title: Cancer Health Empowerment for Living without Pain (Ca-HELP): effects of a tailored education and coaching intervention on pain and impairment.
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.
authors: Department of Internal Medicine and Center for Healthcare Policy and Research, University of California at Davis, USA Department of Pediatrics and Center for Healthcare Policy and Research, University of California at Davis, USA Kaiser Permanente, Northern California, USA Department of Anesthesiology and Pain Management and Center for Healthcare Policy and Research, University of California at Davis, USA Department of Communication, Texas A&M University and Houston Center for Quality and Utilization Studies, Baylor College of Medicine, USA Center for Healthcare Policy and Research, University of California at Davis, USA Division of Hematology-Oncology, University of California at Davis and the Northern California VA Health Care System, USA Oliver Consulting, USA Department of Medicine, Stanford University, USA Department of Family and Community Medicine and Center for Healthcare Policy and Research, University of California at Davis, USA.
authors: Richard L
authors: RL
authors: Kravitz
authors: Daniel J
authors: DJ
authors: Tancredi
authors: Tim
authors: T
authors: Grennan
authors: Donna
authors: D
authors: Kalauokalani
authors: Richard L
authors: RL
authors: Street
authors: Christina K
authors: CK
authors: Slee
authors: Ted
authors: T
authors: Wun
authors: Jennifer Wright
authors: JW
authors: Oliver
authors: Kate
authors: K
authors: Lorig
authors: Peter
authors: P
authors: Franks
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010146:Pain / Q000523:psychology*; D059408:Pain Management; D010147:Pain Measurement; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D011209:Power, Psychological; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome