We have developed a theoretically driven approach to patient education that is termed a representational approach. A representation is a set of beliefs about the cause, temporal course, consequences, cure/control, and symptoms of a health problem, such as cancer pain. In a representational approach to patient education, the nurse assesses the patient's representation of a health problem in order to then present highly individualized corrective information to replace misconceptions and in turn change relevant behaviors. We plan to test the effect of this approach on overcoming patient-related barriers to pain management in persons with cancer. Patient-related barriers are beliefs -- such as exaggerated fears of addiction -- that inhibit patients from making optimal use of analgesic medication. In our previous funding period we demonstrated that an earlier version of this intervention, RIDPAIN, decreased patient-related barriers but had little effect on pain outcomes. We have strengthened RIDPAIN, creating RIDPAINplus, by increasing the sessions from one to three to allow time for the creation and evaluation of patient-specific pain management plans. Based on theory and empirical data regarding significant others' involvement in pain management, we propose that a representational approach will be more powerful if it involves significant others rather than just patients alone.
The specific aims are: (1) to test hypotheses regarding the efficacy of RIDPAINplus when presented to individuals versus dyads compared to care-as-usual control, and (2) to test hypotheses regarding mediating mechanisms. Subjects will be 180 pairs of patients and significant others recruited from three outpatient oncology clinics. The pairs will be randomly assigned to: (a) Solo- RIDPAINplus (only the patient receives the intervention): (b) Dyad RIDPAINplus (both the patient and the significant other receive the intervention), or (c) care-as-usual. Both RIDPAINplus conditions will involve three contacts during which intervention information is presented --baseline, four weeks later and eight weeks later. Subjects complete measures at baseline, post-test (10 weeks after baseline), and follow-up (14 weeks after baseline). Outcomes are pain severity, mood and quality of life. Proposed mediators are analgesic use, patient and significant other barriers, and patient and significant other communication.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Nursing Research Study Section (NURS)
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Hare, Martha L
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University of Wisconsin Madison
Schools of Nursing
United States
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Krause, Melanie R; Serlin, Ronald C; Ward, Sandra E et al. (2010) Testing mediation in nursing research: beyond Baron and Kenny. Nurs Res 59:288-94
Donovan, Heidi S; Kwekkeboom, Kristine L; Rosenzweig, Margaret Q et al. (2009) Nonspecific effects in psychoeducational intervention research. West J Nurs Res 31:983-98
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Ward, Sandra; Donovan, Heidi; Gunnarsdottir, Sigridur et al. (2008) A randomized trial of a representational intervention to decrease cancer pain (RIDcancerPain). Health Psychol 27:59-67
Donovan, Heidi Scharf; Ward, Sandra E; Song, Mi-Kyung et al. (2007) An update on the representational approach to patient education. J Nurs Scholarsh 39:259-65
Ezenwa, Miriam O; Ameringer, Suzanne; Ward, Sandra E et al. (2006) Racial and ethnic disparities in pain management in the United States. J Nurs Scholarsh 38:225-33
Ameringer, Suzanne; Serlin, Ronald C; Hughes, Susan H et al. (2006) Concerns about pain management among adolescents with cancer: developing the Adolescent Barriers Questionnaire. J Pediatr Oncol Nurs 23:220-32
Gunnarsdottir, Sigridur; Serlin, Ronald C; Ward, Sandra (2005) Patient-related barriers to pain management: the Icelandic Barriers Questionnaire II. J Pain Symptom Manage 29:273-85
Ward, Sandra; Donovan, Heidi Scharf; Serlin, Ronald C (2003) An alternative view on ""an alternative paradigm"". Res Nurs Health 26:256-9

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