In previous work, the investigators have demonstrated that cognitive behavioral skills training reduces oral mucositis pain in bone marrow transplant patients. In this proposal the investigators have strengthened their intervention in three ways: 1) They focus solely on pain management rather than on multiple symptoms; 2) They have refined the delivery of the techniques; 3) The investigators propose testing the inclusion of a family member to act as a coach. In past work, patients were trained to apply the cognitive techniques themselves. However, at the time of greatest pain, the mental effects of opioid medications, chemotherapy, total body irradiation, and anxiety interfere with patients' abilities independently to use the skills they have learned in a brief training period. Research and investigator observations suggest that a trained family member can serve effectively as a coach in many cases, providing intensive support when the health care professional cannot be present. The investigators predict the following: 1) Patients who receive training with a family coach will report lower mucositis pain than patients who receive training without a coach; 2) Both of these groups will report less pain than a nontreatment control group; 3) Families with greater levels of conflict or less cohesion will act as less effective coaches; and 4) Coaching will decrease family member emotional distress and perceived burden, in part because it will increase perceived efficacy. This research has applications to other cancer symptom treatment and to other forms of persistent pain.
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