van der Peet, E.H., van den Beuken-van Everdingen, M.H., Patijn, J., Schouten, H.C., van Kleef, M., & Courtens, A.M. (2009). Randomized clinical trial of an intensive nursing-based pain education program for cancer outpatients suffering from pain. Supportive Care in Cancer, 17, 1089–1099.doi: 10.1007/s00520-008-0564-4
To investigate the effect of intensive home-based nurse-provided education on pain levels, pain knowledge, quality of life, anxiety, and depression in patients with cancer
Patients with cancer were randomized to receive either a pain education intervention or usual care. Pain, knowledge, quality of life, anxiety, and depression were measured at baseline and after four and eight weeks. In the intervention group, effects on symptom levels were communicated to the treating physician. The program included a brochure about pain management, instructions about how to record pain intensity in a diary, and simulation of help-seeking behavior. In the intervention group, palliative care nurses made three home visits. After these visits, nurses communicated with the physician, by means of a written report of pain control and recommendations regarding dose or medication changes. Home visits were at weeks 1, 3, and 6. Follow-up telephone calls to members of the intervention group occurred at weeks 4 and 8.
Randomized controlled trial
At four weeks, the level of pain had decreased in the intervention group (p = 0.02) but not at eight weeks. Significant decreases in pain only persisted in those patients with a high pain score (7–10) at baseline (p = 0.00). Knowledge of pain was significantly increased in the intervention group at week 8 (p < 0.00). Authors found no correlation between increased pain knowledge and decreased pain levels. In 60% of cases, recommendations in nurses' reports were ignored.
In the short term, the nurse-administered pain-related education program lowered pain intensity in patients with cancer and increased patients' knowledge about pain.
In regard to pain and pain management, additional attention must be paid to patient education and to communication between patients and healthcare professionals. The following components should be characteristic of patient education programs: involvement of the patient and family or caregivers, communication with the patient to reinforce information and monitor the plan, integration of medical care into the nursing education program, clear instructions regarding provider notification, and use of a pain diary. The components have the potential to reduce pain. Study findings showed that communications to physicians, written by palliative care nurses, were ignored 60% of the time, suggesting that this form of communication is ineffective. Educating the patient and helping patients to self-advocate in interactions with physicians are important goals.