This application, in response to RFA CA-91-25, proposes to educate physicians, nurses, patients and families in the assessment and treatment of cancer pain. Longstanding barriers to adequate cancer pain control persist in part because we lack time- and cost-effective methods for training health care providers and patients to properly use available methodologies. This proposal will determine whether a multimodal education format can be developed that requires little staff time, has low patient burden and can be easily reproduced without repetitive effort from Health Care Providers.
Our aims are to: 1) develop a training method that can be used in physicians' offices and be readily understood and retained by physicians, nurses and patients; 2) test the effect of this training in a controlled clinical trial.
The specific aims of the clinical trial are to determine whether the training: a) improves pain management by preparing physicians and nurses to assess and respond to patients' pain problems, and by providing consultation resources for assistance with uncontrolled pain problems; b) improves cancer pain control by giving patients and families video training, brief interaction, and written materials. In the clinical trial, 42 oncologists, together with their nurses, will be randomly assigned by institution to receive either preparation or no preparation. Those oncologists and nurses in the preparation group will meet with the research nurse and anesthesiologist to view materials provided to patients, review pain assessment, and discuss treatment options and community resources for assistance with unrelieved pain problems. Cancer pain patients at these institutions will then be randomly assigned to one of two groups: 1) 126 will receive training; 2) 126 will receive no training (control). Trained patients will watch the videotape, and participate in a brief discussion and role play with a nurse. They will be given written materials, with a copy of the videotape, to take home as references for themselves and their families. The control group will receive video and written information on psychosocial resources in the community. This will control for the effect of attention given to the treatment group. We hypothesize: 1) that physicians and nurses who are prepared will be more consistent in assessment of pain and side effects, more likely to change treatment when pain relief is inadequate and more likely to seek resources when problems develop; 2) that patients who receive training in pain management will be more interactive with their physicians and nurses regarding their pain needs and will be more effective in using medications to manage symptoms. Consequently, their pain will be better controlled over time, even as their disease progresses. Medical records will be abstracted to record changes in treatment and to identify patient-physician interactions intended to improve pain management. Patients will complete assessments prior to intervention (baseline), by phone contact 72 hours after intervention, and one, three and six months after intervention.
| Syrjala, Karen L; Abrams, Janet R; Polissar, Nayak L et al. (2008) Patient training in cancer pain management using integrated print and video materials: a multisite randomized controlled trial. Pain 135:175-86 |
| Syrjala, K L; Donaldson, G W; Davis, M W et al. (1995) Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatment: a controlled clinical trial. Pain 63:189-98 |
