Lovell, M.R., Forder, P.M., Stockler, M.R., Butow, P., Briganti, E.M., Chye, R., . . . Boyle, F.M. (2010). A randomized controlled trial of a standardized educational intervention for patients with cancer pain. Journal of Pain and Symptom Management, 40(1), 49–59.

To determine if an educational video and/or booklet for people with advanced cancer and pain can improve pain management and quality of life and decrease anxiety, pain, and pain interference

Patients were recruited from multiple oncology and palliative care clinics and were randomly allocated to one of four treatment groups. Patients in group 1 received standard care only. Those in group 2 received standard care plus a booklet. In group 3, patients received standard care plus a video. Group 4 patients received standard care plus a booklet and video. The video depicted patients, a caregiver, and health professionals talking about cancer pain and management. The booklet, published by the New South Wales Cancer Council, contained text and cartoons about pain and its management. Text was written for a reading age of 12 years. Patient assessment was done at baseline and at weeks 2 and 4 after study entry.

• The sample was composed of 140 patients.
• Mean patient age was 69 years.
• Of all patients, 57% were female and 43% were male.
• The sample included a variety of cancer types, with the most frequent being breast and lung cancers. In regard to other patient characteristics, 10% of patients had university-level education, 73% were married, and 77% were in an urban setting. All patients had a pain rating greater than or equal to 2. At baseline, 77% patients were on opioids and 22% were receiving inadequate pain control.

• Multisite
• Outpatient
• Australia

Randomized controlled trial

• Barriers Questionnaire
• Wisconsin Brief Pain Questionnaire
• Pain management index, a composite of the analgesic strength rating and worst-pain rating
• Uniscale for the assessment of global quality of life
• Hospital Anxiety and Depression Scale
• Patients' daily diaries of pain

Barriers were low in all groups at baseline. The barriers scores dropped more in the intervention groups than in the control group, but differences from control or between the other three groups were not significant. There was a significant difference (p < 0.05) in the addiction subscale change in the booklet-only and video-only groups. Authors reported a significantly higher change in average pain (p = 0.0214) between the control and video-and-booklet groups. Authors noted marginal differences in average pain between groups in all other combinations. Reduction in worst pain was significantly greater (p = 0.05) in the video-and-booklet group than in the control group. The size of the differences was small (–1.12). Authors noted no other between-group differences. The presence of a partner increased the effect of any intervention on outcomes (p = 0.004, p < 0.01). According to the pain management index, there was no difference between groups in regard to pain management. Authors observed no difference between groups in regard to anxiety or depression, and they observed no significant change in anxiety or depression. All groups reduced overall consumption of opioids.

In this study a self-administered educational intervention consisting of a booklet and video was associated with a reduction in average pain, worst pain, and fear of addiction.

• The study had a risk of bias due to no blinding.
• The duration of the study was relatively short, four weeks.
• Baseline pain scores of 2 or higher would result in inclusion of patients with only mild pain. Baseline pain intensity data are not provided.
• Authors do not state how much relevant education was included in standard care. Variability among providers could have resulted in substantial differences among subjects.

Findings suggest that standardized education that includes a video and booklet can be helpful in pain management. The effectiveness of the intervention is due, presumably, to greater patient and caregiver involvement in pain management. This study showed that the combination of a booklet and video, along with standard care, was the most effective intervention. The content of each may have reinforced the other. Use of a standardized set of educational materials, such as those used in this study, can be a practical, efficient way to supplement other interventions to manage pain, may be effective in involving patients more directly in pain management, and may help to remove barriers to and misconceptions about pain management.