Purpose/Objectives: To assess the effect of an educational homecare program on pain relief in patients with advanced cancer.
Design: Quasi-experimental (pretest-post-test, nonequivalent group).
Setting: Four community-based primary care centers providing social and healthcare services in the Quebec City region of Canada.
Sample: 80 homecare patients with advanced cancer who were free of cognitive impairment, who presented with pain or were taking analgesics to relieve pain, and who had a life expectancy of six weeks or longer.
Methods: The educational intervention included information regarding pain assessment and monitoring using a daily pain diary and the provision of specific recommendations in case of loss of pain control. Pain intensity data were collected prior to the intervertion, and reassessments were made two and four weeks later. Data on beliefs were collected at baseline and two weeks. All data were collected by personal interviews.
Main Research Variables: Patients' beliefs about the use of opioids; average and maximum pain intensities.
Findings: Patients' beliefs regarding the use of opioids were modified successfully following the educational intervention. Average pain was unaffected in the control group and was reduced significantly in patients who received the educational program. The reduction remained after controlling for patients' initial beliefs. Maximum pain decreased significantly over time in both the experimental and control groups.
Conclusions: An educational intervention can be effective in improving the monitoring and relief of pain in patients with cancer living at home.
Implications for Nursing: Homecare nurses can be trained to effectively administer the educational program during their regular homecare visits.
Allard, P., Maunsell, E., Labbe, J., & Dorval, M. (2001). Educational interventions to improve cancer pain control: A systematic review. Journal of Palliative Medicine, 4, 191-203.
American Pain Society Quality-of-Care Committee. (1995). Quality improvement guidelines for the treatment of acute pain and cancer pain. JAMA, 274, 1874-1880.
Chang, M.C., Chang, Y.C., Chiou, J.F., Tsou, T.S., & Lin, C.C. (2002). Overcoming patient-related barriers to cancer pain management for home care patients: A pilot study. Cancer Nursing, 25, 470-476.
Chelf, J.H., Agre, P., Axelrod, A., Cheney, L., Cole, D.D., Conrad, K., et al. (2001). Cancer-related patient education: An overview of the last decade of evaluation and research. Oncology Nursing Forum, 28, 1139-1147.
Cleeland, C.S. (1987). Barriers to the management of cancer pain. Oncology, 1(2, Suppl.), 19-26.
Cleeland, C.S., Gonin, R., Hatfield, A.K., Edmonson, J.H., Blum, R.H., Stewart, J.A., et al. (1994). Pain and its treatment in outpatients with metastatic cancer. New England Journal of Medicine, 330, 592-596.
Cleeland, C.S., & Ryan, K.M. (1994). Pain assessment: Global use of the Brief Pain Inventory. Annals of the Academy of Medicine, Singapore, 23, 129-138.
Dar, R., Beach, C.M., Barden, P.L., & Cleeland, C.S. (1992). Cancer pain in the marital system: A study of patients and their spouses. Journal of Pain and Symptom Management, 7, 87-93.
de Wit, R., & van Dam, F. (2001). From hospital to home care: A randomized controlled trial of a pain education programme for cancer patients with chronic pain. Journal of Advanced Nursing, 36, 742-754.
de Wit, R., van Dam, F., Hanneman, M., Zandbelt, L., van Buuren, A., van der Heijden, K., et al. (1999). Evaluation of the use of a pain diary in chronic cancer pain patients at home. Pain, 79, 89-99.
de Wit, R., van Dam, F., Zandbelt, L., van Buuren, A., van der Heijden, K., Leenhouts, G., et al. (1997). A pain education program for chronic cancer pain patients: Follow-up results from a randomized controlled trial. Pain, 73, 55-69.
Donabedian, A. (1980). The definition of quality and approaches to its assessment. Explorations in quality assessment and monitoring (vol. 1). Ann Arbor, MI: Health Administration Press.
Donabedian, A. (1985). The methods and findings of quality assessment and monitoring: An illustrated analysis. Explorations in quality assessment and monitoring (vol. 3). Ann Arbor, MI: Health Administration Press.
Du Pen, S.L., Du Pen, A.R., Polissar, N., Hansberry, J., Kraybill, B.M., Stillman, M., et al. (1999). Implementing guidelines for cancer pain management: Results of a randomized controlled clinical trial. Journal of Clinical Oncology, 17, 361-370.
Ferrell, B.A. (2000). Pain management. Clinics in Geriatric Medicine, 16, 853-874.
Ferrell, B.R., Ferrell, B.A., Ahn, C., & Tran, K. (1994). Pain management for elderly patients with cancer at home. Cancer, 74(7, Suppl.), 2139-2146.
Ferrell, B.R., Rhiner, M., & Rivera, L.M. (1993). Development and evaluation of the family pain questionnaire. Journal of Psychosocial Oncology, 10, 21-35.
Ferrell, B.R., & Schneider, C. (1988). Experience and management of cancer pain at home. Cancer Nursing, 11, 84-90.
Ferrell, B.R., Taylor, E.J., Sattler, G.R., Fowler, M., & Cheyney, B.L. (1993). Searching for the meaning of pain: Cancer patients', caregivers', and nurses' perspectives. Cancer Practice, 1, 185-194.
Green, C.R., & Wheeler, J.R. (2003). Physician variability in the management of acute postoperative and cancer pain: A quantitative analysis of the Michigan experience. Pain Medicine, 4(1), 8-20.
Kim, J.E., Dodd, M., West, C., Paul, S., Facione, N., Schumacher, K., et al. (2004). The PRO-SELF® pain control program improves patients' knowledge of cancer pain management. Oncology Nursing Forum, 31, 1137-1143.
Lai, Y.H., Guo, S.L., Keefe, F.J., Tsai, S.L., Chien, C.C., Sung, Y.C., et al. (2004). Effects of brief pain education on hospitalized cancer patients with moderate to severe pain. Supportive Care in Cancer, 12, 645-652.
Maunsell, E., Allard, P., Dorval, M., & Labbe, J. (2000). A brief pain diary for ambulatory patients with advanced cancer: Acceptability and validity. Cancer, 88, 2387-2397.
Mercadante, S. (1999). Pain treatment and outcomes for patients with advanced cancer who receive follow-up care at home. Cancer, 85, 1849-1858.
Miaskowski, C., Dodd, M.J., West, C., Paul, S.M., Tripathy, D., Koo, P., et al. (2001). Lack of adherence with the analgesic regimen: A significant barrier to effective cancer pain management. Journal of Clinical Oncology, 19, 4275-4279.
Oken, M.M., Creech, R.H., Tormey, D.C., Horton, J., Davis, T.E., McFadden, E.T., et al. (1982). Toxicity and response criteria of the Eastern Cooperative Oncology Group. American Journal of Clinical Oncology, 5, 649-655.
Oliver, J.W., Kravitz, R.L., Kaplan, S.H., & Meyers, F.J. (2001). Individualized patient education and coaching to improve pain control among cancer outpatients. Journal of Clinical Oncology, 19, 2206-2212.
Purdue Pharma, Inc., & Canadian Cancer Society. (n.d.). La gestion de votre douleur. Comment prendre la morphine: Guide utile pour vous et votre famille [Managing your pain. A helpful guide for you and your family] [Motion picture]. (Available from the Canadian Cancer Society, P.O. Box 2089, 133 Prince William Street, St. John, New Brunswick, Canada E2L 3T5)
Rimer, B., Levy, M.H., Keintz, M.K., Fox, L., Engstrom, P.F., & MacElwee, N. (1987). Enhancing cancer pain control regimens through patient education. Patient Education and Counseling, 10, 267-277.
Schumacher, K.L., Koresawa, S., West, C., Dodd, M., Paul, S.M., Tripathy, D., et al. (2002). The usefulness of a daily pain management diary for outpatients with cancer-related pain. Oncology Nursing Forum, 29, 1304-1313.
Stewart, A.L., Teno, J., Patrick, D.L., & Lynn, J. (1999). The concept of quality of life of dying persons in the context of health care. Journal of Pain and Symptom Management, 17, 93-108.
Ventafridda, V., Tamburini, M., Caraceni, A., De Conno, F., & Naldi, F. (1987). A validation study of the WHO method for cancer pain relief. Cancer, 59, 850-856.
Von Roenn, J.H., Cleeland, C.S., Gonin, R., Hatfield, A.K., & Pandya, K.J. (1993). Physician attitudes and practice in cancer pain management. Annals of Internal Medicine, 119, 121-126.
Ward, S.E., & Gordon, D. (1994). Application of the American Pain Society quality assurance standards. Pain, 56, 299-306.
Weiss, S.C., Emanuel, L.L., Fairclough, D.L., & Emanuel, E.J. (2001). Understanding the experience of pain in terminally ill patients. Lancet, 357, 1311-1315.
Wells, N., Hepworth, J.T., Murphy, B.A., Wujcik, D., & Johnson, R. (2003). Improving cancer pain management through patient and family education. Journal of Pain and Symptom Management, 25, 344-356.
Yates, P., Edwards, H., Nash, R., Aranda, S., Purdie, D., Najman, J., et al. (2004). A randomized controlled trial of a nurse-administered educational intervention for improving cancer pain management in ambulatory settings. Patient Education and Counseling, 53, 227-237.
Zech, D.F., Grond, S., Lynch, J., Hertel, D., & Lehmann, K.A. (1995). Validation of World Health Organization guidelines for cancer pain relief: A 10-year prospective study. Pain, 63, 65-76.