Kravitz, R.L., Tancredi, D.J., Grennan, T., Kalauokalani, D., Street, R.L., Jr., Slee, C.K., . . . Franks, P. (2011). Cancer Health Empowerment for Living without Pain (Ca-HELP): Effects of a tailored education and coaching intervention on pain and impairment. Pain, 152, 1572–1582.

To determine the effectiveness of a lay-administered tailored education and coaching intervention on cancer pain severity, pain-related impairment, and quality of life  

Patients with baseline “worst pain” of more than 4 on a 0–10 scale or at least moderate functional impairment were randomized to tailored education coaching (TEC) or enhanced usual care (EUC). TEC was delivered by a health educator in a private room one hour prior to the patients' visit with their healthcare provider. The intervention was a brief, patient-centered, tailored education and coaching intervention designed to enhance skills and self-efficacy for communicating with the oncologist while also correcting common misconceptions. The EUC intervention included review of selected aspects of a National Cancer Institute (NCI) booklet on pain control by a health educator. The TEC patients also received the NCI booklet. Patients completed questionnaires before and after the visit and were interviewed by telephone at 2, 5, and 12 weeks. Oncologists and follow-up assessors were blinded to patient group assignments.

• The study reported on 258 patients (126 in the intervention group and 132 in the usual care group).
• Mean patient age was 58 years.
• The intervention group was 77.8% female and 22.2% male. The usual care group was 79.5% female and 20.5% male. 
• Patients had breast and lung cancers and were predominantly white (71%).

• Mutlisite
• Outpatient setting
• Three healthcare systems and one private practice located in the metropolitan Sacramento, CA, area
• Forty-five medical oncologists and three radiation oncologists participated in the study.

Patients were undergoing multiple phases of care.

The study was a randomized controlled trial.

• Pain severity: two component numeric scales     
• Pain impairment: five of thesix items from the Medical Outcomes Study
• Functional status and well-being: physical and mental health components of the SF-12
• Pain misconceptions: 11 five-point Likert scale items based on the Short Barriers Questionnaire
• Self-efficacy for communicating about pain with the cancer doctor: five items in the Perceived Efficacy in Patient-Physician Interactions Scale
• Pain-control self-efficacy: 2 items from the pain management subscale of the Chronic Pain Self-Efficacy Scale
   

The TEC patients had an improvement in pain-related impairment at two weeks (–0.025 points on a five-point scale, 95% confidence interval –0.43 to –0.06, p = 0.01), but it was not sustained at 6 and 12 weeks (p > 0.20). Pain severity was not improved at two weeks (–0.21 points on an 11-point scale, –0.60 to 0.17, p = 0.27). Pain misconceptions in both the intervention and control group decreased significantly between baseline and the two-week follow-up interview (p < 0.001), but there was no significant effect of the intervention on misconceptions at the two-week follow-up (p = 0.8). Communication self-efficacy increased more among the TEC patients than in the control group (p < 0.001).

TEC provides a temporary improvement in pain impairment but not in pain severity.

The TEC intervention was designed to be brief and easy to deliver, but the health educator needed 30–40 hours of training and regular reinforcement (several hours every three to six months) in order to deliver the intervention appropriately. Physicians were not randomized to the study, so they may have learned from the TEC patients and applied it to the EUC patients. Generalizability of findings is limited due to the fact that the study was conducted in a metropolitan area in California, with no blinding.

Because the TEC provided only temporary relief of pain impairment and no improvement of pain severity, it is not recommended for use in cancer-related pain management.