Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website

NRI 97-026 – HSR&D Study

New | Current | Completed | DRA | DRE | Portfolios/Projects | Centers | Career Development Projects

NRI 97-026
Improving Cancer Pain Management Using AHCPR Cancer Pain Guidelines
Marilyn K. Douglas DNSc RN FAAN
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: March 2000 - September 2004

BACKGROUND/RATIONALE:
Cancer pain is a pervasive problem for the person with cancer. Despite advances in knowledge, effective cancer management is infrequently achieved. While this problem is multi-factorial, the patient may have attitudinal barriers to effective pain management that can be ameliorated with novel interventions.

OBJECTIVE(S):
The primary objective of this study is to determine the effects of two nursing interventions on the improvement of pain management (PM), functional status (FS) and quality of life (QOL) in veterans receiving cancer care in VA ambulatory care clinics. The two interventions will utilize selected cancer pain management strategies developed as Clinical Practice Guidelines by the Agency for Health Care Policy and Research (AHCPR). This study will test the hypothesis that those veterans in the intervention arms will have lower pain intensity scores, greater pain relief and satisfaction with PM, and will have higher QOL and FS scores specifically in the areas of physical and social functioning. A secondary aim is to measure the extent that cancer PM is affected by the intervening variables of age, affect, attitudinal barriers, veteran culture, type/stage of disease, and type of cancer treatment.

METHODS:
The design of this randomized trial has one between-subjects factor, GROUP, with three levels (usual care, structured education, individualized coaching), and one within-subjects factor, TIME, with two measures, pre-test and post-test. Patients with cancer pain (n=320) are randomly assigned to one of three groups after stratifications to control for the confounding variables of pain intensity and effects of cancer treatment. Those in the structured education arm view a video on cancer pain management and receive the AHCPR patient pamphlet on cancer pain management. Those subjects in the individualized coaching arm receive the same structured education as above, but also partake in four telephone coaching sessions focusing on the individual's specific pain management problems. The primary outcome variables measured after 12 weeks are: satisfaction with pain management, quality of life and functional status.

FINDINGS/RESULTS:
A convenience sample of 289 adults with pain related to cancer and/or its/treatment participated The sample was predominantly male (88%), veteran, middle-aged (mn=60.8 +/- 11.5 years), with a variety of cancers types; over 30% were receiving cancer therapy. Analysis of variance was used to assess the difference within the three groups in the amount of change in the dependent variables. Patients in the Coaching group demonstrated significantly less interference with function from pain than those in the other groups and improved more in vitality than the Education group participants. They also had less pain, and improved pain relief and emotional well-being, although these were not statistically significant.

IMPACT:
Our study evaluated two interventions aimed at reducing the pain related to cancer. These interventions will improve the quality of life and functional ability of cancer patients experiencing pain from their disease. Our findings will provide guidelines and strategies for both advanced practice and staff nurses caring for veterans experiencing pain from their cancer.

PUBLICATIONS:

Conference Presentations

  1. Gold J, Douglas M, Thomas M, Elliot J, Rao S, Miaskowski C. Posttraumatic Stress and Quality of Life in Adults with Cancer. Paper presented at: American Psychological Association Annual Convention; 2004 Aug 1; Honolulu, HI.
  2. Chou FU, Douglas MK. Using a Body Diagram to Measure Changes in Amount and Location of Pain. Paper presented at: VA VISN 21 Nursing Research Consortium; 2003 Mar 21; Fresno, CA.
  3. Douglas M, Gold J, Thomas M, Elliot J. PTSD Symptoms, Quality of Life, and Functional Status in Adults Treated for Cancer. Paper presented at: VA VISN 21 Nursing Research Consortium; 2003 Mar 21; Fresno, CA.
  4. Elliott J, Douglas MK, Thomas ML, Fraidin L, Rao S, Miaskowski C. The Correlation Between Pain Intensity Scores and Pain Relief Scale Changes in a Cancer Pain Population. Paper presented at: VA VISN 21 Nursing Research Consortium; 2003 Mar 21; Fresno, CA.
  5. Elliot J, Gold J, Douglas M, Thomas M, Rao S, Miaskowski C. PTSD Symptoms, Quality of Life and Functional Status in Adults Treated for Cancer. Paper presented at: American Society for Pain Management Nursing Annual Convention; 2003 Feb 22; Kansas City, MO.
  6. Elliott J, Douglas MK, Thomas ML, Fraidin L, Rao S, Miaskowski C. The Correlation Between Pain Intensity Scores and Pain Relief Scale Changes in a Cancer Pain Population. Paper presented at: American Society for Pain Management Nursing Annual Convention; 2003 Feb 20; Kansas City, MO.
  7. Douglas M. Symptoms of women with angina (SWAN): An international collaborative research project. Paper presented at: Council on Women's Health Issues International Annual Congress; 2002 Jun 27; Seoul, Korea.


DRA: Health Systems
DRE: none
Keywords: Clinical practice guidelines, Nursing, Pain
MeSH Terms: none