Coaching to Improve Care of Cancer Pain
Condition: Pain
MeSH terms: Cancer Pain
Study type: Interventional

Summary: 
      An estimate of 90% of patients with cancer experience at least moderate pain at some point in
      their illness, and 42% of patients do not receive adequate palliation. The main objective of
      this research is to reduce barriers to pain control by creating more effective partnerships
      between patients and their health care providers. The aims of the study are: 1) to compare
      the effects on pain, cancer-related symptoms, and health-related quality of life of a
      standard cancer pain leaflet versus face-to-face, tailored education and coaching; 2) to
      estimate the effect of tailored education and coaching on patients' self confidence for
      managing their pain and participating actively in care; and 3) to examine the mechanisms
      underlying the beneficial effects of the intervention. The proposed model will enhance
      research on pain management in that it is a pilot-tested intervention that is applicable in
      the outpatient setting, based on Social Cognitive Theory, and focused on patient activation
      and education.
    

Detailed description: 
      Background: A small, randomized trial was conducted in 2001, that supplied preliminary
      evidence that a carefully structured, one-time individualized education and coaching
      intervention has the potential to provide important clinical benefits for patients suffering
      from cancer-related pain. The study did not explore the impact of the intervention in a
      larger, more diverse patient population; the duration of the intervention's benefits; or the
      pathway by which the benefits are achieved. This project will attempt to address these issues
      while building on the literature that exists in palliation and physician-patient
      communication.

      Objective/Hypothesis: The main objective of this research is to reduce barriers to pain
      control by creating more effective partnerships between patients and their health care
      providers.

      Specific Aims: The aims of this study are: 1) to compare the effects on pain, cancer-related
      symptoms, and health-related quality of life of a standard educational intervention versus
      face-to-face, tailored education and coaching; 2) to estimate the effect of tailored
      education and coaching on self-efficacy for pain self-management and for participation in
      care; and 3) to examine the mechanisms underlying the beneficial effects of the intervention.

      Study Design: The proposed study is a randomized, controlled trial comparing "education only"
      with tailored education and coaching for patient activation (TEC). Eligible patients
      scheduled to see their oncologist at any of the three participating health systems will be
      invited to participate in the study. Consenting patients will be randomly allocated to TEC or
      education only. The intervention will be applied during a brief session just before the
      scheduled oncology visit. Allocation will be concealed from physicians, interviewers, and
      data analysts. Patients assigned to the usual care group will review the content of a
      standard informational booklet on cancer pain. A health educator will review key learning
      points and be available to answer questions. Patients assigned to the TEC group will receive
      an intervention designed to improve self-efficacy for both pain self-management and
      participation in care. Data will be collected from patients in a private waiting alcove just
      prior to the index visit (personal interview); during the index visit (audio-taping); and
      then two, six, and 12 weeks after the visit (phone interview). In addition to assessing
      effectiveness of the intervention, the study is designed to measure potential mediators and
      intermediate outcomes (attitudes, beliefs, self-efficacy, patient participation, quality of
      care, and adherence) and to examine the mechanisms underlying the intervention's beneficial
      effects. The study will contribute to a test of Social Cognitive Theory by examining whether
      the benefit of the intervention is more powerfully attenuated by changes in attitudes and
      beliefs or by changes in self-efficacy.

      Cancer Relevance: Uncontrolled cancer pain remains prevalent. An estimated 90% of patients
      with cancer experience at least moderate pain at some point in their illness, and 42% of
      patients do not receive adequate palliation. Aside from impairing quality of life,
      uncontrolled pain can contribute to depression, increase the likelihood of suicide, and
      decrease patient acceptance of potentially beneficial therapy. The proposed project is
      valuable in that it will confirm the benefit of patient coaching, elucidate its mechanisms,
      and test Social Cognitive Theory. The proposed model will enlarge existing research on pain
      management in that it is: a (1) pilot tested, easily implementable intervention that is (2)
      applicable in the outpatient setting, (3) based on strong theory that makes predictions about
      mechanisms of benefit, and (4) focused on patient activation as well as education.
    

Intervention name(s): Tailored Education and Coaching
Intervention type(s): Behavioral
Intervention description(s): A: Patients receive one-on-one counseling and education about pain management and improving doctor-patient communication B: Patients receive booklet on cancer pain control
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Other
Keywords: Palliative Care