Pain at the end-of-life is a major concern of cancer patients and their spouses/caregivers. The focus in pain management efforts for cancer pain traditionally has been on the patient. Studies of the spouse and family members, however, have documented that the psychosocial impact of end-of-life care is profound, particularly when cancer pain is present. The ultimate goal of this research is to develop more effective ways to help patients and their spouses cope with cancer pain that occurs at the-end-of life. The proposed feasibility study seeks to evaluate the effectiveness of a new, spouse-guided pain management training protocol that provides spouses and patients with educational information about cancer pain and systematically trains spouses in methods for guiding the patient in the use of pain control techniques (e.g. relaxation training, imagery, and activity pacing strategies). The training will be introduced in three home-based treatment sessions supplemented by a videotape, audiotapes, and written materials. 120 cancer patients having cancer pain and their spouses will be randomly assigned to one of two conditions: spouse-guided pain management training intervention, or a usual care control condition. Assessment measures to be collected pre-, post-treatment, and at 4- and 12-weeks follow-up will measure pain, quality of life, knowledge about cancer pain, frequency of practice with pain management strategies, and spouses' ratings of mood, strain, and self-efficacy. If we find that spouse-guided pain management training is effective, future studies could evaluate this training in patients suffering from pain at the end-of-life due to other diseases (e.g. sickle cell disease or congestive heart failure with unstable angina.) Future studies also could identify the particular spouse-guided pain management training components (e.g. education, relaxation training, imagery training, or training in activity pacing methods) that contribute most to treatment effects. By isolating the active ingredients of this training, one can streamline it, making it more cost-effective and thus more readily available to the large population of patients having pain at end-of-life. The study proposed rigorously evaluates methods for enhancing the effects of spouse-guided pain management training in cancer patients and their spouses. This study may lead to major advances in our understanding of cancer pain that occurs at end-of-life and enlarge our repertoire of methods for effectively treating this pain.
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