A randomized trial of a tailored barriers intervention for Cancer Information Service (CIS) callers in pain

Abstract

Cancer pain management can be improved by overcoming patients' attitudinal barriers to reporting pain and using analgesics. A simple cost-effective barriers intervention designed to reach a large number of persons with cancer has not yet been tested. Such an intervention should be tested against barriers' assessment-alone, as well as no-treatment control. The purpose of this study was to test the efficacy and the cost-effectiveness of a Tailored Barriers Intervention (TBI), an educational intervention tailored to participants' attitudinal barriers toward reporting pain and using analgesics. This was a randomized three-group (TBI, assessment-alone, or control) trial with measures at baseline and 28 days later conducted at the NorthCentral and Heartland offices of the Cancer Information Service (CIS), an NCI program that provides information to persons seeking answers to cancer-related questions. Participants (1256 adult CIS callers diagnosed with cancer with moderate to severe pain in the past week) joined the study and were randomized. Of those participants, 970 (77.23%) provided follow up data. The TBI consisted of educational messages tailored to each participant's attitudinal barriers, delivered orally over the telephone, followed by a printed mailed copy. The outcome measures were attitudinal barriers to pain management, as well as pain outcomes (duration, severity, and interference with life activities). At follow-up the TBI group had significantly lower attitudinal barriers scores compared to assessment-alone and control, but the groups did not differ on the pain outcome variables. TBI and assessment alone had similar cost effectiveness. The TBI needs to be strengthened to achieve reductions in pain severity.

Educational interventions for cancer pain. A systematic review of systematic reviews with nested narrative review of randomized controlled trials

“…Differences in patient pain outcomes between the groups did not reach statistical significance. Patients in the intervention group were more likely to have a reduction in usual pain levels than control Ward [65] RID pain intervention targeting individual patients or dyad of patient plus carer/significant other Usual care x x No improvement in pain outcomes in intervention group compared to control, and including carers did not affect outcomes Wells [66] 15 min video for patients and carers, <30 min individualized pain and analgesic assessment, access to a pain hot line, weekly follow up telephone calls from nurse specialist who did not change analgesics but could suggest patient contact oncologist…”

Experience of Barriers to Pain Management in Patients Receiving Outpatient Palliative Care

“…Several studies using the patient education approach to pain management showed reduced patient-related barriers and improved pain symptoms; [12][13][14][15] however, a tailored barriers intervention resulted in significantly lowered attitudinal barriers scores but did not improve pain outcomes. 16 Cancer pain is a complicated symptom that is frequently reported with other symptoms such as fatigue, depression, and anxiety. Coexisting depression might be one obstacle to pain management in cancer patients.…”

Effectiveness of a Clinical Intervention to Eliminate Barriers to Pain and Fatigue Management in Oncology

“…40,41 Model programs have emphasized patient teaching interventions including the use of pain assessment tools, strategies to dispel misconceptions, and patient coaching regarding the reporting and documenting of their symptoms. 42,43 The ''Passport to Comfort'' intervention was designed and implemented in response to the overwhelming evidence of the impact of these barriers on symptom management, and the intent to move beyond descriptive studies to test innovative models that would eliminate these barriers in palliative care settings.…”