Herr, K., Titler, M., Fine, P.G., Sanders, S., Cavanaugh, J.E., Swegle, J., . . . Forcucci, C. (2012). The effect of a translating research into practice (TRIP)-cancer intervention on cancer pain management in older adults in hospice. Pain Medicine, 13, 1004–1017.

To promote the adoption of evidence-based pain practices for older adults with cancer

• Five-month engagement phase—receipt of three relevant clinical practice guidelines for experimental (E) and control (C) groups, pain training and activities for E hospices
• 12-month implementation phase—E group received tools for implementation (e.g., quick reference guides), nurses completed an evidence-based practice (EBP) pain program, sites received a monthly outreach visit from an expert nurse who audited charts for 48 EBP indicators and provided feedback, participation in a monthly teleconference to discuss progress and strategies, sharing on e-sites, weekly pain assessment and management sessions as desired

• N = 16 hospices and 738 patients
• AGE: Hospices see 30 older patients per year; patients were older adults with a mean age of 77.6 years
• MALES: 55.9%, FEMALES: 44.1%
• KEY DISEASE CHARACTERISTICS: End-stage cancer
• OTHER KEY SAMPLE CHARACTERISTICS: 66.3% white

• SITE: Multi-site 
• SETTING TYPE: Home 
• LOCATION: Midwest hospices

• PHASE OF CARE: End-of-life care
• APPLICATIONS: Elder care

• Retrospective, cluster, randomized control trial of 16 hospices
  • Eight in the E group and eight in the C group

• Cancer Pain Practice Index (CPPI), which lists 11 EBP cancer pain practices for older adults
• Mean pain severity
• Medical record abstract tool inclusive of 48 indicators of EBP for pain management
• Numeric Rating Scale 
• Pain severity scale (0–10)
• Verbal Descriptor Scale for pain intensity (mild, moderate, severe)

No significant differences existed between the E and C groups in regards to improvement in the CPPI. A decrease in pain severity was found from baseline to post-intervention in the E group, but this was not statistically significant.

Numerous factors influence a multicomponent intervention. Culture, competing priorities, intervention complexity, and other factors may have a role. Future studies should focus on more specific factors in need of change. Although the patient sample was large, only eight hospices comprised each group for the study.

• Small sample (less than 30)
• Intervention expensive, impractical, or training needs
• Other limitations/explanation: The sensitivity of the CPPI to detect change in provider practice was not established a priori.

Translating research into practice is a primary goal of nursing, and pain guideline translation is essential to improving pain outcomes. Translation, however, takes time and may not translate immediately to improved patient outcomes.