Cancer Health Empowerment for Living without Pain (Ca-HELP): Effects of a tailored education and coaching intervention on pain and impairment

Richard L Kravitz, Daniel J Tancredi, Tim Grennan, Donna Kalauokalani, Richard L. Street, Christina K. Slee, Theodore Wun, Jennifer Wright Oliver, Kate Lorig, Peter Franks

Research output: Contribution to journalArticle

47 Scopus citations

Abstract

We aimed to determine the effectiveness of a lay-administered tailored education and coaching (TEC) intervention (aimed at reducing pain misconceptions and enhancing self-efficacy for communicating with physicians) on cancer pain severity, pain-related impairment, and quality of life. Cancer patients with baseline "worst pain" of ≥4 on a 0-10 scale or at least moderate functional impairment due to pain were randomly assigned to TEC or enhanced usual care (EUC) during a telephone interview conducted in advance of a planned oncology office visit (265 patients randomized to TEC or EUC; 258 completed at least one follow-up). Patients completed questionnaires before and after the visit and were interviewed by telephone at 2, 6, and 12 weeks. Mixed effects regressions were used to evaluate the intervention adjusting for patient, practice, and site characteristics. Compared to EUC, TEC was associated with increased pain communication self-efficacy after the intervention (P < .001); both groups showed significant (P < .0001), similar, reductions in pain misconceptions. At 2 weeks, assignment to TEC was associated with improvement in pain-related impairment (-0.25 points on a 5-point scale, 95% confidence interval -0.43 to -0.06, P = .01) but not in pain severity (-0.21 points on an 11-point scale, -0.60 to 0.17, P = .27). The improvement in pain-related impairment was not sustained at 6 and 12 weeks. There were no significant intervention by subgroup interactions (P > .10). We conclude that TEC, compared with EUC, resulted in improved pain communication self-efficacy and temporary improvement in pain-related impairment, but no improvement in pain severity. Compared with control, tailored education and coaching for patients with cancer-related pain improved communication self-efficacy and reduced pain-related impairment in the short term but had no sustained benefits.

Original languageEnglish (US)
Pages (from-to)1572-1582
Number of pages11
JournalPain
Volume152
Issue number7
DOIs
StatePublished - Jul 2011

Keywords

  • Barriers to pain control
  • Cancer pain
  • Physician-patient communication
  • Psychoeducational interventions
  • Self-efficacy

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine
  • Neurology
  • Pharmacology

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