Reducing Patient Barriers to Pain and Fatigue Management

Abstract

Pain and fatigue are recognized as critical symptoms that impact quality of life (QOL) for cancer patients. The barriers to pain and fatigue relief have been classified into three categories: patient, professional and system barriers. The overall objective of this trial is to test the effects of the "Passport to Comfort" intervention on reducing barriers to pain and fatigue management for ambulatory care cancer patients. This intervention demonstrates innovation by translating the evidence-based guidelines for pain and fatigue as developed by the National Comprehensive Cancer Network (NCCN) into practice. This quasi-experimental, comparative study utilizes a Phase 1 control group of usual care followed sequentially by a Phase 2 intervention group in which educational and systems change efforts were directed toward improved pain and fatigue management. This paper reports on the patient barriers and the patient education intervention to overcome these barriers. A sample of 187 cancer patients with breast, lung, colon, or prostate cancers, and pain and/or fatigue of ≥ 4 (moderate to severe), were recruited. Patients in the intervention group received four educational sessions on pain/fatigue assessment and management, whereas patients in the control group received usual care. Pain and fatigue barriers and patient knowledge were measured at baseline, one month, and three months post-accrual. Patients in the intervention group experienced significant improvements in pain and fatigue measures immediately post-intervention, and these improvements were sustained over time. The "Passport to Comfort" intervention was effective in reducing patient barriers to pain and fatigue management, as well as increasing patient knowledge regarding pain and fatigue.

Improvements in Health-Related Quality of Life by Comprehensive Cancer Pain Therapy: A Pilot Study with Breast Cancer Outpatients under Palliative Chemotherapy

“…Especially ‘Role Functioning' and ‘Emotional Functioning' received low scores. ‘Fatigue' was a major problem among other symptoms, which was also found by other studies [26,27]. …”

Psychosocial Issues in Cancer Pain

“…Several more recent studies provide additional evidence regarding the efficacy of educational interventions for reducing patient barriers to pain management [35,36] and pain intensity [37], although these interventions did not lead to improvements in other outcomes, including communication with health care providers, satisfaction with care, psychological distress, or QOL. One particularly welldesigned study did obtain significant findings across multiple domains.…”

Holistic Total Pain Management in Palliative Care: Cultural and Global Considerations

“…Discussions should also ensue about belief systems regarding pain and fears of addiction which can assist to bridge the gap between suffering and comfort. Two systematic reviews (21 trials) and meta-analyses (15 trials included in one meta-analysis, 26 in another) found that education for patients, caregivers, and healthcare professionals can decrease pain intensity, [30][31][32] and the greater the dose of the educational intervention, the better the pain outcomes. 31 In regards to patient education, repeated faceto-face interactions seem to be the most effective compared to written information.…”