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Open Access Article
A Randomized, Clinical Trial of Education or Motivational-Interviewing-Based Coaching Compared to Usual Care to Improve Cancer Pain Management
Purpose/Objectives: To test the effectiveness of two interventions compared to usual care in decreasing attitudinal barriers to cancer pain management, decreasing pain intensity, and improving functional status and quality of life (QOL).
Design: Randomized clinical trial.
Setting: Six outpatient oncology clinics (three Veterans Affairs [VA] facilities, one county hospital, and one community-based practice in California, and one VA clinic in New Jersey)
Sample: 318 adults with various types of cancer-related pain.
Methods: Patients were randomly assigned to one of three groups: control, standardized education, or coaching. Patients in the education and coaching groups viewed a video and received a pamphlet on managing cancer pain. In addition, patients in the coaching group participated in four telephone sessions with an advanced practice nurse interventionist using motivational interviewing techniques to decrease attitudinal barriers to cancer pain management. Questionnaires were completed at baseline and six weeks after the final telephone calls. Analysis of covariance was used to evaluate for differences in study outcomes among the three groups.
Main Research Variables: Pain intensity, pain relief, pain interference, attitudinal barriers, functional status, and QOL.
Findings: Attitudinal barrier scores did not change over time among groups. Patients randomized to the coaching group reported significant improvement in their ratings of pain-related interference with function, as well as general health, vitality, and mental health.
Conclusions: Although additional evaluation is needed, coaching may be a useful strategy to help patients decrease attitudinal barriers toward cancer pain management and to better manage their cancer pain.
Implications for Nursing: By using motivational interviewing techniques, advanced practice oncology nurses can help patients develop an appropriate plan of care to decrease pain and other symptoms.
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References
Agency for Health Care Policy and Research. (1994). Managing cancer pain, consumer version, clinical practice guideline number 9. Rockville, MD: U. S. Department of Health and Human Services.
American Cancer Society. (1994). The cancer experience: Living with treatment [Videotape]. Atlanta, GA: American Cancer Society.
Anderson, K. O., Richman, S. P., Hurley, J., Palos, G., Valero, V., Mendoza, T. R., … Cleeland, C. S. (2002). Cancer pain management among underserved minority outpatients: Perceived needs and barriers to optimal control. Cancer, 94, 2295-2304. doi:10.1002/cncr.10414
Apolone, G., Corli, O., Caraceni, A., Negri, E., Deandrea, S., Montanari, M., … Cancer Pain Outcome Research Study Group Investigators. (2009). Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group. British Journal of Cancer, 100, 1566-1574. doi:10.1038/sj.bjc.6605053
Bennett, M. I. (2010). Methodological issues in cancer pain: Non-pharmacological trials. In J. A. Paice, R. F. Bell, E. A. Kalso, & O. A. Soyannwo (Eds.), Cancer pain: From molecules to suffering (pp. 207-218). Seattle, WA: IASP Press.
Bennett, M. I., Bagnall, A., & Closs, S. J. (2009). How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis. Pain, 143, 192-199. doi:10.1016/j.pain.2009.01.016
Boini, S., Briançon, S., Guillemin, F., Galan, P., & Hercberg, S. (2004). Impact of cancer occurrence on health-related quality of life: A longitudinal pre-post assessment. Health and Quality of Life Outcomes, 2, 4. doi:10.1186/1477-7525-2-4
Brockopp, D. Y., Brockopp, G., Warden, S., Wilson, J., Carpenter, J. S., & Vandeveer, B. (1998). Barriers to change: A pain management project. International Journal of Nursing Studies, 35, 226-232. doi:10.1016/S0020-7489(98)00035-2
Burckhardt, C. S., & Jones, K. D. (2005). Effects of chronic widespread pain on the health status and quality of life of women after breast cancer surgery. Health and Quality of Life Outcomes, 3, 30. doi:10.1186/1477-7525-3-30
Cella, D., Tulsky, D. S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., … Harris, J. (1993). The Functional Assessment of Cancer Therapy Scale: Development and validation of the general measure. Journal of Clinical Oncology, 11, 570-579.
Chang, M. C., Chang, Y. C., Chiou, J. F., Tsou, T. S., & Lin, C. C. (2002). Overcoming patient-related barriers to cancer pain management for home care patients. A pilot study. Cancer Nursing, 25, 470-476. doi:10.1097/00002820-200212000-00012
Chang, V., Hwang, S., & Kasimis, B. (2002). Longitudinal documentation of cancer pain management outcomes: A pilot study at a VA medical center. Journal of Pain and Symptom Management, 24, 494-505.
Clotfelter, C. E. (1999). The effect of an educational intervention on decreasing pain intensity in elderly people with cancer. Oncology Nursing Forum, 26, 27-33.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
Cohen, M. Z., Easley, M. K., Ellis, C., Hughes, B., Ownby, K., Rashad, B. G., … Westbrooks, J. B. (2003). Cancer pain management and the JCAHO's pain standards: An institutional challenge. Journal of Pain and Symptom Management, 25, 519-527. doi:10.1016/S0885-3924(03)00068-X
Dahl, J. L. (2004). Pain: Impediments and suggestions for solutions. Journal of the National Cancer Institute. Monographs, 32, 124-127. doi:10.1093/jncimonographs/lgh022
Dalton, J., Keefe, F. J., Carlson, J., & Youngblood, R. (2004). Tailoring cognitive-behavioral treatment for cancer pain. Pain Management Nursing, 5, 3-18. doi:10.1016/S1524-9042(03)00027-4
Daut, R. L., Cleeland, C. S., & Flanery, R. (1983). Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases. Pain, 17, 197-210.
de Wit, R., van Dam, F., Loonstra, S., Zandbelt, L., Van Buuren, A., van der heijden, K., … Abu-Saad, H. H. (2001). Improving the quality of pain treatment by a tailored pain education programme for cancer patients in chronic pain. European Journal of Pain, 5, 241-256.
Elting, E. S., Keefe, D. M., Sonis, S. T., Garden, A. S., Spijkervet, F. K., Barasch, A., … Burden of Illness Head and Neck Writing Committee. (2008). Patient-reported measurements of oral mucositis in head and neck cancer patients treated with radiotherapy with or without chemotherapy: Demonstration of increased frequency, severity, resistance to palliation, and impact on quality of life. Cancer, 113, 2704-2713. doi:10.1002/cncr.23898
Fahey, K. F., Rao, S. M., Douglas, M. K., Thomas, M. L., Elliott, J. E., & Miaskowski, C. (2008). Nurse coaching to explore and modify patient attitudinal barriers interfering with effective cancer pain management. Oncology Nursing Forum, 35, 233-240. doi:10.1188/08.ONF.233-240
Ferreira, K. A., Kimura, M., Teixeira, M. J., Mendoza, T. R., da Nobrega, J. C., Graziani, S. R., & Takagaki, T. Y. (2008). Impact of cancer-related symptom synergisms on health-related quality of life and performance status. Journal of Pain and Symptom Management, 35, 604-616. doi:10.1016/j.jpainsymman.2007.07.010
Fortner, B. V., Demarco, G., Irving, G., Ashley, J., Keppler, G., Chavez, J., & Munk, J. (2003). Description and predictors of direct and indirect costs of pain reported by cancer patients. Journal of Pain and Symptom Management, 25, 9-18.
Given, B., Given, C. W., McCorkle, R., Kozachick, S., Cimprich, B., Rahbar, M. H., & Wojcik, C. (2002). Pain and fatigue management: Results of a nursing randomized clinical trial. Oncology Nursing Forum, 29, 949-955.
Given, C. W., Given, B., Azzouz, F., Stommel, M., & Kozachick, S. (2000). Comparison of changes in physical functioning of elderly patients with new diagnoses of cancer. Medical Care, 38, 482-493.
Harris, K., Chow, E., Zhang, L., Velikova, G., Bezjak, A., Wu, J., … EORTC Quality of Life Group. (2009). Patients' and healthcare professionals' evaluations of health-related quality-of-life issues in bone metastases. European Journal of Cancer, 45, 2510-2518. doi:10.1016/j.ejca.2009.05.024
Hill, C. S., Jr. (1993). The barriers to adequate pain management with opioid analgesics. Seminars in Oncology, 20(2, Suppl. 1), 1-5.
Holen, J. C., Lydersen, S., Klepstad, P., Loge, J. H., & Kassa, S. (2008). The Brief Pain Inventory: Pain's interference with functions is different in cancer pain compared with noncancer chronic pain. Clinical Journal of Pain, 24, 219-225. doi:10.1097/AJP.0b013e31815ec22a
Holzner, B., Kemmler, G., Cella, D., De Paoli, C., Meranger, V., Koop, M., … Sperner-Unterweger, B. (2004). Normative data for functional assessment of cancer therapy. Acta Oncologica, 43, 153-160. doi:10.1080/02841860310023453
Jahn, P., Kitzmantel, J. P., Renz, P., Kukk, E., Kuss, O., Thoke-Colberg, A., … Landenberger, M. (2010). Improvement of pain-related self-management for oncologic patients through a transinstitutional modular nursing intervention: Protocol of a cluster randomized multicenter trial. Trials, 11, 29. doi:10.1186/1745-6215-11-29
Kalauokalani, D., Franks, P., Oliver, J. W., Meyers, F. J., & Kravitz, R. L. (2007). Can patient coaching reduce racial/ethnic disparities in cancer pain control? Secondary analysis of a randomized controlled trial. Pain Medicine, 8, 17-24. doi:10.1111/j.1526-4637.2007.00170.x
Karnofsky, D. A., & Burchenal, J. H. (1949). The clinical evaluation of chemotherapeutic agents in cancer. In C. M. Macleod (Ed.), Evaluation of chemotherapeutic agents (pp. 191-205). New York, NY: Columbia University Press.
McGuire, D. B. (2004). Occurrence of cancer pain. Journal of the National Cancer Institute. Monographs, 32, 51-56. doi:10.1093/jncimonographs/lgh015
McHorney, C. A., Ware, J. E., & Raczek, A. E. (1993). The MOS 36-Item Short Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care, 31, 247-263.
Miaskowski, C., Dodd, M. J., West, C., Paul, S. M., Schumacher, K. L., Tripathy, D., & Koo, P. (2007). The use of a responder analysis to identify differences in patient outcomes following a self-care intervention to improve cancer pain management. Pain, 129, 55-63. doi:10.1016/j.pain.09.031
Miaskowski, C., Dodd, M. J., West, C., Schumacher, K. L., Paul, S. M., Tripathy, D., & Koo, P. (2004). Randomized clinical trial of the effectiveness of a self-care intervention to improve cancer pain management. Journal of Clinical Oncology, 22, 1713-1720. doi:10.1200/JCO.2004.06.140
Mols, F., Coebergh, J., & van de Poll-Franse, L. V. (2007). Health-related quality of life and healthcare utilisation among older long-term cancer survivors: A population-based study. European Journal of Cancer, 43, 2211-2221. doi:10.1016/j.ejca.2007.06.022
Niv, D., & Kreitler, S. (2001). Pain and quality of life. Pain Practice, 1, 150-161.
Oliver, J. W., Kravitz, R. L., Kaplan, S. H., & Meyers, F. J. (2001). Individualized patient education and coaching to improve pain control among cancer outpatients. Journal of Clinical Oncology, 19, 2206-2212.
Prochaska, J. O., & DiClemente, C. C. (1984). The transtheoretical approach: Crossing traditional boundaries of therapy. Homewood, IL: Dow Jones-Irwin.
Serlin, R. C., Mendoza, T. R., Nakamura, Y., & Cleeland, C. S. (1995). When is cancer pain mild, moderate, or severe? Grading pain severity by its interference with function. Pain, 61, 277-284.
Sherman, A. C., Simonton, S., Latif, U., Plante, T. G., & Anaissie, E. J. (2009). Changes in quality-of-life and psychosocial adjustment among multiple myeloma patients treated with high-dose melphalan and autologous stem cell transplantation. Biology of Blood and Marrow Transplantation, 15, 12-20. doi:10.1016/j.bbmt.2008.09.023
Sun, V. C. Y., Borneman, T., Ferrell, B., Piper, B., Koczywas, K., & Choi, K. (2007). Overcoming barriers to cancer pain management: An institutional change model. Journal of Pain and Symptom Management, 34, 359-369. doi:10.1016/j.jpainsymman.2006.12.011
Syrjala, K., Abrams, J. R., Du Pen, A. R., Niles, R., & Rupert, J. (1995). Relieving cancer pain [Videotape]. Seattle, WA: Synaptic Medical Productions.
Syrjala, K., Abrams, J. R., Polissar, N., Hansberry, J., Robinson, J., DuPen, S., … Du Pen, A. R. (2008). Patient training in cancer pain management using integrated print and video materials: A multisite randomized controlled trial. Pain, 135, 175-186. doi:10.1016/j.pain.2007.10.026
Thomas, M. L., Annis, D., & Hwang, S. (2004, April). Examining the effectiveness of opiate use in cancer pain management: Variation across outpatient oncology clinic settings. Paper presented at the Oncology Nursing Society 29th Annual Congress in Anaheim, CA.
Thong, M., Mols, F., Coebergh, J., Roukema, J., & van de Poll-Franse, L. V. (2009). The impact of disease progression on perceived health status and quality of life of long-term cancer survivors. Journal of Cancer Survivorship: Research and Practice, 3, 164-173.
Vallerand, A. H., Hasenau, S., Templin, T., & Collins-Bohler, D. (2005). Disparities between Black and White patients with cancer pain: The effect of perception of control over pain. Pain Medicine, 6, 242-250. doi:10.1111/j.1526-4637.2005.05038.x
Vallerand, A. H., Templin, T., Sasenau, S. M., & Riley-Doucet, C. (2007). Factors that affect functional status in patients with cancer-related pain. Pain, 132, 82-90. doi:10.1016/j.pain.2007.01.029
van den Beuken-van Everdingen, M. H., de Rijke, J. M., Kessels, A. G., Schouten, H. C., van Kleef, M., & Patijn, J. (2007). Prevalence of pain in patients with cancer: A systematic review of the past 40 years. Annals of Oncology, 18, 1437-1449. doi:10.1093/annonc/mdm056
Ward, S., Donovan, H., Gunnarsdottir, S., Serlin, R. C., Shapiro, G. R., & Hughes, S. (2008). A randomized trial of a representational intervention to decrease cancer pain (RIDcancerPain). Health Psychology, 27, 59-67. doi:10.1037/0278-6133.27.1.59
Ward, S., & Gatwood, J. (1994). Concerns about reporting pain and using analgesics: A comparison of persons with and without cancer. Cancer Nursing, 17, 200-206.
Ward, S., Goldberg, N., Miller-McCauley, V., Mueller, C., Nolan, A., Pawlik-Plank, D., … Weissman, D. E. (1993). Patient-related barriers to management of cancer pain. Pain, 52, 319-324.
Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473-483.
Wensing, M., Vingerhoets, E., & Grol, R. (2001). Functional status, health problems, age, and comorbidity in primary care patients. Quality of Life Research, 10, 141-148.
Wittmann, M., Vollmer, T., Schweiger, C., & Hiddemann, W. (2006). The relation between the experience of time and psychological distress in patients with hematological malignancies. Palliative and Supportive Care, 4, 357-363. doi:10.1017/S1478951506060469
Yates, P., Edward, H., Nash, R., Aranda, S., Purdie, D., Najman, J., … Walsh, A. (2004). A randomized controlled trial of a nurse-administered educational intervention for improving cancer pain management in ambulatory settings. Patient Education and Counseling, 53, 227-237. doi:10.1016/S0738-3991(03)00165-4
Zimmerman, C., Burman, D., Swami, N., Krzyzanowska, M. K., Leighl, N., Moore, M., … Tannock, I. (2010). Determinants of quality of life in patients with advanced cancer. Supportive Care in Cancer, 19, 621-629. doi:10.1007/s00520-010-0866-1