Adam, R., Bond, C., & Murchie, P. (2015). Educational interventions for cancer pain. A systematic review of systematic reviews with nested narrative review of randomized controlled trials. Patient Education and Counseling, 98, 269–282. 

STUDY PURPOSE: To review the evidence for educational interventions in cancer-related pain management

TYPE OF STUDY: Systematic review

DATABASES USED: MEDLINE, EMBASE, CINAHL, and Cochrane collaboration

KEYWORDS: Cancer, education, and pain

INCLUSION CRITERIA: Systematic reviews that evaluated educational interventions for cancer pain management; participants were adult patients, caregivers, or health professionals

EXCLUSION CRITERIA: Studies including trials of cognitive behavioral therapy, mindfulness, relaxation, hypnosis, or acupuncture

TOTAL REFERENCES RETRIEVED: 2,066

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist for quality assessment

• FINAL NUMBER STUDIES INCLUDED = 8
• TOTAL PATIENTS INCLUDED IN REVIEW = 18,544 (147 total studies)
• KEY SAMPLE CHARACTERISTICS: Not provided

APPLICATIONS: Palliative care

In the eight systematic reviews included, two reported that educational interventions had a positive impact on pain intensity. The rest did not report any effects on pain outcomes but concluded improved knowledge and adherence to pain medications. A detailed review of randomized, controlled trials included in the systematic reviews reported improved pain intensity outcomes in 12 studies and no significant difference from controls in 18 studies. Educational interventions had at least one of the following components: education on the physiology of cancer-related pain, advice on how to report and communicate pain, enhancements of provider assessments of pain, improved analgesic prescribing, approaches to barriers to nonadherence, nonpharmacologic strategies, or the promotion of pain reassessment.

Educational interventions for healthcare providers improved knowledge and attitudes, but their effects on patient pain outcomes were not demonstrated. Education for patients has shown inconsistent effects on pain outcomes. The key characteristics of effective educational interventions were not clear. Educational interventions for patients improved their knowledge and self-reported pain outcomes.

• The studies included had very different scope and approaches.
• The interventions were heterogeneous in approach, content, timing, and duration.

Evidence regarding the effectiveness of educational and psychoeducational interventions to reduce cancer-related pain outcomes showed mixed results. However, in some studies, education had a positive effect on pain intensity. These interventions improved knowledge. Educational interventions are low-risk and can empower patients to self-manage pain. Evidence in this review suggested that ongoing patient contact and reinforcement is needed to maintain any gains from educational interventions. The most effective components and method of education delivery are not clear. This area could benefit from additional research.