Evaluation of a Cancer Pain Education Module
Purpose/Objectives: To assess whether a case-based cancer pain education module would lead to acquisition and retention of knowledge and attitudes at the graduate nursing student level.
Design: Quasi-experimental pretest, post-test, and follow-up.
Setting: Three nursing schools in the New England area.
Sample: 92 graduate nursing students.
Methods: An oncology nurse specialist delivered seven two- to fourhour seminars integrated in existing pharmacology, primary care, or adult health courses. Participants' cancer pain knowledge was assessed at four time points with a paper-and-pencil test: before the seminar, immediately after, and approximately 6 and 24 months after the seminar.
Main Research Variable: Cancer pain knowledge.
Findings: The intervention was effective in improving students' knowledge of cancer pain management and assessment (p = 0.0001), and the effect was retained at 6 and 24 months (p = 0.0001 and p = 0.0024, respectively).
Conclusions: Policymakers, clinicians, and professional organizations have recommended providing cancer pain education during professional training to overcome the continuing problem of the undertreatment of cancer pain. The education module used was effective in changing students' knowledge of cancer pain management, and the results suggest that this knowledge is lasting.
Implications for Nursing: Early cancer pain education for nurses may play an important role in improving pain control for patients with cancer. Although this study did not evaluate the application of cancer pain knowledge to clinical practice, the results support the notion that advanced practice nurses can improve their cancer pain management knowledge and attitudes while in training. One implication is that this shift in attitudes and knowledge will translate to effective management of pain in varied healthcare settings.
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References
Albanese, M.A., & Mitchell, S. (1993). Problem-based learning: A review of literature on its outcomes and implementation issues. Academic Medicine, 68(1), 52-81.
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. (1987). Principles of analgesic use in the treatment of acute pain and chronic cancer pain: A concise guide to medical practice. Washington, DC: Author.
Bernabei, R., Gambassi, G., Lapane, K., Landi, F., Gatsonis, C., Dunlop, R., et al. (1998). Management of pain in elderly patients with cancer. JAMA, 279, 1877-1882.
Bonomi, A.E., Ajax, M., Shikiar, R., & Halpern, M. (1999). Cancer pain management: Barriers, trends, and the role of pharmacists. Journal of the American Pharmaceutical Association (Washington, DC), 39, 558-566.
Breitbart, W., Rosenfeld, B., & Passik, S.D. (1998). The Network Project: A multidisciplinary cancer education and training program in pain management, rehabilitation, and psychosocial issues. Journal of Pain and Symptom Management, 15, 18-26.
Carr, D.B. (2001). The development of national guidelines for pain control: Synopsis and commentary. European Journal of Pain, 5(Suppl. A), 91-98.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.
Drayer, R.A., Henderson, J., & Reidenberg, M. (1999). Barriers to better pain control in hospitalized patients. Journal of Pain and Symptom Management, 17, 434-440.
Elliott, T.E., Murray, D.M., Elliott, B.A., Braun, B., Oken, M.M., Johnson, K.M., et al. (1995). Physician knowledge and attitudes about cancer pain management: A survey from the Minnesota Cancer Pain Project. Journal of Pain and Symptom Management, 10, 494-504.
Elliott, T.E., Murray, D.M., Oken, M.M., Johnson, K.M., Elliott, B.A., & Post-White, J. (1995). The Minnesota Cancer Pain Project: Designs, methods, and education strategies. Journal of Cancer Education, 10, 102-112.
Ellwood, P.M. (1988). Outcomes management: A technology of patient experience. New England Journal of Medicine, 318, 1549-1556.
Feletti, G. (1993). Inquiry based and problem based learning: How similar are these approaches to nursing and medical education? Higher Education Research and Development, 12, 143-156.
Ferrell, B., Virani, R., Grant, M., Vallerand, A., & McCaffery, M. (2000). Analysis of pain content in nursing textbooks. Journal of Pain and Symptom Management, 19, 216-228.
Jacox, A., Carr, D.B., & Payne, R. (1994). Preface: Policy issues related to clinical practice guidelines. Journal of Pain and Symptom Management, 9, 143-145.
Jacox, A., Carr, D.B., Payne, R., et al. (1994). Management of cancer pain [Clinical practice guideline no. 9]. Rockville, MD: Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Public Health Service.
Janjan, N.A., Martin, C.G., Payne, R., Dahl, J.L., Weissman, D.E., & Hill, C.S. (1996). Teaching cancer pain management: Durability of educational effects of a role model program. Cancer, 77, 996-1001.
Kreft, I., & De Leeuw, J. (1999). Introducing multilevel modeling. Thousand Oaks, CA: Sage.
Lasch, K.E., Greenhill, A., Wilkes, G., Carr, D.B., Lee, M., & Blanchard, R. (2002). Why study pain? A qualitative analysis of medical and nursing faculty and students' knowledge of and attitudes toward cancer pain management. Journal of Palliative Medicine, 5, 57-71.
Lasch, K.E., Wilkes, G., Lee, J., & Blanchard, R. (2000). Is hands-on experience more effective than didactic workshops in post-graduate cancer pain education? Journal of Cancer Education, 15, 218-222.
Lasch, K.E., Wilkes, G., Montuori, L., Leonard, C., Chew, P., & Hilton, S. (2000). Using focus group methods to develop multicultural cancer pain education materials. Pain Management Nursing, 1, 129-138.
Miaskowski, C. (1994). Pain management: Quality assurance and changing practice. In G.F. Gebhart, D.L. Hammond, & T.S. Jensen (Eds.), Progress in pain research and management: Proceedings of the Seventh World Congress on Pain (Vol. 2, pp. 75-96). Seattle, WA: IASP Press.
Miaskowski, C. (2000). Two double-edged swords. Pain Management Nursing, 1, 27-28.
Owens, K. (2000). Effects of nursing education on students' pain management knowledge. Nurse Educator, 25(1), 33-37.
Pargeon, K.L., & Hailey, B.J. (1999). Barriers to effective cancer pain management: A review of the literature. Journal of Pain and Symptom Management, 18, 358-368.
Portenoy, R.K. (1992). Cancer pain: From curriculum to practice change. Journal of Clinical Oncology, 10, 1830-1832.
Portenoy, R.K., & Lesage, P. (1999). Management of cancer pain. Lancet, 353, 1695-1700.
Sloan, P.A., Montgomery, C., & Musick, D. (1998). Medical student knowledge of morphine for the management of cancer pain. Journal of Pain and Symptom Management, 15, 359-364.
Sterman, E., Gauker, S., & Krieger, J. (2003). A comprehensive approach to improving cancer pain management and patient satisfaction. Oncology Nursing Forum, 30, 857-864.
Swenson, C.J. (2002). Ethical issues in pain management. Seminars in Oncology Nursing, 18, 135-142.
Task Force on Pain Management. (1996). Practice guidelines for cancer pain management. A report by the American Society of Anesthesiologists Task Force on Pain Management, Cancer Pain Section. Anesthesiology, 84, 1243-1257.
Thompson, A.R., Savidge, M.A., Fulper-Smith, M., & Strode, S.W. (1999). Testing a multimedia module in cancer pain management. Journal of Cancer Education, 14, 161-163.
Wallace, K.G., Reed, B.A., Pasero, C., & Olsson, G.L. (1995). Staff nurses' perceptions of barriers to effective pain management. Journal of Pain and Symptom Management, 10, 204-213.
Weinstein, S.M., Laux, L.F., Thornby, J.I., Lorimor, R.J., Hill, C.S., Jr., Thorpe, D.M., et al. (2000). Physicians' attitudes toward pain and the use of opioid analgesics: Results of a survey from the Texas Cancer Pain Initiative. Southern Medical Journal, 93, 479-487.
Weissman, D.E., & Dahl, J.L. (1990). Attitudes about cancer pain: A survey of Wisconsin's first-year medical students. Journal of Pain and Symptom Management, 5, 345-349.
Weissman, D.E., & Dahl, J.L. (1995). Update on the Cancer Pain Role Model Education Program. Journal of Pain and Symptom Management, 10, 292-296.
Weissman, D.E., Dahl, J.L., & Beasley, J.W. (1993). The Cancer Pain Role Model Program of the Wisconsin Cancer Pain Initiative. Journal of Pain and Symptom Management, 8, 29-35.
Wells, M., Dryden, H., Guild, P., Levack, P., Farrer, K., & Mowat, P. (2001). The knowledge and attitudes of surgical staff towards the use of opioids in cancer pain management: Can the hospital palliative care team make a difference? European Journal of Cancer Care, 10, 201-211.
Wilkerson, L. (2002, January). Learning in a clinical setting. Thurston Lecture presented at Beth Israel Deaconess Institute for Research and Education, Boston, MA.
World Health Organization. (1990). Cancer pain relief and palliative care: Report of a WHO expert committee. Geneva, Switzerland: Author.
World Health Organization. (1996). Cancer pain relief: A guide to opioid availability (2nd ed.). Geneva, Switzerland: Author.
Worrall, G., Chaulk, P., & Freake, D. (1997). The effects of clinical practice guidelines on patient outcomes in primary care: A systematic review. Canadian Medical Association Journal, 156, 1705-1712.