The major goal of the current proposal is the development of a cancer pain interactive videodisc, an innovative educational format for teaching health care professionals about the complexities of the assessment and treatment of cancer pain and barriers (e.g., concerns about drug addiction) to the effective management of cancer pain. The advantages of the interactive videodisc technology include; 1) state-of-the-art information relevant to procedures for effective pain control, rehabilitation, and use of psychosocial knowledge and techniques can be succinctly presented that conform to the Guidelines for Cancer Pain Management which are being established by the Agency for Health Care Policy and Research (AHCPR); 2) once developed, in interactive videodisc is permanent product that can be utilized as an educational tool at all levels of medical education and as a research tool to study the impact of a structured educational format on health care professionals' factual knowledge, attitudes, and performance with regard to cancer pain management; 3) because the disc is easily disseminated, physicians in rural communities can have access to a high quality presentation of cancer pain management techniques; 4) because this is a computer-based technology, the interactive videodisc can easily be modified to reflect new development in the field; and 5) the use of interactive media technology is consistent with the unanimous passage by Congress of the High Performance Computing Act which establishes a national priority to build an information infrastructure linking personal computers to central computing nodes which can be used for research and education. Following the development of the cancer pain interactive videodisc, the remainder of the grant period will be devoted to dissemination and testing. The cancer pain videodisc will be disseminated to physicians at the Dartmouth-Hitchcock Medical Center, Outreach Clinic Hospitals (small community hospitals in New Hampshire and Vermont) affiliated with the Norris Cotton Cancer Center, and other physician group identified by the New Hampshire and Vermont Cancer Pain Initiatives and the New Hampshire American Cancer Society Physician Liaison System within the context of a randomized study. Physicians will be randomly assigned to be exposed to one of two educational formats: 1) Enhanced Dissemination Intervention, the cancer pain interactive videodisc plus two interventions designed to enhance the educational impact of the disc (a facilitator who assists in the development of office systems to aid in cancer pain assessment and management and a physician reminder system) or 2) Usual Dissemination Intervention, the written form of the AHCPR Guidelines for Cancer Pain Management. At pre- and post-intervention, physicians knowledge and attitudes (questionnaire) and behavior (chart review and patient exit questionnaire) will be assessed. We predict that physicians exposed to the interactive videodisc plus the interventions to enhance its educational impact will demonstrate greater pre- to post test change on measures of knowledge and attitudes and conform to the AHCPR Guidelines for Cancer Pain Management with a larger percentage of patients.
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