title: A systematic evaluation of content, structure, and efficacy of interventions to improve patients' self-management of cancer pain.
abstract: BACKGROUND
  Cancer pain continues to be extensively undertreated, despite established guidelines. Although the efficacy of interventions that support patients' self-management of cancer pain has been demonstrated in several studies, the most effective components of these interventions remain unknown.
  
  
  OBJECTIVE
  The purpose of this review of experimental and quasi-experimental studies was to systematically describe the structure and content components, as well as the efficacy of various components, of interventions designed to improve patients' self-management of cancer pain.
  
  
  METHODS
  A systematic review of the literature was done that supplemented the 2009 meta-analysis of Bennett et al. Intervention components were categorized using content analysis. The intervention components were compared based on their calculated largest effect sizes (ESs) within each study (i.e., Hedges G(u) for between-group differences in pain intensity scores).
  
  
  RESULTS
  Based on 34 publications (i.e., 24 interventions), seven structure and 16 content components were identified. In 11 studies with statistically significant ESs, the largest ES within each study ranged from -1.87 to -0.44, which represented clinically meaningful effects. No single component was found to have a discernable influence on ES.
  
  
  CONCLUSIONS
  This analysis provides researchers and clinicians with a detailed overview of the various structural and content components, as well as various combinations that were tested in intervention studies to improve cancer pain management. However, because of a variety of limitations, the most efficacious intervention components or combination of components remain to be determined in future studies.
authors.affiliation: Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland.
authors.forename: Antje
authors.initials: A
authors.lastname: Koller
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
authors.forename: Sabina
authors.initials: S
authors.lastname: De Geest
authors.forename: Oliver
authors.initials: O
authors.lastname: Opitz
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Spichiger
mesh_terms: D000328:Adult; D003071:Cognition; D003695:Delivery of Health Care; D017408:Guidelines as Topic; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010148:Intractable Pain / Q000209:etiology / Q000628:therapy*; D010166:Palliative Care / Q000379:methods*; D010353:Patient Education as Topic; D012107:Research Design; D012648:Self Care / Q000379:methods*