Many persons with cancer have beliefs about reporting pain and using analgesics (e.g., concern about side effects and fear of addiction) that interfere with their ability to cope with pain. These beliefs are termed patient-related barriers to pain management. Individuals who endorse these barriers tend to under-utilize analgesics; those not endorsing these barriers tend to use adequate analgesics. We tested the impact of a standardized educational intervention (SEI) comprised of: (a) sensory and coping information for analgesic side effect management, and (b) information intended to change beliefs about opioids. Preliminary analyses reveal statistically significant but small differences in analgesic use in the intervention and the care-as-usual control group; those receiving the intervention were more likely to use adequate analgesics. The intervention, however, had no impact on the hypothesized mediator (change in beliefs). To improve the effect size for analgesic use, and to have an impact on beliefs and overall quality of life (QOL) we plan to test an individualized intervention based on patients' representations of cancer pain. A representation is a set of beliefs about the cause, temporal course, consequences, cure/control, and identity of a health problem. By addressing patients representations of cancer pain, we may be able to change beliefs that act as barriers to adequate analgesic use, thereby improving QOL. Patients with metastatic or progressive breast, prostate, or lung cancer of multiple myeloma will be randomized to: (a) the SEI that we tested in the previous study; (b) SEI plus an individualized representational intervention (SEI-REP); or, (c) care-as-usual control. QOL outcomes are perceived health and well-being. Proposed mediators are beliefs (barriers) and coping (analgesic use). Valid and reliable measures of study variables will be obtained at baseline and one and two months later.
Specific aims are to: (1) evaluate the efficacy of the representational intervention among adults with cancer pain. We predict that those receiving SEI-REP will have better QOL outcomes compared to those receiving SEI alone who will in turn have better outcomes than the control group. (2) Examine mechanisms -- test for mediation effects. We predict that the representational intervention will have an impact on beliefs which in turn affect coping (appropriate use of analgesics) and that coping will affect QOL outcomes. Subjects will be recruited from three medical oncology clinics in Wisconsin, one of which serves substantial numbers of minority patients. Power analyses revealed that 194 subjects are needed for hypothesis testing; 232 will be recruited so that after dropout, 194 are on study.
| Krause, Melanie R; Serlin, Ronald C; Ward, Sandra E et al. (2010) Testing mediation in nursing research: beyond Baron and Kenny. Nurs Res 59:288-94 |
| Donovan, Heidi S; Kwekkeboom, Kristine L; Rosenzweig, Margaret Q et al. (2009) Nonspecific effects in psychoeducational intervention research. West J Nurs Res 31:983-98 |
| Ward, Sandra E; Serlin, Ronald C; Donovan, Heidi S et al. (2009) A randomized trial of a representational intervention for cancer pain: does targeting the dyad make a difference? Health Psychol 28:588-97 |
| Gunnarsdottir, Sigridur; Ward, Sandra; Serlin, Ronald C (2008) Attitudinal barriers to cancer pain management in the Icelandic population. Cancer Nurs 31:95-102 |
| Ward, Sandra; Donovan, Heidi; Gunnarsdottir, Sigridur et al. (2008) A randomized trial of a representational intervention to decrease cancer pain (RIDcancerPain). Health Psychol 27:59-67 |
| Donovan, Heidi Scharf; Ward, Sandra E; Song, Mi-Kyung et al. (2007) An update on the representational approach to patient education. J Nurs Scholarsh 39:259-65 |
| Ezenwa, Miriam O; Ameringer, Suzanne; Ward, Sandra E et al. (2006) Racial and ethnic disparities in pain management in the United States. J Nurs Scholarsh 38:225-33 |
| Ameringer, Suzanne; Serlin, Ronald C; Hughes, Susan H et al. (2006) Concerns about pain management among adolescents with cancer: developing the Adolescent Barriers Questionnaire. J Pediatr Oncol Nurs 23:220-32 |
| Gunnarsdottir, Sigridur; Serlin, Ronald C; Ward, Sandra (2005) Patient-related barriers to pain management: the Icelandic Barriers Questionnaire II. J Pain Symptom Manage 29:273-85 |
| Ward, Sandra; Donovan, Heidi Scharf; Serlin, Ronald C (2003) An alternative view on ""an alternative paradigm"". Res Nurs Health 26:256-9 |
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