title: Improvement of pain-related self-management for cancer patients through a modular transitional nursing intervention: a cluster-randomized multicenter trial.
abstract: Patients' self-management skills are affected by their knowledge, activities, and attitudes toward pain management. This trial aimed to test the Self Care Improvement through Oncology Nursing (SCION)-PAIN program, a multimodular structured intervention to reduce patients' barriers to self-management of cancer pain. Two hundred sixty-three patients with diagnosed malignancy, pain>3 days, and average pain > or = 3/10 participated in a cluster-randomized trial on 18 wards in 2 German university hospitals. Patients on the intervention wards received, in addition to standard pain treatment, the SCION-PAIN program consisting of 3 modules: pharmacologic, nonpharmacologic pain management, and discharge management. The intervention was conducted by specially trained cancer nurses and included components of patient education, skills training, and counseling. Starting with admission, patients received booster sessions every third day and one follow-up telephone counseling session within 2 to 3 days after discharge. Patients in the control group received standard care. Primary end point was the group difference in patient-related barriers to self-management of cancer pain (Barriers Questionnaire-BQ II) 7 days after discharge. The SCION-PAIN program resulted in a significant reduction of patient-related barriers to pain management 1 week after discharge from the hospital: mean difference on BQ II was -0.49 points (95% confidence interval -0.87 points to -0.12 points; P=0.02). Furthermore, patients showed improved adherence to pain medication; odds ratio 8.58 (95% confidence interval 1.66-44.40; P=0.02). A post hoc analysis indicated reduced average and worst pain intensity as well as improved quality of life. This trial reveals the positive impact of a nursing intervention to improve patients' self-management of cancer pain.
authors.affiliation: University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany Institute for Biometry and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany Institute for Health and Nursing Science, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany University Hospital rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Jahn
authors.forename: Oliver
authors.initials: O
authors.lastname: Kuss
authors.forename: Heike
authors.initials: H
authors.lastname: Schmidt
authors.forename: Alexander
authors.initials: A
authors.lastname: Bauer
authors.forename: Maria
authors.initials: M
authors.lastname: Kitzmantel
authors.forename: Karin
authors.initials: K
authors.lastname: Jordan
authors.forename: Susann
authors.initials: S
authors.lastname: Krasemann
authors.forename: Margarete
authors.initials: M
authors.lastname: Landenberger
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D016000:Cluster Analysis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000628:therapy; D009859:Oncology Nursing; D010146:Pain / Q000209:etiology / Q000451:nursing* / Q000523:psychology; D010349:Patient Compliance; D010351:Patient Discharge; D012648:Self Care / Q000379:methods* / Q000523:psychology*; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cancer pain; Care transition; Patient education; Patient-related barriers; Self-management