Patient training in cancer pain management using integrated print and video materials: a multisite randomized controlled trial

Abstract

Standard guidelines for cancer pain treatment routinely recommend training patients to reduce barriers to pain relief, use medications appropriately, and communicate their pain-related needs. Methods are needed to reduce professional time required while achieving sustained intervention effectiveness. In a multisite, randomized controlled trial, this study tested a pain training method versus a nutrition control. At six oncology clinics, physicians (N=22) and nurses (N=23) enrolled patients (N=93) who were over 18 years of age, with cancer diagnoses, pain, and a life expectancy of at least 6 months. Pain training and control interventions were matched for materials and method. Patients watched a video followed by about 20 min of manual-standardized training with an oncology nurse focused on reviewing the printed material and adapted to individual concerns of patients. A follow-up phone call after 72 h addressed individualized treatment content and pain communication. Assessments at baseline, one, three, and 6 months included barriers, the Brief Pain Inventory, opioid use, and physician and nurse ratings of their patients' pain. Trained versus control patients reported reduced barriers to pain relief (P<.001), lower usual pain (P=.03), and greater opioid use (P<.001). No pain training patients reported severe pain (>6 on a 0-10 scale) at 1-month outcomes (P=.03). Physician and nurse ratings were closer to patients' ratings of pain for trained versus nutrition groups (P=.04 and <.001, respectively). Training efficacy was not modified by patient characteristics. Using video and print materials, with brief individualized training, effectively improved pain management over time for cancer patients of varying diagnostic and demographic groups.

Figure 1

Flow diagram of patient progress through the study.

Figure 2

Mean barriers to pain relief scores, with standard errors, by intervention group over time from baseline, pre-randomization, to six-month outcome evaluation.

Figure 3

Mean usual pain rating, with standard errors, by intervention group over time from baseline, pre-randomization, to six-month outcome evaluation.

Figure 4

Mean difference between patient rating of pain vs. (4a) physician rating of the patient’s pain, and (4b) nurse rating of the patient’s pain, by intervention group over time with standard errors. Possible score range is -10 to 10.

Figure 5

Mean daily opioid use, in morphine equivalent doses with log transformation and standard errors, by intervention group over time from baseline to six-month outcomes.