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Objective-To determine the efficacy in overcoming attitudinal barriers to reporting cancer pain and using analgesics of an educational intervention presented to patients accompanied by a significant other (SO) compared to patients alone.Design-Patient-SO pairs (N=161) were randomized to the Dyad condition (patient and SO received the intervention), Solo condition (patient received the intervention), or care-as-usual. Dyad and Solo conditions received the intervention at baseline, and two-and four-weeks later. Main Outcome Measures-Patientsand SOs attitudes about analgesic use and patients' pain outcomes (pain severity, pain relief, interference with life, negative mood, and global quality of life [QOL]) at baseline (T1), five weeks later (T2), and nine weeks later (T3).Results-Completers' analyses revealed no significant differences between groups at T2. At T3, patients in the Dyad and the Solo groups showed greater decreases in attitudinal barriers compared to controls. T1-T3 changes in patients' barriers mediated between the Dyad and Solo interventions and pain severity, pain relief, pain interference, negative mood, and global QOL. Conclusion-The intervention was no more efficacious when it was presented to dyads than to patients alone. Conditions under which to include SOs in interventions need to be determined. Keywords cancer pain; representational intervention; patient education; dyadsMany persons with cancer are reticent to report pain and to use potent analgesics to control their pain because of their attitudinal barriers, including excessive fear of addiction and fatalism about achieving pain control (Thomason, McCune, Bernard, Winer, Tremont, & Lindley, 1998;Ward, Goldberg, Miller-McCauley, Mueller, Nolan, Pawlik-Plank, et al., 1993). Attempts to overcome these attitudinal barriers have yielded mixed results, with patient education interventions found to be effective for some but not all outcomes such as pain severity and quality of life (de Wit, van Dam, Zandbelt, van Buuren, van der Hejden, et al., 1997;Kim, Dodd, West, Paul, Facione, Schumacher et al., 2004;Oliver, Kravitz, Kaplan, & Meyers, Ward, Donovan, Gunnarsdottir, Serlin, Shapiro, & Hughes, 2008). Many of these interventions have lacked strong guidance from theory and it is therefore challenging to determine precisely why effects are inconsistent. The purpose of the present study was to test the efficacy of an intervention that has evolved from a theoretical perspective on patient education termed the Representational Approach to patient education (Donovan & Ward, 2001;Donovan, Ward, Song, Heidrich, Gunnarsdottir, & Phillips, 2007).The Representational Approach is based on two complementary theories, one that addresses the structure of knowledge and another that addresses the processes through which knowledge changes. Leventhal's Common Sense Model (Leventhal, & Diefenbach, 1991) focuses on the structure of health-related knowledge, i.e., on person's cognitive representations of health problems and the influence of those representati...

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The C-SCAT demonstrated feasibility and acceptability. With refinement based on study results, the C-SCAT has potential to: (a) empower AYAs to communicate their symptom experience and partner with providers in their care; (b) improve symptom management and ameliorate distress; and (c) translate to use with other highly symptomatic populations.

Greater clarity and consistency are needed in the use of the terms race, ethnicity, and minority. Groups were treated as if they were homogeneous, and details were lacking about whether subgroups of different races or ethnicities had been studied. Although reported disparities in pain management were small, they were consistent. Further research is needed to examine differences within groups and to explain possible reasons for disparities across groups.