Education Development Center, Inc. (EDC), the Massachusetts General Hospital (MGH), The Fallon Healthcare System, and The New England Biomedical Research Foundation (NEBRF) propose a study of 1,360 cancer patients and 160 physicians and nurses from 8 clinics, randomized into four treatment and four control sites. The study seeks to determine the effect of a two-tiered (organizational and individual) dissemination strategy on healthcare providers' adoption of the Agency for Health Care Policy and Research's recently published cancer pain guideline. The dissemination strategy we propose has two interrelated facets: an organizational component that will encourage caregivers to adopt new organizational procedures and an individual behavior change component, in the tradition of academic detailing [2-4] and other face-to-face dissemination strategies [5-10]. The study will target physicians, nurses, and pharmacists within the primary care clinics of The Fallon Healthcare System, vertically integrated managed care system serving a community-based population of over 165,000 patients in Central Massachusetts. Control clinics will receive Fallon's standard strategy for disseminating new practice guidelines, which involves the circulation of printed summaries and a brief one-time overview. Treatment clinics will receive an enhanced intervention aimed at moving beyond simple knowledge of the guidelines to changes in office routine and clinical practice that will in turn lead to changes in patient outcomes. Primary study hypotheses are that compared to control group patients, treatment group patients will: (1) report lower ratings of pain intensity; (2) report an enhanced quality of life, as measured by the extent to which pain interferes with sleep, work, and other aspects of daily living; (3) receive more appropriate analgesic regimens; (4) be less likely to be readmitted to the hospital for pain control; (5) be more likely to be referred to hospice and referred there earlier. Secondly hypotheses are that: (1) Compared to control group patients and families, treatment group patients and families will report greater satisfaction with how the cancer patient's pain was managed; (2) Physicians and nurses in the treatment clinics will demonstrate greater knowledge, better attitudes, and report more appropriate practices than their control group counterparts; (3) physicians will make fewer errors in the choice of drug types, doses, and scheduling of analgesic prescriptions. The most stringent test of the effectiveness of dissemination strategies is their impact on patient outcome [70]. Yet, there are very few studies that have attempted to measure the effect of dissemination strategies aimed at promoting practice guidelines' adoption on patient outcomes. Thus, one important result of this study is that it will provide a rigorous test of a behavior change intervention's impact on patients as well as providers.
