Home and Community Care Digest

Home and Community Care Digest December 2002 : 0-0

Brief education for home cancer pain self-management is inadequate for patients and family caregivers; ongoing clinician coaching is important


This qualitative study examined problems with home-based cancer pain self-management regimens that are faced by patients and family caregivers. The researchers conclude that patients require ongoing clinician coaching to self-manage pain, and that very brief education periods are minimally effective.
Background: Oncology patients and their family caregivers play a critical role in cancer pain management. As most curative and palliative care measures take place on an outpatient basis, pain is primarily managed at home. A comprehensive review of the literature identified that patients must have adequate knowledge and skill to use a pain management regimen at home. Despite the responsibility placed on cancer patients and their family members for pain management, little systematic investigation has been directed toward understanding the practical day-to-day problems encountered by patients and their family caregivers.

Method: This US study was a qualitative analysis that was part of a large randomized controlled trial (RCT) to test the effectiveness of a self-care intervention called the PROSELF Pain Control Program. This 6-week cancer intervention included detailed information and education in the principles of pain management and individualized coaching. Nursepatient- family caregiver interactions were audio taped to monitor the standardized delivery of the intervention. Quality assurance reviews of these audiotapes revealed that they were a rich data source about patients' pain management practices at home. The researchers asked: 1) What difficulties with pain management do patients and family caregivers bring to a nurses' attention during a teaching and coaching intervention?; and 2) What strategies do patients and their family caregivers use to manage their pain at home? Themes and sub-themes pertaining to the day-to-day pain management practices of patients and their family caregivers were derived via inductive content analysis of the transcribed tapes.

Findings: The process of putting a pain management regimen into practice consisted of 7 steps: 1) obtaining the prescribed medications; 2) accessing information; 3) tailoring the prescribed regimen to meet individual needs; 4) managing side effects; 5) cognitively processing information and remembering complex information; 6) managing new or unusual pain; and 7) managing multiple symptoms simultaneously. Ongoing access to clinicians able to coach patients at the initiation of home pain management regimens and at critical periods was minimal. Patients experienced various difficulties with the day-to-day process of using their pain management regimens even after they overcame any initial reluctance to use analgesic medications and were instructed on how to use the medication. Difficulty with one or more of these processes was thought to lead to ineffective pain control.

Conclusions: Health policy makers must be made aware of the limited effectiveness of brief periods of education about pain management and health policies must allow adequate time with clinicians so that patients can acquire adequate pain self-management skills.

Reference: Schumacher K L, Koresawa S, West C, Hawkins C, Johnson C, Wais E, Dodd M, Paul S, Tripathy D, Koo P, Miakowski C. Putting cancer pain management regimes into practice at home. Journal of Pain and Symptom Management 2002; 23:5.


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