2009
Excerpt
Pain is a significant problem for patients with cancer. There is evidence that despite widespread availability of effective pain relief strategies in Australia, cancer pain is often poorly controlled. Patient education about pain for people with cancer has been shown to improve patient knowledge, attitudes and pain control. The candidate sought to develop an education package to help improve cancer pain management.
An initial qualitative study was conducted to determine Australian cancer patients' and caregivers' perspectives with regard to pain and its management. Patients and caregivers were recruited from oncology and palliative care services and were eligible if they had pain and cancer. Focus group discussions were conducted using standard qualitative methods with patients and caregivers in separate groups. Sixteen patients and nine caregivers participated. Focus groups were transcribed and analysed to identify mutually exclusive themes. Two broad issues emerged: pain and pain management. Regarding cancer pain, five themes emerging from the groups included: a) pain experience, b) communicating about pain, c) the impact on the patient, d) the coping mechanisms and e) the meaning of the pain. Regarding pain management, themes consisted of a) experiences, b) coping, c) needs and d) concerns.
This study confirmed that Australian cancer patients and their caregivers have considerable needs for information about cancer pain and its management. Patients are reluctant to use analgesia and have a number of attitudinal and knowledge barriers to communicating about pain and using pain relief medications and therefore there is a need for targeted education.
In order to address these patient needs, education materials including a booklet and a video were created. The booklet was written to reading age year 8 (13 years of age), with a question and answer format, captions and cartoons. The content addressed cancer pain and its management including commonly held misconceptions. The 17 minute video addressed the same issues depicting patients and carers talking about their experiences and health professionals offering explanations about pain mechanisms and approaches to treatment.
The efficacy of the educational intervention was tested in a multi-site randomised controlled trial. Patients were eligible if they had: metastatic or locally advanced cancer, cancer pain>/= 2/10 in the last week, English proficiency (although patients from a wide variety of ethnic backgrounds were included), a prognosis of greater than one month to allow for measurement of outcomes, and were outpatients, aged greater than 18 years, who were receiving cancer treatment at participating hospitals, and had given signed informed consent. Patients completed baseline assessments and then received a booklet, video, both the booklet and video, or standard care. Outcome measures at two and four weeks included the Barriers Questionnaire, Brief Pain Inventory, Global Quality of Life Scale, Hospital Anxiety and Depression Scale, Daily Pain Diary and feedback questions. Adequacy of analgesia was calculated using the Pain Management Index. Baseline Barriers scores were lower than reported in previous studies. Patients receiving any items of the intervention had reduced average pain scores and reduced concerns about addiction, and patients receiving the booklet and video had reduced average and worst pain scores. Those receiving the booklet only reduced their opioid use.
The candidate therefore suggests this is an effective, feasible, and relatively inexpensive adjunct to a multi-pronged pain management approach.