This study is an extension of our current research and focuses on promoting adoption of evidence-based practices (EBPs) to improve the quality of pain management for elder persons with cancer. The study addresses barriers to consistent adoption of pain management clinical practice guidelines for assessing and treating cancer pain in elders. These elders suffer needlessly from pain related to their cancer, its treatment, and related co morbid conditions. Despite existence of evidence-based guidelines to improve assessment and management of pain in this vulnerable population, adoption and use of recommendations based on best scientific evidence lags and is sporadic at best. Even in the hospice setting where pain control is a priority, there is considerable variation and patients still die in unresolved pain. A secondary barrier underlying effective pain management in this population is patient and family caregiver non-adherence to the pain treatment plan. Effective implementation of current Clinical Practice Guidelines (CPGs) that include evidence-based strategies for addressing this barrier may further contribute to improved quality of pain management for elders at the end of life. Translating Research into Practice (TRIP) is an active process of promoting use of evidence by healthcare providers that may improve pain management practices for elders with cancer pain. The proposed randomized control trial builds on our successful TRIP-Acute Pain intervention that demonstrated improved quality of acute pain management for hospitalized elders with hip fractures and savings of healthcare dollars. This study will evaluate the effect of an interdisciplinary multifaceted TRIP intervention focused on increasing EBPs for assessing and managing pain in elder hospice patients with cancer pain. The study aims are as follows: 1) Test the effect of a multifaceted TRIP-Cancer Pain intervention on pain severity, pain interference, pain relief and quality of life in elder hospice patients with cancer pain;2) Test the effect of a multifaceted TRIP-Cancer Pain intervention on promoting adoption, by health care providers, of cancer pain management EBPs for elder hospice patients with cancer pain;3) Determine the effectiveness of a multifaceted TRIP-Cancer Pain intervention on patient adherence to the pain treatment plan;and 4) Evaluate the persistence of change in process and outcome variables at long-term follow-up (6 months post intervention).

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA115363-05
Application #
7655485
Study Section
Special Emphasis Panel (ZCA1-SRRB-3 (M1))
Program Officer
O'Mara, Ann M
Project Start
2005-09-09
Project End
2011-06-30
Budget Start
2009-07-01
Budget End
2010-06-30
Support Year
5
Fiscal Year
2009
Total Cost
$435,026
Indirect Cost
Name
University of Iowa
Department
Type
Schools of Nursing
DUNS #
062761671
City
Iowa City
State
IA
Country
United States
Zip Code
52242
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Herr, Keela; Titler, Marita; Fine, Perry G et al. (2012) The effect of a translating research into practice (TRIP)--cancer intervention on cancer pain management in older adults in hospice. Pain Med 13:1004-17
Black, Brianne; Herr, Keela; Fine, Perry et al. (2011) The relationships among pain, nonpain symptoms, and quality of life measures in older adults with cancer receiving hospice care. Pain Med 12:880-9
Reid, M Cary; Bennett, David A; Chen, Wen G et al. (2011) Improving the pharmacologic management of pain in older adults: identifying the research gaps and methods to address them. Pain Med 12:1336-57
Herr, Keela; Titler, Marita; Fine, Perry et al. (2010) Assessing and treating pain in hospices: current state of evidence-based practices. J Pain Symptom Manage 39:803-19
Fine, Perry; Herr, Keela; Titler, Marita et al. (2010) The cancer pain practice index: a measure of evidence-based practice adherence for cancer pain management in older adults in hospice care. J Pain Symptom Manage 39:791-802
Sanders, Sara; Mackin, Melissa Lehan; Reyes, Jimmy et al. (2010) Implementing evidence-based practices: considerations for the hospice setting. Am J Hosp Palliat Care 27:369-76
Mackin, Melissa Lehan; Herr, Keela; Bergen-Jackson, Kimberly et al. (2009) Research participation by older adults at end of life: barriers and solutions. Res Gerontol Nurs 2:162-71
Bergen-Jackson, Kimberly; Sanders, Sara; Herr, Keela et al. (2009) Determining Community Provider Practices in Hospices: The Challenges of Documentation. J Hosp Palliat Nurs 11:334-341