, 746–754.

To evaluate Self Care Improvement through Oncology Nursing (SCION-PAIN), a nursing-administered program to reduce patients’ barriers and improve pain management and pain-related discharge management

The intervention was a nurse-led counseling program to improve pain management and pain-related discharge management by reducing patient-related cognitive barriers. In the intervention group, the SCION-PAIN program was administered by specially trained ward nurses in cooperation with a study nurse. Initial education was standardized, and follow-up was tailored to individual needs. Three initial sessions were provided during hospital stay, and a follow-up telephone counseling session was done two to three days after discharge. Study measures were obtained at baseline, at discharge, and on days 7, 14, and 28 after discharge.

• N = 202  
• AVERAGE AGE = 55.9 years (control); 57.75 years (intervention)
• MALES: 60 (57.1%) control; 59 (57.8%) intervention, FEMALES: 45 (42.9%) control; 43 (42.2%) intervention
• KEY DISEASE CHARACTERISTICS: Gynecologic tumors 21/105 (20%) control and 20/101 (19.8%) intervention; urologic tumors 4/105 (3.8%) control and 12/101 (11.9%) intervention; hematologic malignancies 15/105 (14.3%) control and 1/101 (1%) intervention; gastrointestinal tumors 26/105 (24.8%) control and 40/101 (39.6%) intervention; other tumors 39/105 (37.1%) control and 28/101 (27.7%) intervention

• SITE: Multi-site  
• SETTING TYPE: Multiple settings (inpatient and home setting)
• LOCATION: Eighteen oncology wards from two German university hospitals

• PHASE OF CARE: Active antitumor treatment

Cluster-randomized trial

• The effectiveness of the SCION-PAIN program was assessed by the difference in patient-related barriers to the management of cancer pain between the control and intervention groups using the Barriers Questionnaire II.
• Secondary endpoints were measured with the Brief Pain Inventory (BPI), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ), the German Pain Coping Questionnaire (GPCQ), and the Medication Adherence Scale (MAS).
• Health-related quality of life was measured by the EORTC-QLQ C30.

Compared to usual care, the SCION-PAIN program reduced cognitive barriers in cancer pain management more effectively (p < 0.02), and patients who participated in this program showed a significant increase in perceived knowledge of cancer pain. There was no difference between the groups in average or worst pain intensity. Patients in the intervention group adhered better to pain medications (p = 0.02).

The results of this study demonstrated the effectiveness of the SCION-PAIN program as a brief, easily administered, nurse-led intervention to improve the self-management of pain in patients with cancer. Patient education could help to empower patients to actively participate in their pain treatment and develop self-management skills, improving adherence through care transitions. Participants in the program demonstrated a lower intensity of pain.

• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Findings not generalizable
• Intervention expensive, impractical, or training needs
• Subject withdrawals ≥ 10%
• Other limitations/explanation: Small number of randomized clusters; effects caused by differing personalities of the included participants; the responses to the information provision, different levels of social support, or of mental resilience were not assessed systematically

The results of this study emphasized the integral role of nurses as part of the supportive or palliative care team. This study also confirmed that the inpatient period provides a very valuable and suitable timeframe to improve patients’ self-management and communication skills to prepare them for care transitions.