Improving cancer pain management in communities: Main results from a randomized controlled trial

Abstract

The purpose of this randomized controlled community trial is to evaluate the effects of a community intervention utilizing opinion leaders and educational strategies on the cancer pain management knowledge, attitudes, and the practices of physicians and nurses, and cancer pain reported by patients. Six Minnesota communities participated in the study. The three communities randomized to the intervention received educational programs over 15 months. The clinical community opinion leaders participated in a minifellowship, developed community task forces, and interacted with their peers. This strategy was reinforced with community outreach programs, clinical practice guidelines, educational materials, and media events. The primary study end point was patients' pain intensity score. Comparing intervention to control communities, pain prevalence declined slightly, pain management index improved slightly, pain intensity scores increased slightly, patient and family attitude scores did not change, and physicians' and nurses' knowledge and attitude scores improved slightly. None of these changes, however, reached statistical significance. Participation in at least one intervention program improved physicians' and nurses' knowledge and attitude scores that approached statistical significance. Our results suggest that community opinion leaders combined with other educational programs may improve cancer pain management, but this strategy requires further study. The results suggest that more intense intervention application may be effective. Effective strategies to improve cancer pain management remain elusive.

Identifying the Educationally Influential Physician: A Systematic Review of Approaches

“…25 This study queried respondents to rate themselves on a 1 to 5 scale (with 1 being low and 5 being high) for 6 items, including talking to colleagues, amount of information given during conversations, frequency of requests for information, relative likelihood of sharing with or receiving ideas from colleagues, and general use as a source of advice. A study by Elliott et al 11 indicated "self-selection" as one of two identification methods, although this method was described as identifying individuals who "expressed willingness to participate in the study. "…”

“…Grimshaw, 25 as indicated previously, combined the sociometric and self-designating approaches to study general practitioner and specialist opinion leaders in Scotland. Elliott et al 11 used both sociometric (adapted Hiss et al 4 ) and self-selection (willingness to participate) approaches in their study of cancer pain management. A third study combined sociometric and informant methods to study strategies for improving breast-feeding rates.…”

“…Other studies did not clearly specify the selection criteria used to identify an EIP. 11,15,23 Finally, 2 studies compared 3 different selection criteria: (1) physicians receiving nominations in all three of the EI Identification Instrument criteria, 4 (2) the most frequently identified 5%, and (3) those nominated 12 or more times. 3,26 These studies demonstrated that various criteria do not identify the same number of people.…”

“…Interventions have ranged from informal undirected interactions between EIPs and other physicians. [5][6][7][10][11][12][13][14][15] to EIP presentations at grand rounds and other lectures. 11,16−19 and audit with feedback.…”

Mechanism-based cancer-pain therapy

“…Classroom style teaching to healthcare professionals can improve knowledge of cancer pain management but there is good evidence that this has no significant impact on patient outcomes [1,6,18]. Encouraging a change in healthcare professional behavior (activity) is needed.…”