The purpose of this study is to disseminate a tested Pain Education Intervention (PEI) for elderly cancer patients and their caregivers in community home care agencies. The sample will consist of 480 elderly patients with chronic cancer pain and their primary caregivers (N-480) selected from six home care agencies randomly assigned to experimental or control conditions. The two phases of this four year study include Supervised Dissemination (Phase I, N-240) and Independent Dissemination (Phase II, N-240). In Phase I, the six agencies, matched by agency type, are randomly assigned to the experimental PEI or usual care control group. The Experimental group agencies will receive training provided to the participating nurses and Supervised Dissemination by involvement of the research staff. The nurses will implement the PEI with their patients during three home visits over a period of two weeks. The PEI includes components of pain assessment, pharmacologic intervention and non-drug strategies. Evaluation visits are conducted at pre intervention and l, 3 and 7 weeks post education. After 18 months of Phase I data collection, the data will be analyzed to determine the impact of the intervention.. The control group agencies will then be crossed over to receive the PEI training. In Phase II, all six agencies will use the PEI with patients in the form of Independent Dissemination with limited interaction from the investigators. Thins study is based on the conceptual model of Pain and Quality of Life and applies the theory of Diffusion of Innovation to extend pain management into home care of the elderly patient in pain and family caregivers. The study includes three hypotheses measuring dependent variable including Patient Outcomes (Pain Knowledge and Attitudes, Pain Experience, a Quality of Life) and Caregiver Outcomes (Caregiver Knowledge and Attitude Quality of Life and Caregiver Burden). The study also includes three exploratory questions related to nurse's knowledge and attitudes about pain, the costs of pain management at home and impact of community dissemination of pain information such as release of AHCPR guidelines. This study addresses the NCI Cancer Control program areas of applications research and community oncology.
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